Biomedical subjects

Simon Stewart

Publications and source records attributed to Simon Stewart.

57 records · Page 4Linked to original sources

PubMedDate not supplied

Seasonal variation in AF-related admissions to a coronary care unit in a "hot" climate: fact or fiction?

BACKGROUND: Seasonal variations in atrial fibrillation (AF)-related morbidity and mortality have been demonstrated in "cold" northern European climates, but there are few data describing such a phenomenon in a "hot" climate. RESEARCH OBJECTIVE: To examine the pattern of AF-related admissions to a coronary care unit (CCU) in South Australia operating within a Mediterranean climate, and to determine potential differences according to mean daily temperatures. PATIENT COHORT AND METHODS: A total of 144 admissions to the CCU during the 30 hottest and coldest days (60 days in total) during the calendar year 2001 were analyzed in respect to the absolute number of admissions and the profile of those admitted during "hot" and "cold" days. RESULTS: Overall, there were significantly more admissions to the CCU on "cold" as opposed to "hot" days (90 vs 54 patients in 30 days, P < or = .001). Of the 24 patients found to be in AF on presentation to hospital, 18 (75%) were admitted on cold days (P < .05). Alternatively, during "hot" days, patients were more likely to be diagnosed with unstable angina rather than acute myocardial infarction (46% vs 30%, P = .07) with proportionately fewer patients in AF at the time (11% vs 20%, P = NS). CONCLUSIONS: These preliminary data suggest that the phenomenon of seasonal variations in AF-related morbidity extend beyond colder climates to hotter climates with sufficiently large relative (as opposed to absolute) changes in ambient temperatures during the year.

Aged↗

PubMedDate not supplied

Rationale and design of the National Benchmarking and Evidence-based National Clinical Guidelines for Chronic Heart Failure Management Programs Study.

OBJECTIVES: The National Benchmarks and Evidence-Based National Clinical Guidelines for Heart Failure Management Programs Study is a national, multicenter study designed to determine the nature, range, and effect of interventions applied by chronic heart failure management programs (CHF-MPs) throughout Australia on patient outcomes. Its primary objective is to use these data to develop national benchmarks and evidence-based clinical guidelines and optimize their cost-effective application by reducing quality and outcome variability. DATA SOURCES/STUDY SETTING: Primary data will be collected from CHF-MP coordinators and CHF patients enrolled in these programs on a national basis. Secondary outcome data will be collected from a national morbidity record and from patients' medical records. STUDY DESIGN: Stage I of the study involves a prospective clinical audit of all CHF-MPs throughout Australia (n = 45) to determine the extent of variability in programs currently. Stage II is a prospective cross-sectional survey design enrolling 1,500 patients (average of 40 patients per program) to firstly determine the typical profile of patients being managed via a CHF-MP in Australia and, secondly, the subsequent morbidity and mortality during the 6-month follow-up. Outcome data will be subject to multivariate analysis to determine the key components of care in this regard. All study data will be then examined in the final stage of the study (III) to develop national benchmarks for the application and auditing of CHF-MPs in Australia. CONCLUSION: Variability in patient outcomes is a product of heterogeneity among CHF-MPs. The development of national benchmarks will minimize such heterogeneity and will provide a greater level of evidence for their cost-effective application.

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PubMedDate not supplied

Nursing sans frontières: a three year case study of multi-state registration to support nursing practice using information technology.

OBJECTIVE: To highlight the registration issues for nurses who wish to practice nationally, particularly those practicing within the telehealth sector. DESIGN: As part of a national clinical research study, applications were made to every state and territory for mutual recognition of nursing registration and fee waiver for telenursing cross border practice for a period of three years. These processes are described using a case study approach. OUTCOME: The aim of this case study was to achieve registration in every state and territory of Australia without paying multiple fees by using mutual recognition provisions and the cross-border fee waiver policy of the nurse regulatory authorities in order to practice telenursing. RESULTS: Mutual recognition and fee waiver for cross-border practice was granted unconditionally in two states: Victoria (Vic) and Tasmania (Tas), and one territory: the Northern Territory (NT). The remainder of the Australian states and territories would only grant temporary registration for the period of the project or not at all, due to policy restrictions or nurse regulatory authority (NRA) Board decisions. As a consequence of gaining fee waiver the annual cost of registration was a maximum of dollars 145 per annum as opposed to the potential dollars 959 for initial registration and dollars 625 for annual renewal. CONCLUSIONS: Having eight individual nurses Acts and NRAs for a population of 265,000 nurses would clearly indicate a case for over regulation in this country. The structure of regulation of nursing in Australia is a barrier to the changing and evolving role of nurses in the 21st century and a significant factor when considering workforce planning.

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