Clinical audit of the use of total contact casting for treatment of plantar foot ulcerations: A podiatry/plaster room joint initiative

Mr Joshua Palaya1, Mr Scott  Grieve2, Mr Barry  Zeitzen2

1Podiatry South, Hobart, Australia, 2Plaster Clinic/Physiotherapy Service, Hobart, Australia

Evidence-based practice indicates that a Total Contact Cast (TCC) or a non-removable knee high device is the ‘gold standard’ for offloading neuropathic plantar foot ulcers and for the management of Charcot Neuroarthropathy. The Podiatry Service along with the Plaster Room (Physiotherapy Service) has responded to this evidence by commencing a joint TCC clinic in October 2016. Prior to this the ‘gold standard’ of care was not available to patients in Southern Tasmania with barriers to providing this care identified as; the lack of skill or suitably trained staff, inconvenience to the patient, cost of consumables and preference for other sub-optimal treatment modalities. Since October 2016 the interdisciplinary clinic has enabled better access and care for patients, maximised the utilisation of existing skill sets, reduced cost and use of sub-optimal treatment options.

Following ethics approval by the Tasmanian Health and Medical Human Research Ethics Committee an ongoing audit has been developed to evaluate our hypothesis that patients undergoing weekly total contact casting are expected to have a reduction in time to heal and remain healed for the long term with minimal iatrogenic complications. The 3 main outcome measures explored are:

  1. Reduction in time to heal: Measured by the length of time the ulcer has been present versus the length of time it takes to heal in a total contact cast measured in weeks.
  2. Remaining healed: Measured by the number of weeks the patient remains healed at the same site of initial ulceration following cessation of total contact casting.
  3. Iatrogenic complications from a total contact cast such as formation of a new ulcer, abrasions, blistering, infection, ulcer deterioration, falls and amputation will be recorded on an ongoing basis for each patient.

This poster will present the outcomes of this ongoing innovative collaboration.

 


Biography:

Josh has a special interest in lower limb biomechanics and offloading of the high risk foot. He has developed this interest in his role as a Podiatrist in the THS but has also worked in rural/regional WA, Bangladesh and various locations in Southern Tasmania. During this time he has had good exposure to the complexities of managing the high risk foot in various settings and has applied this knowledge in leading the current collaboration with the plaster technicians to achieve better outcomes in this group of patients.

Cognitive outcomes and intervention attendance of Tasmanian preterm pre-schoolers

Mrs Sari O’Meagher1,2, Dr Kimberley  Norris2, Dr Nenagh Kemp2

1Tasmanian Health Service (RHH, Department of Psychology), Hobart, Australia, 2University of Tasmania, School of Medicine (Psychology), Hobart, Australia

Background

Children born preterm are at higher risk of having developmental and cognitive difficulties. Little is known if there are differences in cognitive outcomes, attendance rates in therapy or associated social and medical risks between preterm pre-school children from South, North and North-West Tasmania. It is important to identify if any groups of preterm children coming from different areas have worse outcomes than others and whether they have equal access to intervention and therapies. Identification of any inequities could enable action to ensure that all Tasmanian preterm pre-schoolers are appropriately supported prior to entering schooling.

 Method

184 children born preterm (<33 weeks gestation) in Tasmania during 2007-2009, and cared for at the Royal Hobart Hospital, were identified for this study. The parents of 141 (77%) children agreed to participate in the study. The preterm children were assessed by using cognitive assessment tools (WPPSI-III, NEPSY-II, Day-Night Stroop and Shape School Task) at the age of 4 years prior to starting kindergarten. Social and medical risk factors and attendance at the Early Childhood Services, speech therapy, occupational therapy and physiotherapy were recorded for the purpose of comparison.

 Results

There were no significant differences in cognitive outcomes between the preterm pre-schoolers from South, North and North-West Tasmania. Also, the social and medical risk factors were similar, apart from a shorter stay at the Royal Hobart Hospital for the children from Northern Tasmania. Nevertheless, there were regional differences in attendance rates in early intervention and allied health therapies.

 Conclusions

Tasmanian preterm pre-school children did not have significant differences in risk factors or cognitive outcomes based on their residential region, albeit their intervention attendance rates varied. Further studies investigating associations between educational and allied health intervention and outcomes are warranted.


Biography:

Sari O’Meagher works as a psychologist at the Royal Hobart Hospital paediatric services. She is completing her PhD at the University of Tasmania relating to cognitive outcomes of young preterm children.

Strong and steady community exercise program – to enhance strength, endurance and balance to decrease falls in the community

Mrs Annette Mooney1, Mrs Carmel  Illsley1, Mrs Simone  Edwards1, Ms Rhonda Passlow1, Mrs Linda Clark1

1Calvary Health Care Kogarah, Oatley, Australia

Clients of CCH (Calvary Community Health) are over 65 years and generally house bound or have poor access to their community and healthcare. The Strong and Steady program provides an opportunity to exercise in both the gym and pool with emphasis on strengthening and balance with the goal of improving general activity, daily function, standing balance, and to reduce falls.

Hydrotherapy has been provided as part of the CCH service for more than 20 years.  In this time little had changed and clients attended however, there was no review of patient outcomes or effect of the service.  The CCH Physio team undertook a period of review and initially sought to improve the hydrotherapy program by improving the assessment process and including outcome measures and satisfaction survey.

After consideration of best practice and the need for a land based exercise program the team utilised a collaborative approach to develop and implement a new model of care.  Based on a day rehabilitation unit approach, an exercise program was developed for both the gymnasium and pool. It includes cardiovascular, strength, range of movement and balance components and is suitable for the age of our client group.

The clients are provided with transport to ensure they are able to access the service. Assistance with transferring, dressing, and showering is provided if needed.  The clients are provided with sandwiches and a drink after the session and as part of this have time to socialise.

As attendance is billed as a half day hospital admission the program is able to fund the increases in staffing that are required to run it.  This includes staffing for the physiotherapy aide and some administration.

Strong and Steady is now an integral part of the CHCK service and has resulted in an increase in referrals from Local Health District.


Biography:

Team of Community Physiotherapists  with many years of combined experience who have a goal to maintain health and function in the elderly and also to prevent falls with the primary strategy of exercise . A collaborative team approach has seen the development of the Strong and Steady Exercise Program with positive and lasting functional outcomes.

Knowledge in the key of E (EPOCH, that is)

Ms Teresa Beck-Swindale1

1Buttfield Library, THS-NW, Burnie, Australia

Sometimes it feels that knowledge is locked away; that the best bits are unknowable, hidden, beyond reach.

Library staff are there to unlock that knowledge; to ferret, wrangle and ply that information so that it emerges from its fetters to be readily available to assist the Allied Health team in finding great health options for their clients.

Library Managers are Allied Health professionals too; striving to deliver quality information to enhance patient care.

We would like to share and promote new electronic resources added in 2017 for the benefit of the Allied Health sector in Tasmania.

This includes ClinicalKey delivering a wealth of material in e-books, journals, patient education and multimedia resources; specific AH sources include physiotherapy videos, pharmacology texts and images for rehabilitation exercises.

There are many new journals and e-books in full text on our revamped EPOCH site (Electronic Portal for Online Clinical Help) we would like to showcase, for example Food Science & Nutrition, Archives of Physiotherapy and Journal of Hand Therapy.

Specific databases for the allied health field such as  OT Seeker and PEDRo will be promoted as keys to answer individual reference inquiries.

Library staff will be available during the lunch break at the conference to undertake “on the spot” information inquiries, supplying answers then and there or taking away for follow up. The Library Services poster stall will have giveaways and visual demonstrations via laptop on information searching.

 


Biography:

Library Manager, Dr Richard Buttfield Library, North West Regional Hospital, Burnie for THS – NW for the past 5 years, delivering health information to all staff across the north west; working in collaboration with THS health library staff in Launceston and Hobart as well as UTAS.

Establishing a monitoring system in Tasmania to help identify inappropriate infant formula marketing

Caryn Batchelor1, Alison  Graham2, Julie Williams2

1Public Health Services, Department Of Health And Human Services, Launceston, Australia; 2Public Health Services, Department Of Health And Human Services, Hobart, Australia

Background: In an effort to protect breastfeeding and to establish and support appropriate infant and young child feeding practices, Australia adopted the Marketing of Infant Formulas: Manufacturers and Importers Agreement (MAIF Agreement) in 1992, based on the International Code of Marketing of Breast-Milk Substitutes (WHO Code).

Breastfeeding Coalition Tasmania formed over 20 years ago with the mission to work together to protect, promote and support breastfeeding in Tasmania. A key priority for the group is to identify and report marketing practices that have the potential to undermine breastfeeding.

The process for submitting complaints to the MAIF tribunal has been ad hoc. Six complaints were submitted over the past six years, with one upheld by the MAIF tribunal. This resulted in the company changing their infant formula labels.

Aim: To establish a consistent approach to monitoring and reporting inappropriate infant formula marketing practices in Tasmania.

Results: Data collection and analysis tools were developed and tested. Data was collected from 88 infant formula labels, 27 company websites, four social media sites, one billboard, and seven retail outlets.  Of the 88 infant formula products, 53 (60%) are covered by the MAIF Agreement. All data were found to contain promotional material potentially in breach of the WHO Code and possibly the MAIF Agreement. Twenty-nine complaints were completed for submission to the Department of Health.  Further complaints are yet to be finalised.

Conclusion: Public Health Services will undertake annual monitoring and analysis of infant formula marketing practices in Tasmania. Establishing a consistent monitoring system in Tasmania will help build evidence of infant formula marketing practices that are inconsistent with the MAIF Agreement and WHO Code. This evidence is required to advocate for a review of the MAIF Agreement to strengthen Australia’s stance on infant formula marketing and protect breastfeeding from commercial pressures and misleading information.


Biography:

Caryn is an Accredited Practising Dietitian working in the Health Improvement Unit of Public Health Services. Caryn has a background in clinical dietetics, having worked in public and private hospitals and private practice. Since joining the public health team just over six months ago, Caryn has developed a keen interest in infant and early childhood nutrition, particularly in the feeding relationship and body image. Caryn is pleased to be here today to share with you the exciting new system Tasmanian community dietitians, in partnership with Breastfeeding Coalition Tasmania, are implementing to protect breastfeeding from commercial pressures and misleading information.

Resilience – Stress Proof Your Brain

Facilitator: Robynne Rankine

Imagine being less stressed, more focused, and happier every day of your life.
If given the choice, we would all choose to be less stressed, to feel happier, and to experience a more optimal state of wellbeing. So why are these outcomes so hard to achieve? The answer is quite simple. No one has taught us how. It turns out that just as you train your body for fitness, you can train your mind for wellbeing.

In this workshop we explore the secrets to creating a life with more energy, vitality and clarity every day, and the skills to bounce back and thrive when things don’t go according to plan? While we can’t avoid challenges in the workplace, what we can do is build our own resilience, our team resilience, we can learn from the experience, and be more successful and resourceful in the future. This workshop teaches practices proven to stress-proof the brain by mastering your emotional responses to stress using mindfulness and neuroplasticity that anyone can integrate into their daily lives.

Ikigai: profession, passion, mission, vocation

Rosalie Martin

The Japanese word ikigai refers to the combination of profession, passion, mission and vocation – what you can be paid for, what you are good at, what you love, and what the world needs. Ikigai has been the driver of the Just Sentences and Just Time projects at Risdon Prison, as well as the several other community-based projects which Chatter Matters Tasmania has initiated and conducted. In this session, Chatter Matters’ founder, speech pathologist and criminologist Rosie Martin, will share her journey and the insights and learnings arising from it.


Biography:

Rosalie is a criminologist, an accredited facilitator with the Center for Courage & Renewal, and a clinical speech pathologist with more than 30 years experience.

Long lamenting inequity and inadequacy in services to support those with impaired communication and literacy, in 2013 Rosalie founded a charity, Chatter Matters Tasmania (soon to rebrand as language. life.) and began the Just Sentences literacy pilot project and Just Time parent-child attachment programs in Tasmania’s Risdon Prison. To gain better context for bringing speech pathology interventions into prison settings, Rosalie completed Criminology Honours in 2016 and is now preparing to undertake a PhD in Criminology.

Rosalie was awarded 2017 Tasmanian Australian of the Year for the work she began at the prison. She is grateful for the platform this recognition has afforded her to speak, raise awareness, educate and champion the cause of literacy for all; and to promote the value of kind communication in evidence-based service delivery.

More than anything else, Rosalie is aware that nothing worth doing is ever done alone – she has enormous gratitude for the support, direction and opportunity she has received from family, friends and many colleagues.

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