The Medical journal of Australia
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Comparative Study
Association between diabetes and coronary heart disease in Aboriginal people: are women disadvantaged?
To determine the incidence rate of coronary heart disease (CHD) in Australian Aboriginal people with type 2 diabetes, and to compare the impact of diabetes on CHD risk in Aboriginal women and men. ⋯ Aboriginal women with diabetes experienced a significantly higher risk of CHD than women without diabetes. Although the difference was not statistically significant, women with diabetes had a higher CHD risk than men with diabetes.
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Towards a Safer Culture (TASC) aims to provide a safer culture in hospital departments by introducing clinical pathways for the management of patients with acute coronary syndromes or stroke. Specific clinical pathways have been implemented for patients with different levels of risk to guide the most appropriate evidence-based medical care for each patient. Pathways facilitate continuity of care across different clinical departments by identifying gaps in care, and clarifying tasks and responsibilities. ⋯ A comprehensive range of educational/training strategies is used to facilitate multidisciplinary teamwork and promote clinical leadership. Phase 1 of TASC was successfully piloted at four hospitals in New South Wales, Victoria and Queensland. TASC is currently being rolled out to 29 hospitals in NSW and three hospitals in Western Australia.
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Comparative Study
Burden of disease and injury in Aboriginal and non-Aboriginal populations in the Northern Territory.
To quantify the burden of disease and injury for the Aboriginal and non-Aboriginal populations in the Northern Territory. ⋯ A comprehensive assessment of fatal and non-fatal conditions is important in describing differentials in health status of the NT population. Our study provides comparative data to identify health priorities and facilitate a more equitable distribution of health funding.
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The concept of the Clinical Support Systems Program (CSSP) was transformed from an idea into reality through the efforts of representatives of the Australian Government Department of Health and Ageing and the Royal Australasian College of Physicians. This collaboration involved developing common ground between two different perspectives: those of the funder/policy/administrative sector and those of the clinical practice world. Bridging these differences to establish an agreed approach to moving forward was a lengthy and difficult process. ⋯ Compromise, persistence and commitment to the end-goal by the parties involved were important features in building and maintaining the momentum of the change process. Many of the difficulties experienced could be traced to differences in decision-making processes between the clinical and the administrative paradigms. Knowledge brokers can assist in bridging the different languages and perspectives of the groups involved.
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As part of the Clinical Support Systems Program, the Monash University Consortium conducted a project to identify factors influencing the implementation of clinical evidence into routine hospital practice, Australia. Training was required in the process of clinical practice improvement (CPI) and the nature of evidence. One of the most helpful instruments for change was to point to active models of quality assurance as exemplars. ⋯ CPI requires rapid feedback on the effectiveness of the implementation. Access to this information and the confluence of management skill, an ability to translate research evidence into routine clinical behaviour and an understanding of the process of quality assurance are central. Effective CPI is only possible when the larger hospital administrative culture is committed to providing the necessary resources.