Ambulance Tasmania attendances to falls related incidents: Commencement of a Tasmanian dataset

Mr John Cannell1, Mr Alex Wilson2

1Tasmanian Health Service North, Launceston, Australia, 2Ambulance Tasmania, Hobart, Australia

Whilst falls occur across the age spectrum, allied health staff are particularly involved in the minimization of harm and prevention of falls in the older population. Published literature reports that in the western world an average of 25% of over 60 year olds and 30% of over 65 year olds fall each year. One tenth of these falls result in people seeking assistance from a health professional.

Understanding the incidence of falls in older community dwelling Tasmanians is difficult. There are no published studies or reports. Whilst there are systems within healthcare settings to record and monitor the incidence there is no equivalent option for the community. As Ambulance Tasmania attends a proportion of community falls which require medical assistance and review, their clinical data provides insight into the incidence of injurious falls.

Tasmanian Paramedics record their assessment and client management in an electronic module called the Victorian Ambulance Clinical Information System (VACIS). This system is used in multiple states of Australia. Through application to Ambulance Tasmania, Tasmanian Health Services North has been able to access and analyse one year of de-identified case information. 10329 of the 72096 case notes for the 2016-17 financial year contained the words “fall” or “fell”.

Providing analysis and breakdown of these cases across the Tasmania will provide insight and assist service development to allied health professions. Rates by locality, region, age, transportation to hospital, are able to be accessed from the data. Using keyword searches, falls which involved sporting activities or modes of transport are able to be separated from mechanical or syncopal falls.

The incidence and consequences of falls in our ageing population is creating further pressure on our health system. Utilising the Ambulance Tasmania’s VACIS dataset will assist us to understand and plan for the health needs of our Tasmanian population.


Biography:

John is the clinical lead physiotherapist for rehabilitation at the LGH. He has a been an active member of hospital and regional falls committees for over 10 years. John, like many allied health professions, is trying to move to a more proactive model of falls prevention. This presentation showcases a new initiative to share information which is able to guide our future health care service development.

Go home, sit less. The impact of home versus rehabilitation environment on activity levels of stroke survivors (iREAct)

Ms Dawn Simpson1,2, Dr Monique  Breslin2, Dr Toby  Cumming3, Associate Professor Coralie English4,5, Dr Seana  Gall2, Dr   Matthew Schmidt6, Dr Michele Callisaya1,2

1Physiotherapy Department Tasmanian Health Service South, Hobart, Australia, 2Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia, 3Stroke Division, Florey Institute of Neurosciences and Mental Health, Melbourne, Australia, 4School of Health Sciences, University of Newcastle, Newcastle, Australia, 5University of Newcastle Priority Research Centre for Stroke and Brain Injury, Hunter Medical Research Institute, Newcastle, Australia, 6School of Health Sciences, University of Tasmania, Hobart, Australia

Background: Sedentary time is high and physical activity low following stroke. There is limited understanding of factors which promote greater activity, and consequently improve function and reduce cardiovascular risk. We examined whether change in environment (hospital/home) influenced the time spent sitting, upright and walking, as well as factors predicting any change.

Methods: 34 participants with stroke were recruited consecutively from 2 rehabilitation units. An activity monitor (ActivPAL3) was worn for 7 days (24 hours/day) at 2 time points: final week in hospital, and first week home. Other measures included mood (HADS), fatigue (FAS) and physical function (gait speed, 6 min walk). Linear mixed models (adjusted for waking hours) were performed with activity time as the outcome and environment as the exposure.

Results: Activity data was available at both time points for 32 (94%) participants (mean age 68 [SD 13] years, 53% male). At home participants spent 45 fewer minutes sitting (95% CI -84,-6 p=0.023), 45 more minutes upright (95% CI 6 ,85 p=0.024), 12 minutes more walking (95% CI 5-19 p=0.001) and completed 712 additional steps per day (95% CI 188 ,1236 p=0.008), compared to the final week in hospital. Better mood prior to discharge predicted differences for all activity outcomes, with the addition of lower fatigue for better walking outcomes (p≤0.05).

Conclusions: Change in environment from hospital to home reduced sitting time and increased time spent in physical activity and daily step count. The environment may be a modifiable factor which clinicians can target to reduce sitting time and promote increases in physical activity.


Biography:

Dawn is a physiotherapist with 19 years clinical experience, predominantly working in rehabilitation, with a particular interest in stroke rehab. She is the team leader physiotherapist for rehabilitation at the Royal Hobart Hospital, and this study was conducted by the Rehabilitation Physiotherapy Team. She is a also PhD candidate at the Menzies Institute for Medical research in Hobart, Tasmania. Her PhD project focuses on sedentary behaviour and physical activity after stroke, and what factors may influence these behaviours.

Preoperative physiotherapy prior to abdominal surgery is memorable and has high impact: a mixed methods study

Ms Ianthe Boden1,2, Ms Nadia Zalucki1, Dr Doa El-Ansary2, Dr Laura Browning2,3, Dr Elizabeth Skinner2,3, Professor Linda Denehy2

1Launceston General Hospital, West Launceston, Australia, 2Physiotherapy Department, University of Melbourne, Melbourne, Australia, 3Division of Allied Health, Western Health, Footscray, Australia

Objectives: To; 1) assess memorability and treatment fidelity of preoperative physiotherapy education prior to elective upper abdominal surgery and, 2) to explore patient opinions on preoperative education. Design: Mixed-methods analysis of a convenience sample within a larger parallel-group, double-blinded, randomised controlled trial with concealed allocation and intention-to-treat analysis. Setting: Tertiary Australian hospital. Participants: Twenty-nine patients having upper abdominal surgery attending preadmission clinic within six-weeks of surgery. Intervention: The control group received an information booklet about preventing pulmonary complications with early ambulation and breathing exercises.  The experimental group received an additional face-to-face 30-minute physiotherapy education and training session on pulmonary complications, early ambulation, and breathing exercises. Outcome measures: Primary outcome was proportion of participants who remembered the taught breathing exercises following surgery. Secondary outcomes were recall of information sub-items and attainment of early ambulation goals. These were measured using standardised scoring of a semi-scripted digitally-recorded interview on the 5th postoperative day, and the attainment of early ambulation goals over the first two postoperative days. Results: Experimental group participants were six-times more likely to remember the breathing exercises (95% CI 1.7 to 22) and 11-times more likely (95%CI 1.6 to 70) to report  physiotherapy as the most memorable part of preadmission clinic. Participants reported physiotherapy education content to be detailed, interesting, and of high value. Some participants reported not reading the booklet and professed a preference for face-to-face information delivery. Conclusion: Face-to-face preoperative physiotherapy education and training prior to upper abdominal surgery is memorable and has high treatment fidelity.


Biography:

Ianthe Boden is the Cardiorespiratory Team Leader at the Launceston General Hospital. Ianthe is currently completing a PhD at The University of Melbourne investigating the prevention of pulmonary complications following abdominal surgery. Ianthe’s first randomised controlled trial, LIPPSMACK-POP, has won major research prizes at Physiotherapy, Anaesthetics, and Surgery conferences. Ianthe is currently Chief Investigator of two active randomised controlled trials (ICEAGE and NIPPER PLUS) and leading CHESTY (Chest infection prevalence after surgery). CHESTY will be one of the largest international collaborative trials in Cardiorespiratory Physiotherapy and will involve over 50 hospitals world-wide.

Anterior Communicating (ACom) artery aneurysm: Clinical syndromes and presentations

Dr Clare Ramsden1

1Tasmanian Health Service, Hobart, Australia

Anterior Communicating (ACom) Artery aneurysm syndrome was first defined in the 1980s, and initially included severe memory impairment, confabulation, and personality changes. Following an early growth of research in this area, there has been limited literature in the last decade, although ACom aneurysm (both clipping and rupture) continues be a common presentation in neurosurgical environments. In addition, there have been changes in both imaging and surgical technology over the past decade that affect outcomes and survivability. This presentation will review the literature on the cognitive sequelae of ACom aneurysms, the functional impact, and examine appropriate assessments for this population.


Biography:

Dr Clare Ramsden completed her neuropsychology training at La Trobe University before working in private, public and third sector organisations in Australia, England and New Zealand. The majority of her clinical experience has been in the field acquired brain injury.

Nutrition interventions for renal dialysis patients

Ms Robyn Montgomery1

1Dhhs, Hobart, Australia

In November 2016  an audit of 56 haemodialysis dependent patients was undertaken.

  • 40% of the group were classified as malnourished
  • 64% of these malnourished patients are male,
  • 32% have diabetes
  • 11% were underweight and 50% overweight
  • 86% were public patients and 14% private patients. This audit will allow for more targeted intervention.

In 2014 the Diabetes and Nutrition departments began the process of developing a protocol for the management of hypoglycaemia. Previous to this protocol, the RHH has followed a guideline which had led to a number of dialysis patients requiring extra dialysis. The  dialysis was required to remove excess fluid or manage hyperkalaemia as a result of this ward treatment.  The new protocol now protects dialysis patients from these adverse outcomes.


Biography:

Robyn is a dietitian who has specialised in renal nutrition for the last 20yrs. Robyn’s interest in renal nutrition began in north Queensland where she was able to home visit people who were independently dialysing in remote indigenous communities. She has been in Hobart since 2011 as the renal dietitan.
Robyn is developing a special interest in management of people with type 1 diabetes and who are dialysis dependent.

Mapping physical, cognitive and social Activity in RehabilitatIOn (MARIO): Activity on the Acute Rehabilitation Unit (THS-S)

Mr Sam de Zoete1, Mr Brendon Bakes2, Ms Dawn Simpson1, Ms  MIchele Callisaya1

1Physiotherapy Department, Tasmanian Health Service South, Hobart, Australia, 2Acute Rehabilitation Unit, Royal Hobart Hospital, Hobart, Australia

Background: Emerging evidence suggests that enriched rehabilitation environments (physical, cognitive and social) enhance recovery and outcome by facilitating greater intensity and repetitions of practice. However, studies show that patients in rehabilitation are often alone and inactive for much of the day. We aimed to describe the activity of patients on the Acute Rehabilitation Unit (Royal Hobart Hospital) using behavioural mapping.

Methods: Data were collected according to a standardised procedure for one weekday (8.00am to 4.00pm). Patients were observed every 15 minutes by researchers who recorded the location, type, postural position, people present during the activity observed. We collected additional measures of diagnosis category (neurology, orthopaedic, medical, other), mobility status and age. Descriptive statistics were used to describe the percentage of time in each location, activity type and position.

Results: 17 of 18 ward patients were successfully observed.  Patients were categorised as: orthopaedic (n=4), neurological (n=11), medical (n=1), and surgical (n=1). Location: Patients were noted to spend 67% of time in bedroom and 11% of time in the therapy gym. People: Patients spent 36% of the audited time alone and 43% with staff. 10% of total time was spent with Physiotherapy. Activity: Patients were seen to be inactive 29% of time (8% of time sleeping), and 55% of time active (physical, social or cognitive). 16% of time was unobservable. Position: Patients spent 2.4% of time walking, 6 % of time walking, 44% of time sitting in a chair and 30% of time lying in bed.

Conclusions: Patients spent less time alone than reported as average in prior literature. However, the data suggests patients spent large portions of their day inactive and confined to their rooms. This information will be used by the ward to drive discussion and strategies on ways activity may be increased in the future.


Biography:

Sam de Zoete is the senior Physiotherapist on the Acute Rehabilitation Unit at the Royal Hobart Hospital. Over the past 15 years he has worked in various Physiotherapy roles throughout Australia from urban Melbourne to remote Arnhem Land. Whilst in this position, Sam has participated in both research and numerous quality improvement projects aimed at reaching the ever elusive: an enriched oasis of rehabilitation within the walls of a nebulous tertiary hospital

Family violence screening in the acute health setting

Mrs Gretchen Scott1, Ms Kath Kerr2

1ThS- Social Work Services, Howrah, Australia, 2THS-Famliy Violence Counselling and Support Services, ,

Victims of Family Violence are high users of health services but are often not identified. This limits the capacity of health services to intervene and provide appropriate and effective health care. It can also lead to victims remaining isolated, being misdiagnosed and missed opportunities to prevent further injury or death to the woman and protection of children involved.

Hospital Emergency Departments  are crucial points in the health system for identifying and intervening early in Family Violence (also known as intimate partner violence).  Women use the ED as one of their primary health services when they are in a violent relationship, but are unlikely to disclose unless asked directly (Ramsden & Bonner, 2002).

Given the difficulties in identifying abused women within health services and the importance of identification in early intervention, the practice of routinely enquiring of all women about domestic violence has been widely advocated (Campbell, 2002).

The Family Violence Screening and Identification project aimed to improve the recognition and early intervention of family violence for patients attending the Emergency Department and the Assessment and Planning Unit of the Royal Hobart (RHH).


Biography:

Kath has worked in area of FV for 20 years primarily managing the Family Violence Counselling & Support Service. FVCSS provide immediate emotional support, risk & safety assessment, information on nature of FV, referrals & advocacy.The delivery of training on family violence has been a feature of Kath’s work history.

Gretchen Scott is the Clinical Lead Social Worker for WACS at RHH.She has worked for a number of years as a FV Trainer and is passionate about the role of the Health Service in identifying and responding to victims of FV.

Ambulance Tasmania attendances to falls related incidents: Commencement of a Tasmanian dataset

Mr John Cannell1, Mr Alex Wilson2

1Tasmanian Health Service North, Launceston, Australia, 2Ambulance Tasmania, Hobart, Australia

Whilst falls occur across the age spectrum, allied health staff are particularly involved in the minimization of harm and prevention of falls in the older population. Published literature reports that in the western world an average of 25% of over 60 year olds and 30% of over 65 year olds fall each year. One tenth of these falls result in people seeking assistance from a health professional.

Understanding the incidence of falls in older community dwelling Tasmanians is difficult. There are no published studies or reports. Whilst there are systems within healthcare settings to record and monitor the incidence there is no equivalent option for the community. As Ambulance Tasmania attends a proportion of community falls which require medical assistance and review, their clinical data provides insight into the incidence of injurious falls.

Tasmanian Paramedics record their assessment and client management in an electronic module called the Victorian Ambulance Clinical Information System (VACIS). This system is used in multiple states of Australia. Through application to Ambulance Tasmania, Tasmanian Health Services North has been able to access and analyse one year of de-identified case information. 10329 of the 72096 case notes for the 2016-17 financial year contained the words “fall” or “fell”.

Providing analysis and breakdown of these cases across the Tasmania will provide insight and assist service development to allied health professions. Rates by locality, region, age, transportation to hospital, are able to be accessed from the data. Using keyword searches, falls which involved sporting activities or modes of transport are able to be separated from mechanical or syncopal falls.

The incidence and consequences of falls in our ageing population is creating further pressure on our health system. Utilising the Ambulance Tasmania’s VACIS dataset will assist us to understand and plan for the health needs of our Tasmanian population.


Biography:

John is the clinical lead physiotherapist for rehabilitation at the LGH. He has a been an active member of hospital and regional falls committees for over 10 years. John, like many allied health professions, is trying to move to a more proactive model of falls prevention. This presentation showcases a new initiative to share information which is able to guide our future health care service development.

A trial of non-slip socks for reducing falls risk on an acute hospital ward

Miss Sophie Leworthy1

1Royal Hobart Hospital, Hobart, Australia

Background:  Evidence indicates the cost of inpatients falling and sustaining injury whilst in hospital is immense, both to the individual and to the health system. Typically the risk of falls is higher on wards that accommodate older people with complex conditions such as delirium and dementia; observations in the Royal Hobart Hospital Acute Older Persons Unit (AOPU) align with this.

Aim:  Non-slip socks were introduced for a 4 month trial in an attempt to reduce the risk of falling for patients admitted to this ward. The socks were offered to all patients and it was their choice to accept or decline the intervention after receiving information regarding their purpose.

Method:  Subjective and objective data, in the form of incident reports and pre-discharge surveys, were collected from patients over the 4 month trial period. In addition staff were surveyed at half way and the end of the trial for their feedback on adjustments required, their perception of the success of the socks in reducing patient falls risk, and how the intervention affected their workload. The socks used for the trial were specifically selected for their double sided grip and purchased from a medical supplier.

Results:  The data indicated a decrease in the number of falls recorded during the trial period, compared with the same period the previous year. Furthermore, all patients and staff viewed the socks as a positive intervention for reducing the risk of falls.

Conclusion:  Based on the results of this trial non-slip socks are now an intervention offered to every patient admitted to the AOPU to reduce their risk of falling.  The socks are also available for purchase from the auxiliary in the hospital canteen.


Biography:

Sophie is a senior Occupational Therapist who has been working at the Royal Hobart Hospital for 10 years. For the last 6 years she has been working on the Acute Older Persons Unit (AOPU). Sophie is about to finish her Master of Gerontology from Charles Sturt University, during which she completed a literature review on the use of non-slip socks in falls prevention.  This has led to a trial of non-slip socks on the AOPU.

Prospective associations of osteosarcopenia and osteodynapenia with incident fracture and mortality over 10 years in community-dwelling older adults

Mr Saliu Balogun1, Prof. Tania  Winzenberg1, Dr Karen  Wills1, Dr David  Scott2,3, Dr Michele  Callisaya1,2, Prof Graeme  Jones1, Dr Dawn  Aitken1

1Menzies Institute For Medical Research, University Of Tasmania, Hobart, Australia, 2Department of Medicine, School of Clinical Sciences at Monash Health, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia, 3Australian Institute for Musculoskeletal Science, Melbourne Medical School (Western Campus), the University of Melbourne, , St Albans, Australia

Aim: This study aims to examine whether low muscle mass (sarcopenia) or strength (dynapenia), in the presence of osteoporosis/osteopenia, increase fracture and mortality risk over 10 years in community-dwelling older adults.

Methods: Data for 1032 participants (52% women; mean age 62.9±7.4 years) studied at baseline, 2.5, 5 and 10 years (SD) were analysed. Mortality was ascertained from the death registry and fractures were self-reported. Muscle mass was assessed as appendicular lean mass (ALM) using dual energy X-ray absorptiometry, normalised to body mass index (BMI). Muscle strength was assessed as hand grip strength (HGS) using dynamometer. Osteosarcopenia and osteodynapenia were defined as the lowest 20% of the sex-specific distribution for muscle mass or strength respectively, and T-scores of the total femur and/or L1-L4 < –1.

Results: Incident fracture and mortality over 10 years were 17% and 15% respectively. Incident fracture was significantly higher among osteodynapenic (RR=2.07, 95% CI: 1.26–3.39) but not osteosarcopenic participants (RR 1.48, 95% CI: 0.83-2.64). In contrast, mortality was significantly higher among osteosarcopenic (RR=1.49, 95% CI: 1.01–2.21) but not osteodynapenic participants (RR=1.03, 95% CI: 0.68–1.57).

Conclusion: In the presence of osteoporosis/osteopenia, low muscle mass increase mortality risk whereas low muscle strength increase fracture risk. This finding demonstrates the significance of combined assessments of osteopenia/osteoporosis with muscle mass or strength in order to identify a subset of older people who are at a significantly higher risk of fracture and mortality respectively.


Biography:

Saliu Balogun is a Physiotherapist and a final year PhD candidate at the Menzies Institute for Medical Research, University of Tasmania. In 2012, he was awarded the prestigious British Commonwealth scholarship to study for his master’s degree in Gerontology at the Centre for Research on Ageing University of Southampton. Saliu completed his Bachelor of Physiotherapy degree at the College of Medicine, University of Lagos.

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