1
|
Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, Ransolin N, Carrigan A, Long J, Hutchinson K, Goirand M, Bierbaum M, Bleckly F, Hibbert P, Churruca K, Clay-Williams R. Correction: Strategies to improve care for older adults who present to the emergency department: a systematic review. BMC Health Serv Res 2024; 24:304. [PMID: 38454470 PMCID: PMC10918891 DOI: 10.1186/s12913-024-10766-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024] Open
Affiliation(s)
- Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Theresa Hensel
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brasil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Magali Goirand
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Felicity Bleckly
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| |
Collapse
|
2
|
Austin EE, Cheek C, Richardson L, Testa L, Dominello A, Long JC, Carrigan A, Ellis LA, Norman A, Murphy M, Smith K, Gillies D, Clay-Williams R. Improving emergency department care for adults presenting with mental illness: a systematic review of strategies and their impact on outcomes, experience, and performance. Front Psychiatry 2024; 15:1368129. [PMID: 38487586 PMCID: PMC10937575 DOI: 10.3389/fpsyt.2024.1368129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/08/2024] [Indexed: 03/17/2024] Open
Abstract
Background Care delivery for the increasing number of people presenting at hospital emergency departments (EDs) with mental illness is a challenging issue. This review aimed to synthesise the research evidence associated with strategies used to improve ED care delivery outcomes, experience, and performance for adults presenting with mental illness. Method We systematically reviewed the evidence regarding the effects of ED-based interventions for mental illness on patient outcomes, patient experience, and system performance, using a comprehensive search strategy designed to identify published empirical studies. Systematic searches in Scopus, Ovid Embase, CINAHL, and Medline were conducted in September 2023 (from inception; review protocol was prospectively registered in Prospero CRD42023466062). Eligibility criteria were as follows: (1) primary research study, published in English; and (2) (a) reported an implemented model of care or system change within the hospital ED context, (b) focused on adult mental illness presentations, and (c) evaluated system performance, patient outcomes, patient experience, or staff experience. Pairs of reviewers independently assessed study titles, abstracts, and full texts according to pre-established inclusion criteria with discrepancies resolved by a third reviewer. Independent reviewers extracted data from the included papers using Covidence (2023), and the quality of included studies was assessed using the Joanna Briggs Institute suite of critical appraisal tools. Results A narrative synthesis was performed on the included 46 studies, comprising pre-post (n = 23), quasi-experimental (n = 6), descriptive (n = 6), randomised controlled trial (RCT; n = 3), cohort (n = 2), cross-sectional (n = 2), qualitative (n = 2), realist evaluation (n = 1), and time series analysis studies (n = 1). Eleven articles focused on presentations related to substance use disorder presentation, 9 focused on suicide and deliberate self-harm presentations, and 26 reported mental illness presentations in general. Strategies reported include models of care (e.g., ED-initiated Medications for Opioid Use Disorder, ED-initiated social support, and deliberate self-harm), decision support tools, discharge and transfer refinements, case management, adjustments to liaison psychiatry services, telepsychiatry, changes to roles and rostering, environmental changes (e.g., specialised units within the ED), education, creation of multidisciplinary teams, and care standardisations. System performance measures were reported in 33 studies (72%), with fewer studies reporting measures of patient outcomes (n = 19, 41%), patient experience (n = 10, 22%), or staff experience (n = 14, 30%). Few interventions reported outcomes across all four domains. Heterogeneity in study samples, strategies, and evaluated outcomes makes adopting existing strategies challenging. Conclusion Care for mental illness is complex, particularly in the emergency setting. Strategies to provide care must align ED system goals with patient goals and staff experience.
Collapse
Affiliation(s)
- Elizabeth E. Austin
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Colleen Cheek
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Lieke Richardson
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Luke Testa
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Amanda Dominello
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Janet C. Long
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Ann Carrigan
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Louise A. Ellis
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| | - Alicia Norman
- Centre for the Health Economy, Macquarie University Business School, Macquarie University, Macquarie, NSW, Australia
| | - Margaret Murphy
- Western Sydney Local Health District, New South Wales Health, Sydney, NSW, Australia
| | - Kylie Smith
- Emergency Care Institute, New South Wales Agency for Clinical Innovation, New South Wales Health, Sydney, NSW, Australia
| | - Donna Gillies
- Quality and Safeguards Commission, National Disability Insurance Scheme, Sydney, NSW, Australia
| | - Robyn Clay-Williams
- The Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Science, Macquarie University, Macquarie, NSW, Australia
| |
Collapse
|
3
|
Testa L, Richardson L, Cheek C, Hensel T, Austin E, Safi M, Ransolin N, Carrigan A, Long J, Hutchinson K, Goirand M, Bierbaum M, Bleckly F, Hibbert P, Churruca K, Clay-Williams R. Strategies to improve care for older adults who present to the emergency department: a systematic review. BMC Health Serv Res 2024; 24:178. [PMID: 38331778 PMCID: PMC10851482 DOI: 10.1186/s12913-024-10576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 01/08/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND The aim of this systematic review was to examine the relationship between strategies to improve care delivery for older adults in ED and evaluation measures of patient outcomes, patient experience, staff experience, and system performance. METHODS A systematic review of English language studies published since inception to December 2022, available from CINAHL, Embase, Medline, and Scopus was conducted. Studies were reviewed by pairs of independent reviewers and included if they met the following criteria: participant mean age of ≥ 65 years; ED setting or directly influenced provision of care in the ED; reported on improvement interventions and strategies; reported patient outcomes, patient experience, staff experience, or system performance. The methodological quality of the studies was assessed by pairs of independent reviewers using The Joanna Briggs Institute critical appraisal tools. Data were synthesised using a hermeneutic approach. RESULTS Seventy-six studies were included in the review, incorporating strategies for comprehensive assessment and multi-faceted care (n = 32), targeted care such as management of falls risk, functional decline, or pain management (n = 27), medication safety (n = 5), and trauma care (n = 12). We found a misalignment between comprehensive care delivered in ED for older adults and ED performance measures oriented to rapid assessment and referral. Eight (10.4%) studies reported patient experience and five (6.5%) reported staff experience. CONCLUSION It is crucial that future strategies to improve care delivery in ED align the needs of older adults with the purpose of the ED system to ensure sustainable improvement effort and critical functioning of the ED as an interdependent component of the health system. Staff and patient input at the design stage may advance prioritisation of higher-impact interventions aligned with the pace of change and illuminate experience measures. More consistent reporting of interventions would inform important contextual factors and allow for replication.
Collapse
Affiliation(s)
- Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Theresa Hensel
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, University Hospital of Southern Denmark, Aabenraa, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Universidade Federal Do Rio Grande Do Sul, Porto Alegre, RS, Brasil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Janet Long
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Magali Goirand
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mia Bierbaum
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Felicity Bleckly
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Peter Hibbert
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Allied Health and Human Performance, IIMPACT in Health, University of South Australia, Adelaide, 5001, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| |
Collapse
|
4
|
Hayba N, Cheek C, Austin E, Testa L, Richardson L, Safi M, Ransolin N, Carrigan A, Harrison R, Francis-Auton E, Clay-Williams R. Strategies to Improve Care in the Emergency Department for Culturally and Linguistically Diverse Adults: a Systematic Review. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01876-z. [PMID: 38117444 DOI: 10.1007/s40615-023-01876-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 11/01/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND The emergency department (ED) is an important gateway into the health system for people from culturally and linguistically diverse (CALD) backgrounds; their experience in the ED is likely to impact the way they access care in the future. Our review aimed to describe interventions used to improve ED health care delivery for adults from a CALD background. METHODS An electronic search of four databases was conducted to identify empirical studies that reported interventions with a primary focus of improving ED care for CALD adults (aged ≥ 18 years), with measures relating to ED system performance, patient outcomes, patient experience, or staff experience. Studies published from inception to November 2022 were included. We excluded non-empirical studies, studies where an intervention was not provided in ED, papers where the full text was unavailable, or papers published in a language other than English. The intervention strategies were categorised thematically, and measures were tabulated. RESULTS Following the screening of 3654 abstracts, 89 articles underwent full text review; 16 articles met the inclusion criteria. Four clear strategies for targeting action tailored to the CALD population of interest were identified: improving self-management of health issues, improving communication between patients and providers, adhering to good clinical practice, and building health workforce capacity. CONCLUSIONS The four strategies identified provide a useful framework for targeted action tailored to the population and outcome of interest. These detailed examples show how intervention design must consider intersecting socio-economic barriers, so as not to perpetuate existing disparity. REGISTRATION PROSPERO registration number: CRD42022379584.
Collapse
Affiliation(s)
- Nematullah Hayba
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia.
| | - Elizabeth Austin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Luke Testa
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Internal Medicine Research Unit, Department of Regional Health Research, University Hospital of Southern Denmark, Aabenraa, University of Southern Denmark, Odense, Denmark
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Emilie Francis-Auton
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, North Ryde, 2109, Australia
| | - Robyn Clay-Williams
- Construction Management and Infrastructure Post-Graduation Program (PPGCI), Federal University of Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
| |
Collapse
|
5
|
Cheek C, Hayba N, Richardson L, Austin EE, Francis Auton E, Safi M, Ransolin N, Vukasovic M, De Los Santos A, Murphy M, Harrison R, Churruca K, Long JC, Hibbert PD, Carrigan A, Newman B, Hutchinson K, Mitchell R, Cutler H, Holt L, Braithwaite J, Gillies D, Salmon PM, Walpola RL, Zurynski Y, Ellis LA, Smith K, Brown A, Ali R, Gwynne K, Clay-Williams R. Experience-based codesign approach to improve care in Australian emergency departments for complex consumer cohorts: the MyED project protocol, Stages 1.1-1.3. BMJ Open 2023; 13:e072908. [PMID: 37407042 DOI: 10.1136/bmjopen-2023-072908] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] Open
Abstract
INTRODUCTION Emergency department (ED) care must adapt to meet current and future demands. In Australia, ED quality measures (eg, prolonged length of stay, re-presentations or patient experience) are worse for older adults with multiple comorbidities, people who have a disability, those who present with a mental health condition, Indigenous Australians, and those with a culturally and linguistically diverse (CALD) background. Strengthened ED performance relies on understanding the social and systemic barriers and preferences for care of these different cohorts, and identifying viable solutions that may result in sustained improvement by service providers. A collaborative 5-year project (MyED) aims to codesign, with ED users and providers, new or adapted models of care that improve ED performance, improve patient outcomes and improve patient experience for these five cohorts. METHODS AND ANALYSIS Experience-based codesign using mixed methods, set in three hospitals in one health district in Australia. This protocol introduces the staged and incremental approach to the whole project, and details the first research elements: ethnographic observations at the ED care interface, interviews with providers and interviews with two patient cohorts-older adults and adults with a CALD background. We aim to sample a diverse range of participants, carefully tailoring recruitment and support. ETHICS AND DISSEMINATION Ethics approval has been obtained from the Western Sydney Local Health District Human Research Ethics Committee (2022/PID02749-2022/ETH02447). Prior informed written consent will be obtained from all research participants. Findings from each stage of the project will be submitted for peer-reviewed publication. Project outputs will be disseminated for implementation more widely across New South Wales, Australia.
Collapse
Affiliation(s)
- Colleen Cheek
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Nema Hayba
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Lieke Richardson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Elizabeth E Austin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Emilie Francis Auton
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Mariam Safi
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Natália Ransolin
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Matthew Vukasovic
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
| | - Aaron De Los Santos
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Margaret Murphy
- Department of Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia
- University of Sydney, Sydney, New South Wales, Australia
| | - Reema Harrison
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kate Churruca
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Janet C Long
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Peter D Hibbert
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- University of South Australia Division of Health Sciences, Adelaide, South Australia, Australia
| | - Ann Carrigan
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Bronwyn Newman
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Karen Hutchinson
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Henry Cutler
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Macquarie University Centre for the Health Economy, Macquarie University, Sydney, New South Wales, Australia
| | - Leanne Holt
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Donna Gillies
- NDIS Quality and Safeguards Commission, Penrith, New South Wales, Australia
| | - Paul M Salmon
- Centre for Human Factors and Sociotechnical Systems, University of the Sunshine Coast, Sunshine Coast, Queensland, Australia
| | - Ramesh Lahiru Walpola
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yvonne Zurynski
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise A Ellis
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Kylie Smith
- Emergency Care Institute, NSW Agency for Clinical Innovation, St Leonards, New South Wales, Australia
| | - Anthony Brown
- Western Sydney University, Penrith, New South Wales, Australia
| | - Reza Ali
- Department of Emergency Medicine, Blacktown and Mount Druitt Hospital, Blacktown, New South Wales, Australia
| | - Kylie Gwynne
- Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Robyn Clay-Williams
- Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| |
Collapse
|
6
|
Cheek C, Elmer H, Anderson T, Baxter T, Wooler M. Decommissioning and recommissioning a regional hospital in response to a COVID-19 outbreak. Rural Remote Health 2021; 21:6256. [PMID: 33822637 DOI: 10.22605/rrh6256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
CONTEXT The COVID-19 outbreak at the North West Regional Hospital (NWRH) site in Tasmania, Australia in April 2020 was both rapid and tragic. Within 10 days of identification of the first healthcare worker infection, both hospitals had closed, and all patients were discharged or decanted to other facilities within the state. The entire hospital staff (approximately 1300 people) and their households (approximately 3000-4000 people) were furloughed for 14 days to halt the spread of infection. During the furlough period, a decommissioning, terminal clean and recommissioning process was undertaken alongside recovery and reorientation of the workforce to personal protective equipment. Within 4 days of closure, an Australian Defence Force and Australian Medical Assistance Team team opened the prioritised emergency department to provide emergency care for the local community, supported by modified diagnostic services. The decommissioning and cleaning rolled on over the ensuing month, in a predetermined priority order. As staff returned from quarantine, they recommissioned their clinical areas. The final ward, a modified medical isolation wing, reopened on day 29. ISSUE Disaster management activities may be grouped under four main headings: prevention, preparedness, response and recovery. There are many opportunities for improvement and learning, and this article focuses on the local response and recovery, describing the process undertaken from the perspective of a small management group. Authors CC, HE, TB and MW were on the ground during the decommissioning process, then managed aspects of the cleaning and recommissioning remotely from furlough. Authors TA and TC provided specialist IPC support and developed education remotely. LESSONS LEARNED Almost 2 months on, no new COVID-19 infections had been reported. The aim of this article is to provide a foundation for site-specific adaptation to include in pandemic escalation plans in other regional and rural settings.
Collapse
Affiliation(s)
- Colleen Cheek
- Tasmania Health Service North West, PO Box 43, Burnie, Tas. 7320, Australia
| | - Hayley Elmer
- Tasmania Health Service North West, PO Box 43, Burnie, Tas. 7320, Australia
| | - Tara Anderson
- Tasmania Health Service South, GPO Box 1061, Hobart, Tas. 7001, Australia
| | - Trent Baxter
- Tasmania Health Service North West, PO Box 43, Burnie, Tas. 7320, Australia
| | - Maxine Wooler
- Tasmania Health Service North West, PO Box 43, Burnie, Tas. 7320, Australia
| |
Collapse
|
7
|
Reeves NS, Cheek C, Hays R, Sargent A, McComiskie A, Santini C, Nguyen J, Chalwe K, Mubarak A. Increasing interest of students from under‐represented groups in medicine—A systematised review. Aust J Rural Health 2020; 28:236-244. [DOI: 10.1111/ajr.12609] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 12/01/2019] [Accepted: 02/11/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Nicole S. Reeves
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Colleen Cheek
- Tasmanian Health Service—North West Burnie TAS Australia
| | - Richard Hays
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Aryelle Sargent
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Alice McComiskie
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Carlos Santini
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Jamie Nguyen
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Khezia Chalwe
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| | - Adil Mubarak
- College of Health and Medicine Rural Clinical School University of Tasmania Burnie TAS Australia
| |
Collapse
|
8
|
Smith JD, Edwards E, Jones PD, Cheek C, Hays RB. Transition from an MBBS to an MD program – Using innovation and thinking outside the square. MedEdPublish 2019. [DOI: 10.15694/mep.2019.000197.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was marked as recommended. Background There has been a trend globally to move from a Bachelor of Medicine, Bachelor of Surgery (MBBS) to a Doctor of Medicine (MD) for primary medical education. This shift has seen many Australian universities change to an MD, mostly from graduate entry programs. This paper describes the novel and unique 3+2 model from one Australian university, that enabled undergraduate entry, student flexibility, and a master's exit qualification without increasing time.Methods The method included a curriculum review in 2013 where its problem-based learning curriculum shifted from a seven to a five-semester program; changing the third year to a virtual hospital clinical year using simulation, and introducing in 2016 a new 3+2 curriculum model in the final two years using a 100 point system as a masters level program. ResultsThe MD model was described in the external evaluation as 'novel and innovative', where students can choose from three project options - a research project, or a professional project or an international capstone experience as well as a number of scholarly tasks. The structure is fully integrated with the existing curriculum and assessment process, supported by an innovative technology platform.ConclusionNow in its third year of implementation this innovative model is breaking new ground in the way in which a masters level MD program could be developed, whilst maintaining undergraduate entry.
Collapse
|
9
|
McGirr J, Seal A, Barnard A, Cheek C, Garne D, Greenhill J, Kondalsamy-Chennakesavan S, Luscombe GM, May J, Mc Leod J, O'Sullivan B, Playford D, Wright J. The Australian Rural Clinical School (RCS) program supports rural medical workforce: evidence from a cross-sectional study of 12 RCSs. Rural Remote Health 2019; 19:4971. [PMID: 30827118 DOI: 10.22605/rrh4971] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Many strategies have been implemented to address the shortage of medical practitioners in rural areas. One such strategy, the Rural Clinical School Program supporting 18 rural clinical schools (RCSs), represents a substantial financial investment by the Australian Government. This is the first collaborative RCS study summarising the rural work outcomes of multiple RCSs. The aim of this study was to combine data from all RCSs' 2011 graduating classes to determine the association between rural location of practice in 2017 and (i) extended rural clinical placement during medical school (at least 12 months training in a rural area) and (ii) having a rural background. METHODS All medical schools funded under the RCS Program were contacted by email about participation in this study. De-identified data were supplied for domestic students about their gender, origin (rural background defined as having lived in an Australian Standard Geographic Classification-Remoteness Area (ASGC-RA) 2-5 area for at least 5 years since beginning primary school) and participation in extended rural clinical placement (attended an RCS for at least 1 year of their clinical training). The postcode of their practice location according to the publicly available Australian Health Practitioner Regulation Agency (AHPRA) register was collected (February to August 2017) and classified into rural and metropolitan areas using the ASGC 2006 and the more recent Modified Monash Model (MMM). The main outcome measure was whether graduates were working in a 'rural' area (ASGC categories RA2-5 or MMM categories 3-7) or 'metropolitan' area. Pearson's χ2 test was used to detect differences in gender, rural background and extended placement at an RCS between rural and metropolitan practice locations. Binary logistic regression was used to determine odds of rural practice and 95% confidence intervals (CIs) were calculated. RESULTS Although data were received from 14 universities, two universities had not started collecting origin data at this point so were excluded from the analysis. The proportion of students with a rural background had a range of 12.3-76.6% and the proportion who had participated in extended RCS placement had a range of 13.7-74.6%. Almost 17% (16.6%) had a principal practice postcode in a rural area (according to ASGC), range 5.8-55.6%, and 8.3% had a principal practice postcode in rural areas (according to MMM 3-7), range 4.5-29.9%. After controlling for rural background, it was found that students who attended an RCS were 1.5 times more likely to be in rural practice (95%CI 1.2-2.1, p=0.004) using ASGC criteria. Using the MMM 3-7 criteria, students who participated in extended RCS placement were 2.6 times as likely to be practising in a rural location (95%CI 1.8-3.8, p<0.001) after controlling for rural background. Regardless of geographic classification system (ASGC, MMM) used for location of practice and of student background (metropolitan or rural), those students with an extended RCS had an increased chance of working rurally. CONCLUSION Based on the combined data from three-quarters (12/16) of the Australian medical schools who had a graduating class in 2011, this suggests that the RCS initiative as a whole is having a significant positive effect on the regional medical workforce at 5 years post-graduation.
Collapse
Affiliation(s)
- Joe McGirr
- Rural Clinical School, School of Medicine Sydney, The University of Notre Dame, Australia
| | - Alexa Seal
- Rural Clinical School, School of Medicine Sydney, The University of Notre Dame, Australia
| | - Amanda Barnard
- Charles Sturt University and Western Sydney University Joint Program in Medicine
| | - Colleen Cheek
- Rural Clinical School, School of Medicine, College of Health and Medicine, University of Tasmania
| | - David Garne
- Community, Primary, Remote and Rural, School of Medicine, University of Wollongong
| | - Jennene Greenhill
- Flinders University Rural Clinical School (FURCS), Flinders University
| | | | | | - Jenny May
- University of Newcastle Department of Rural Health, University of Newcastle
| | | | | | - Denese Playford
- Rural Clinical School of Western Australia, The University of Western Australia
| | - Julian Wright
- Department of Rural Health, Rural Clinical School, The University of Melbourne
| |
Collapse
|
10
|
Cheek C, Hays R, Allen P, Walker G, Shires L. Building a medical workforce in Tasmania: A profile of medical student intake. Aust J Rural Health 2019; 27:28-33. [PMID: 30719777 DOI: 10.1111/ajr.12445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2018] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To identify under-represented groups in a medical school intake. DESIGN Descriptive analysis of student demographic characteristics. SETTING One state-wide medical school. PARTICIPANTS All students enrolled between 2010 and 2016. MAIN OUTCOME MEASURE(S) Proportion of students from regional and rural areas, state versus independent schools, highest parental qualification, Aboriginal or Torres Strait Islander students. RESULTS Of 819 students, 472 (57.6%) were from Tasmania, five (1.1%) identified as Aboriginal or Torres Strait Islanders, 335 (71.0%) completed their secondary education at independent schools and 137 (29.0%) at government schools. The overall median Modified Monash Model was 2 (range 1-6) and median Australia Statistical Geography Standard Remoteness Area was 2 (inner regional: range 1-4), reflecting that a majority came from one of the two main cities. Over two-thirds (69.5%) had a parent with a Bachelor degree or higher qualification, regardless of the school attended. Just under half (225, 47.7%) of all Tasmanian students attended a secondary school with a parental contribution of ≥$5000 per annum. These students attended a small number of independent schools, with the proportion relatively stable over the period from 2010 to 2016. CONCLUSION Widening participation and widening access initiatives to graduate doctors who understand and want to work in communities in need might not be working as well in Tasmania as elsewhere in Australia. Social accountability might be improved by adapting a rural classification that reflects the demographic profile of Tasmania.
Collapse
Affiliation(s)
- Colleen Cheek
- Rural Clinical School, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Richard Hays
- School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Penny Allen
- Rural Clinical School, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Gary Walker
- Rural Clinical School, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Lizzi Shires
- Rural Clinical School, School of Medicine, College of Health and Medicine, University of Tasmania, Hobart, Tasmania, Australia
| |
Collapse
|
11
|
Affiliation(s)
- Katherine Davis
- Rural Clinical School, School of Medicine, College of Health and MedicineUniversity of Tasmania Burnie Tasmania
| | - Emily Doole
- Rural Clinical School, School of Medicine, College of Health and MedicineUniversity of Tasmania Burnie Tasmania
| | - Colleen Cheek
- Rural Clinical School, School of Medicine, College of Health and MedicineUniversity of Tasmania Burnie Tasmania
| | - Lizzi Shires
- Rural Clinical School, School of Medicine, College of Health and MedicineUniversity of Tasmania Burnie Tasmania
| |
Collapse
|
12
|
Cheek C, Hays R, Smith J, Allen P. Improving case study research in medical education: a systematised review. Med Educ 2018; 52:480-487. [PMID: 29178211 DOI: 10.1111/medu.13469] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 07/26/2017] [Accepted: 09/04/2017] [Indexed: 06/07/2023]
Abstract
CONTEXT Case study research (CSR) is a research approach that guides holistic investigation of a real phenomenon. This approach may be useful in medical education to provide critical analyses of teaching and learning, and to reveal the underlying elements of leadership and innovation. There are variations in the definition, design and choice of methods, which may diminish the value of CSR as a form of inquiry. OBJECTIVES This paper reports an analysis of CSR papers in the medical education literature. The review aims to describe how CSR has been used and how more consistency might be achieved to promote understanding and value. METHODS A systematised review was undertaken to quantify the number of CSR articles published in scholarly medical education journals over the last 10 years. A typology of CSR proposed by Thomas and Myers to integrate the various ways in which CSR is constructed was applied. RESULTS Of the 362 full-text articles assessed, 290 were excluded as they did not meet the eligibility criteria; 76 of these were titled 'case study'. Of the 72 included articles, 50 used single-case and 22 multi-case design; 46 connected with theory and 26 were atheoretical. In some articles it was unclear what the subject was or how the subject was being analysed. CONCLUSIONS In this study, more articles titled 'case study' failed than succeeded in meeting the eligibility criteria. Well-structured, clearly written CSR in medical education has the potential to increase understanding of more complex situations, but this review shows there is considerable variation in how it is conducted, which potentially limits its utility and translation into education practice. Case study research might be of more value in medical education if researchers were to follow more consistently principles of design, and harness rich observation with connection of ideas and knowledge to engage the reader in what is most interesting.
Collapse
Affiliation(s)
- Colleen Cheek
- Rural Clinical School, Faculty of Health, University of Tasmania, Burnie, Tasmania, Australia
| | - Richard Hays
- Rural Clinical School, Faculty of Health, University of Tasmania, Burnie, Tasmania, Australia
| | - Janie Smith
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Penny Allen
- Rural Clinical School, Faculty of Health, University of Tasmania, Burnie, Tasmania, Australia
| |
Collapse
|
13
|
Cheek C, Hays R, Allen P, Walker G, Shires L. Building a local medical workforce in Tasmania: where are international fee-paying medical graduates likely to work? Rural Remote Health 2017; 17:4292. [PMID: 28846850 DOI: 10.22605/rrh4292] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Much of regional Australia continues to face challenges in recruitment and retention of medical practitioners, despite the apparently successful rural medical education initiatives funded by the Commonwealth Government. International fee-paying (IFP) medical students are a significant component of Australian medical education, contributing additional income and more diverse learning environments for universities. Their contribution to the Australian medical workforce is harder to determine. After obtaining registration, IFP graduates may apply to remain in Australia as skilled migrants. Since 1999 there has been a 325% increase in the number of international medical students in Australia, with approximately 73% of IFP graduates remaining in Australia for at least some postgraduate training. Recognising the potential contribution of IFP students to the Tasmanian medical workforce, the authors sought better understanding of the career intentions and work locations of IFP graduates from the medical program in Tasmania, Australia, through two studies. Firstly, a quantitative study was conducted of the locations of all IFP graduates from the Tasmanian medical program, and then a qualitative study exploring graduating students' intentions and factors that contribute to their decisions about work location choices. METHODS This was a cohort study of IFP students who graduated from the University of Tasmania School of Medicine over the period 2000-2015. Work locations for 2016 were mapped to a Modified Monash rurality classification. Semi-structured interviews were held with 15 final year IFP medical students, exploring career intentions and location preferences. RESULTS There were 261 IFP graduates, 54.4% male. The most common country of origin was Malaysia (55.2%). In 2016, 189 (72.4 %) were working in Australia, 42 (16.1%) in Tasmania and 126 (66.7%) in areas categorised as Modified Monash 1. Recent graduates in postgraduate year 1/2 (71.3%) were more likely to be working in Tasmania but most left for specialty training. All 15 interview participants intended to remain in Australia for at least their intern year, although at enrolment only six had planned to remain. Factors influencing workplace location decisions were (1) 'professional': greater appeal of Australian medical workplaces, intention to pursue a speciality, and to complete this at an Australian metropolitan hospital; (2) 'social': proximity to family/partner or opportunity to meet a prospective partner, family obligations, positive rural experiences; and (3) 'location': direct travel access to family. CONCLUSIONS IFP graduates from the Tasmanian medical program make an important contribution to the Australian mainland metropolitan medical workforce, but play only a small role in workforce development for both Tasmania and the broader Australian rural and remote context. Most IFPs do not choose to work rurally. Rurally focused medical programs need to consider how they place IFP students to meet both the learning and career needs of IFP students and the goal of the rural medical programs in developing a rural workforce.
Collapse
Affiliation(s)
- Colleen Cheek
- University of Tasmania Rural Clinical School, Private Bag 3513, Burnie Tasmania, Australia 7320..
| | - Richard Hays
- School of Medicine, University of Tasmania, Private Bag 34, Hobart, Tasmania, Australia 7000..
| | - Penny Allen
- University of Tasmania Rural Clinical School, Private Bag 3513, Burnie Tasmania, Australia 7320..
| | - Gary Walker
- University of Tasmania Rural Clinical School, Private Bag 3513, Burnie Tasmania, Australia 7320..
| | - Lizzi Shires
- University of Tasmania Rural Clinical School, Private Bag 3513, Burnie Tasmania, Australia 7320..
| |
Collapse
|
14
|
Abstract
OBJECTIVE Point-of-care ultrasound (POCUS) assists in the rapid diagnosis of conditions in the Emergency Department (ED). POCUS has been introduced to international medical curricula; however, there is no described implementation of clinically focused POCUS education in Australian medical schools. We wanted to investigate whether a formal curriculum can be effective and feasible in an Australian medical school. METHODS Pre-post intervention study of a focused curriculum based on the Extended Focused Assessment with Sonography in Trauma (E-FAST) examination, consisting of online and practical teaching, was implemented for Year-4 and -5 medical students. An online questionnaire was used to measure knowledge, image interpretation and confidence prior to the intervention. After the intervention and ED placement, the questionnaire was repeated and students were assessed performing the E-FAST examination on a healthy volunteer. RESULTS Twenty-seven students participated in both the pre-intervention and post-intervention questionnaires. There was a significant improvement in confidence in performing the E-FAST after the intervention [p < 0.001]. There was also a significant improvement in ultrasound knowledge and image interpretation skills. For the formative assessment, the mean score was 31.8 out of 33 and 22 of 27 students (82%) passed the assessment. There is no described implementation of clinically focused point-of-care ultrasound education in Australian medical schools CONCLUSIONS: We have demonstrated that a focused curriculum can improve POCUS knowledge and skills. The curriculum was feasible and well received. With global trends to include POCUS in medical education, Australian institutions should consider upskilling their medical graduates.
Collapse
Affiliation(s)
- John Ang
- Emergency Department, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Brian Doyle
- Emergency Department, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Penny Allen
- Research Fellow, University of Tasmania Rural Clinical School, Burnie, Tasmania, Australia
| | - Colleen Cheek
- Research Fellow, University of Tasmania Rural Clinical School, Burnie, Tasmania, Australia
| |
Collapse
|
15
|
Turner L, Spencer L, Strugnell J, Di Tommaso I, Tate M, Allen P, Cheek C, Cooper J, Chang J. Young people have their say: What makes a youth-friendly general practice? Aust Fam Physician 2017; 46:70-74. [PMID: 28189137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND The health of young people can be considered an indicator of the health of Australia's future population. To improve access to healthcare, the perspectives of adolescents on the design and delivery of services need to be championed. The objective of this study was to identify what young people in north-west Tasmania value when seeking healthcare at general practices. METHODS The study was conducted at a single high school in rural Tasmania. Students aged 16-18 years were invited to participate in an electronic survey seeking their views and preferences for presenting to their general practitioner (GP). RESULTS One hundred and fifty-five students, with a mean age of 17 years, were surveyed. GPs were the usual healthcare providers for 98.4% of participants, and 86% stated that they would like to discuss mental health, substance use and sexual health with their GP. DISCUSSION GPs can improve access to care for young people through good communications skills and treating young people as young adults.
Collapse
|
16
|
Cheek C, Hays R, Allen P, Smith JD. Research knowledge and skills in primary medical training – a cross-sectional audit. MedEdPublish 2016. [DOI: 10.15694/mep.2016.000101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article was migrated. The article was marked as recommended. Background: Internationally, medical education has either adopted, or is moving toward, a Masters level qualification at completion. This reflects the higher-level learning outcomes and potentially facilitation of thinking and decision-making required of medical graduates. In Australia, the main difference between bachelor and masters programs appears to be the level of research skills training. This study explores the characteristics of research training in medical schools and alignment with higher education qualification frameworks. Methods: A cross-sectional audit was conducted of 22 medical schools in Australia and New Zealand, seeking information on: degree type, entry requirement, research knowledge and skills taught, teaching format, and barriers to offering students research experiences. Results: Information about 15 medical programs was obtained, with Australian Qualifications Framework or New Zealand Qualifications Framework Level 7, 8 or 9E outcomes. All included a variety of teaching methods on biomedical ethics, principles of evidence-based practice, and search strategies for medical evidence, critical appraisal of the literature and disease surveillance/epidemiology. Small projects were available in all programs, although voluntary in Level 7/8 programs and mandatory in Level 9E programs. Conclusions: There appear to be few differences in research training and learning outcomes from Level 7 and Level 9E programs, although Level 9E programs have a more systematic approach and assurance that all graduates can achieve the higher outcomes. Barriers to successful implementation relate to finding curriculum space and sufficient research training capacity for all medical students.
Collapse
|
17
|
Fleming TM, Bavin L, Stasiak K, Hermansson-Webb E, Merry SN, Cheek C, Lucassen M, Lau HM, Pollmuller B, Hetrick S. Serious Games and Gamification for Mental Health: Current Status and Promising Directions. Front Psychiatry 2016; 7:215. [PMID: 28119636 PMCID: PMC5222787 DOI: 10.3389/fpsyt.2016.00215] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/28/2016] [Indexed: 11/14/2022] Open
Abstract
Computer games are ubiquitous and can be utilized for serious purposes such as health and education. "Applied games" including serious games (in brief, computerized games for serious purposes) and gamification (gaming elements used outside of games) have the potential to increase the impact of mental health internet interventions via three processes. First, by extending the reach of online programs to those who might not otherwise use them. Second, by improving engagement through both game-based and "serious" motivational dynamics. Third, by utilizing varied mechanisms for change, including therapeutic processes and gaming features. In this scoping review, we aim to advance the field by exploring the potential and opportunities available in this area. We review engagement factors which may be exploited and demonstrate that there is promising evidence of effectiveness for serious games for depression from contemporary systematic reviews. We illustrate six major categories of tested applied games for mental health (exergames, virtual reality, cognitive behavior therapy-based games, entertainment games, biofeedback, and cognitive training games) and demonstrate that it is feasible to translate traditional evidence-based interventions into computer gaming formats and to exploit features of computer games for therapeutic change. Applied games have considerable potential for increasing the impact of online interventions for mental health. However, there are few independent trials, and direct comparisons of game-based and non-game-based interventions are lacking. Further research, faster iterations, rapid testing, non-traditional collaborations, and user-centered approaches are needed to respond to diverse user needs and preferences in rapidly changing environments.
Collapse
Affiliation(s)
- Theresa M Fleming
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Lynda Bavin
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Eve Hermansson-Webb
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Sally N Merry
- Department of Psychological Medicine, University of Auckland , Auckland , New Zealand
| | - Colleen Cheek
- University of Tasmania Rural Clinical School , Burnie, TAS , Australia
| | - Mathijs Lucassen
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand; Department of Health, Wellbeing and Social Care, The Open University, Milton Keynes, UK
| | - Ho Ming Lau
- Department of Psychiatry, VU University Medical Center , Amsterdam , Netherlands
| | - Britta Pollmuller
- School of Art and Design, Auckland University of Technology , Auckland , New Zealand
| | - Sarah Hetrick
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, University of Melbourne , Parkville, VIC , Australia
| |
Collapse
|
18
|
Cheek C, Allen P, Shires L, Parry D, Ruigrok M. Low-acuity presentations to regional emergency departments: What is the issue? Emerg Med Australas 2015; 28:145-52. [PMID: 26708775 DOI: 10.1111/1742-6723.12526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 10/12/2015] [Accepted: 11/04/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To explore GP-referrals and self-referrals to EDs and factors associated with patients seeking low-acuity care at ED. METHOD Retrospective analysis of all ED presentations to Mersey Community Hospital and North West Regional Hospital (Tasmania) between 1 January 2009 and 31 December 2013. Cross-sectional survey of patients presenting to the EDs for care triaged as low-acuity. RESULTS There were 255,365 ED presentations in the retrospective data: 11,252 (4.4%) GP-referrals and 218,205 (85.4%) self-referrals. At ED 49% of GP-referrals were triaged ATS 4 or 5 and 35% of self-referrals were triaged ATS 1-3. There were 138 (84.2%) low-acuity patients who completed the survey; predominantly, all attended for acute injury or illness. Single point-of-care convenience was most commonly selected (71%) as a reason for attending ED. CONCLUSIONS Over 85% of patients who seek emergency care in this region self-refer, so understanding health-seeking behaviour is important. Most low-acuity patients are acutely injured or unwell, and the decision to go to ED is based on their perception of accessibility of expertise aligned with their need. The term 'GP-type' is misleading in this context and should not be used. Providing low-acuity care in parallel with providing a specialised emergency service meets the needs of the local community and is likely to be the lowest cost model in a regional and rural area. Funding models must reflect the actual cost of delivering this important service rather than presentation types.
Collapse
Affiliation(s)
- Colleen Cheek
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Penny Allen
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Lizzi Shires
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | - Denise Parry
- Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia
| | - Marielle Ruigrok
- Tasmanian Health Organisation North West, North West Regional Hospital, Burnie, and Mersey Community Hospital, Latrobe, Tasmania, Australia
| |
Collapse
|
19
|
Shires L, Allen P, Cheek C, Wilson D. Regional universities and rural clinical schools contribute to rural medical workforce, a cohort study of 2002-2013 graduates. Rural Remote Health 2015. [DOI: 10.22605/rrh3219] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
20
|
Shires L, Allen P, Cheek C, Deb W. Regional universities and rural clinical schools contribute to rural medical workforce, a cohort study of 2002 to 2013 graduates. Rural Remote Health 2015; 15:3219. [PMID: 26245841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
Abstract
INTRODUCTION Rural clinical schools and regionally based medical schools have a major role in expanding the rural medical workforce. The aim of this cohort study was to compare location of practice of graduates from the University of Tasmania School of Medicine's clinical schools based in the larger cities of Hobart and Launceston (UTAS SoM), with those graduates who spent at least 1 year at the University of Tasmania School of Medicine's Rural Clinical School based in the smaller regional city of Burnie (UTAS RCS) in Australia. Specifically, the aim was to quantify the proportion who worked in an Australian regional or remote location, or in the regional cities and smaller towns within Tasmania. METHODS The 2014 locations of practice of all graduates from the UTAS SoM and UTAS RCS between 2002 and 2013 were determined using the postcode listed in the Australian Health Practitioners Authority database. These postcodes were mapped against the Australian Bureau of Statistics Australian Standard Geographic Classification - Remoteness Areas (ASGC-RA) and the 2011 Census population data for Tasmania to define Modified Monash Model classifications. RESULTS The study tracked 974 UTAS SoM graduates; 202 (21%) spent at least 1 year at the Rural Clinical School (UTAS RCS graduates). Students who had spent a year at the UTAS RCS were five times more likely to be working in RA3 to RA5 than those who hadn't spent a clinical year there (28% vs 7%, χ2(1)=59.5, p<0.0001) (odds ratio (OR) 4.9, 95% confidence interval (CI) 3.2-7.6). Using the Modified Monash Model, it was found that UTAS RCS graduates were nine times more likely (OR 9.0, 95%CI 4.7-17.2) to be working in the regional cities and smaller towns of Tasmania. CONCLUSIONS This study adds to the growing evidence that training medical students in rural areas delivers graduates that work rurally. The additional year spent in a rural area, even when their medical school is in a regional city, significantly affects their workplace choices over the first 3 years post-graduation.
Collapse
Affiliation(s)
- Lizzi Shires
- UTAS Rural Clinical School, Burnie, Tasmania, Australia.
| | - Penny Allen
- UTAS Rural Clinical School, Burnie, Tasmania, Australia.
| | - Colleen Cheek
- UTAS Rural Clinical School, Burnie, Tasmania, Australia.
| | - Wilson Deb
- UTAS Rural Clinical School, Burnie, Tasmania, Australia.
| |
Collapse
|
21
|
Cheek C, Fleming T, Lucassen MF, Bridgman H, Stasiak K, Shepherd M, Orpin P. Integrating Health Behavior Theory and Design Elements in Serious Games. JMIR Ment Health 2015; 2:e11. [PMID: 26543916 PMCID: PMC4607397 DOI: 10.2196/mental.4133] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 02/11/2015] [Accepted: 03/16/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Internet interventions for improving health and well-being have the potential to reach many people and fill gaps in service provision. Serious gaming interfaces provide opportunities to optimize user adherence and impact. Health interventions based in theory and evidence and tailored to psychological constructs have been found to be more effective to promote behavior change. Defining the design elements which engage users and help them to meet their goals can contribute to better informed serious games. OBJECTIVE To elucidate design elements important in SPARX, a serious game for adolescents with depression, from a user-centered perspective. METHODS We proposed a model based on an established theory of health behavior change and practical features of serious game design to organize ideas and rationale. We analyzed data from 5 studies comprising a total of 22 focus groups and 66 semistructured interviews conducted with youth and families in New Zealand and Australia who had viewed or used SPARX. User perceptions of the game were applied to this framework. RESULTS A coherent framework was established using the three constructs of self-determination theory (SDT), autonomy, competence, and relatedness, to organize user perceptions and design elements within four areas important in design: computer game, accessibility, working alliance, and learning in immersion. User perceptions mapped well to the framework, which may assist developers in understanding the context of user needs. By mapping these elements against the constructs of SDT, we were able to propose a sound theoretical base for the model. CONCLUSIONS This study's method allowed for the articulation of design elements in a serious game from a user-centered perspective within a coherent overarching framework. The framework can be used to deliberately incorporate serious game design elements that support a user's sense of autonomy, competence, and relatedness, key constructs which have been found to mediate motivation at all stages of the change process. The resulting model introduces promising avenues for future exploration. Involving users in program design remains an imperative if serious games are to be fit for purpose.
Collapse
Affiliation(s)
- Colleen Cheek
- Rural Clinical School School of Medicine University of Tasmania Burnie Australia
| | - Theresa Fleming
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Mathijs Fg Lucassen
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Heather Bridgman
- Centre for Rural Health University of Tasmania Launceston Australia
| | - Karolina Stasiak
- Werry Centre for Child and Adolescent Mental health Department of Psychological Medicine University of Auckland Auckland New Zealand
| | - Matthew Shepherd
- School of Counselling Human Services and Social Work University of Auckland Auckland New Zealand
| | - Peter Orpin
- Centre for Rural Health University of Tasmania Launceston Australia
| |
Collapse
|
22
|
Allen P, Cheek C, Foster S, Ruigrok M, Wilson D, Shires L. Low acuity and general practice-type presentations to emergency departments: a rural perspective. Emerg Med Australas 2015; 27:113-8. [PMID: 25720647 DOI: 10.1111/1742-6723.12366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2015] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate the number of general practice (GP)-type patients attending a rural ED and provide a comparative rural estimate to a metropolitan study. METHODS Analysis of presentations to the two EDs in Northwest Tasmania from 1 January 2009 to 31 December 2013 using the Diagnosis, Sprivulis, Australian College of Emergency Medicine (ACEM) and the Australian Institute of Health and Welfare (AIHW) methods to estimate the number of GP-type presentations. RESULTS There were 255,365 ED presentations in Northwest Tasmania during the study period. There were 86,973 GP-type presentations using the ACEM method, 142,006 using the AIHW method, 174,748 using the Diagnosis method and 28,922 low acuity patients identified using the Sprivulis method. CONCLUSIONS The proportion of GP-type presentations identified using the four methods ranged from 15% to 69%. The results suggest that triage status and self-referral are not reliable indicators of low acuity in this rural area. In rural areas with a shortage of GPs, it is likely that many people appropriately self-refer to ED because they cannot access a GP. The results indicate that the ACEM method might be most useful for identifying GP-type patients in rural ED. However, this requires validation in other regions of Australia.
Collapse
Affiliation(s)
- Penny Allen
- Rural Clinical School, University of Tasmania, Burnie, Tasmania, Australia
| | | | | | | | | | | |
Collapse
|
23
|
Allen PL, Cheek C, Ruigrok M. Rural emergency departments supplement general practice care. Med J Aust 2015; 202:17-8. [PMID: 25588432 DOI: 10.5694/mja14.01114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/15/2014] [Indexed: 11/17/2022]
|
24
|
Cheek C, Skinner T, Ellis I. Measuring the environmental cost of health-related travel from rural and remote Australia. Med J Aust 2014; 200:260-2. [PMID: 24641145 DOI: 10.5694/mja13.00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/14/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Colleen Cheek
- Rural Clinical School, University of Tasmania, Burnie, TAS, Australia.
| | - Timothy Skinner
- Psychological and Clinical Sciences, Charles Darwin University, Darwin, NT, Australia
| | - Isabelle Ellis
- School of Nursing and Midwifery, University of Tasmania, Burnie, TAS, Australia
| |
Collapse
|
25
|
Cheek C, Bridgman H, Fleming T, Cummings E, Ellis L, Lucassen MF, Shepherd M, Skinner T. Views of Young People in Rural Australia on SPARX, a Fantasy World Developed for New Zealand Youth With Depression. JMIR Serious Games 2014; 2:e3. [PMID: 25659116 PMCID: PMC4307819 DOI: 10.2196/games.3183] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2013] [Revised: 01/17/2014] [Accepted: 01/18/2014] [Indexed: 12/18/2022] Open
Abstract
Background A randomized control trial demonstrated that a computerized cognitive behavioral therapy (cCBT) program (Smart, Positive, Active, Realistic, X-factor thoughts [SPARX]) was an appealing and efficacious treatment for depression for adolescents in New Zealand. Little is known about the acceptability of computerized therapy programs for rural Australians and the suitability of computerized programs developed in one cultural context when used in another country. Issues such as accents and local differences in health care access might mean adjustments to programs are required. Objective This study sought to explore the acceptability of SPARX by youth in rural Australia and to explore whether and how young people would wish to access such a program. Methods Focus groups and semistructured interviews were conducted with 16 young people attending two youth-focused community services in a small, rural Tasmanian town. An inductive data-driven approach was used to identify themes using the interview transcripts as the primary data source. Interpretation was supported by demographic data, observer notes, and content analysis. Results Participants reported that young people want help for mental health issues but they have an even stronger need for controlling how they access services. In particular, they considered protecting their privacy in their small community to be paramount. Participants thought computerized therapy was a promising way to increase access to treatment for youth in rural and remote areas if offered with or without therapist support and via settings other than school. The design features of SPARX that were perceived to be useful, included the narrative structure of the program, the use of different characters, the personalization of an avatar, “socialization” with the Guide character, optional journaling, and the use of encouraging feedback. Participants did not consider (New Zealand) accents off-putting. Young people believed the SPARX program would appeal to those who play computer games generally, but may be less appealing for those who do not. Conclusions The findings suggest that computerized therapy offered in ways that support privacy and choice can improve access to treatment for rural youth. Foreign accents and style may not be off-putting to teenage users when the program uses a playful fantasy genre, as it is consistent with their expectation of fantasy worlds, and it is in a medium with which they already have a level of competence. Rather, issues of engaging design and confidential access appeared to be more important. These findings suggest a proven tool once formally assessed at a local level can be adopted cross-nationally.
Collapse
Affiliation(s)
- Colleen Cheek
- Rural Clinical School, University of Tasmania, Burnie, Australia.
| | | | | | | | | | | | | | | |
Collapse
|
26
|
Skinner I, Cheek C, Jaffray L, Skinner T. Making a case for telehealth: measuring the carbon cost of health-related travel. Rural Remote Health 2013. [DOI: 10.22605/rrh2723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
27
|
Ellis I, Cheek C, Jaffray L, Skinner T. Making a case for telehealth: measuring the carbon cost of health-related travel. Rural Remote Health 2013; 13:2723. [PMID: 24299428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Telehealth services are promoted to reduce the cost of travel for people living in rural areas. The previous Australian Government, through the national Digital Economy Strategy, invested heavily in telehealth service development, at the same time introducing a carbon pricing mechanism. In planning a range of new telehealth services to a rural community the authors sought to quantify the travel conducted by people from one rural area in Australia to access health care, and to calculate the associated carbon emissions. METHODS A population survey was conducted over a 1-week period of health-related travel events for the year 1 July 2011 to 30 June 2012 of all households on King Island, a community situated between the Australian mainland state of Victoria and the state of Tasmania. Validated emissions calculators were sourced from the Carbon Neutral website, including the vehicle and fuel use calculator and air travel carbon calculator, to calculate the total emissions associated with the fuel burned in tonnes of carbon dioxide equivalent (tCO2e). RESULTS Thirty nine percent of the population (625 participants) reported a total of 511 healthcare-related travel events. Participants travelled a total of 346 573 km and generated 0.22 tCO2e per capita. Participants paid the cost of their own travel more than 70% of the time. CONCLUSIONS Dependence on fossil fuels for transport in a carbon economy has a significant impact on total healthcare carbon emissions. Alternative models of care, such as telehealth, need be developed for an environmentally sustainable healthcare system for rural and remote areas.
Collapse
Affiliation(s)
- Isabelle Ellis
- School of Nursing and Midwifery, University of Tasmania, Burnie, Tasmania, Australia.
| | | | | | | |
Collapse
|
28
|
Cummings E, Cheek C, Van Der Ploeg W, Orpin P, Behrens H, Condon S, Jaffray L, Ellis I, Ringeisen Arnold B, Brogan R, Skinner T. The Cradle Coast personally controlled electronic health record evaluation research. Stud Health Technol Inform 2012; 178:14-19. [PMID: 22797013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
In 2010 the Federal Government announced funding over two years to create a Personally Controlled Electronic Health Record (PCEHR) for Australians. One of the wave 2 implementation sites is the Cradle Coast in Tasmania. A PCEHR Program Benefits and Evaluation Partner (BEP) has been appointed to undertake evaluation activities with the e-health lead implementation sites. In addition to this implementation a comprehensive research plan has been developed and commenced through the Rural Clinical School at the University of Tasmania. The overarching aim of the research agenda is to evaluate the outcomes of various elements of the 4C project as it evolves and is implemented, from multiple perspectives. The research agenda is important as it expands upon the NEHTA mandated evaluation and provides an holistic overview of the PCEHR implementation process and outcomes for clinicians, patients and family members. This paper will detail the planned evaluation and its progress to date.
Collapse
Affiliation(s)
- Elizabeth Cummings
- eHealth Services Research Group, School of Computing and Information Systems, University of Tasmania, Tasmania.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Piercy KW, Cheek C, Teemant B. Challenges and Psychosocial Growth for Older Volunteers Giving Intensive Humanitarian Service. The Gerontologist 2011; 51:550-60. [DOI: 10.1093/geront/gnr013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
30
|
Cheek C, Radley S. Diverticulosis: fibre is the key. Practitioner 1999; 243:321-4. [PMID: 10492975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Affiliation(s)
- C Cheek
- Dept of Surgery, Queen Elizabeth Hospital, Birmingham
| | | |
Collapse
|
31
|
Cheek C. A prospective study of adult inguinal hernia repairs using absorbable sutures. J R Coll Surg Edinb 1997; 42:428-9. [PMID: 9448408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
32
|
Cheek C. Use of skin staples for securing the mesh in the Lichtenstein repair of inguinal hernia. Ann R Coll Surg Engl 1996; 78:398. [PMID: 8712667 PMCID: PMC2502563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
|