Mapping Australia's COVID-19 quarantine cohort journeys.

BACKGROUND: Australia rapidly developed COVID-19 quarantine programs to reduce the adverse outcomes of a novel pathogen imported by visitors and returned travellers. Different quarantine pathways were utilised over the pandemic, yet no definitive cohort map exists to guide future preparedness. We created a whole-of-system cohort journey map of Australian quarantine cohorts to inform future pandemic preparedness activities. METHODS: Australian parliamentary websites and Google were searched for publicly available grey literature from 2019 to 2023. Data about quarantine cohorts, pandemic plans and documents, journey activities, viral escape events, and quarantine recommendations were extracted and plotted to produce a whole-of-system cohort journey map. RESULTS: The system mapping process identified 22 distinct quarantine cohort journeys during COVID-19, yet few of the cohorts were mentioned in pandemic and emergency plans. Viral escape events were documented 27 times, and COVID-19 reviews and inquiries produced 282 quarantine-specific recommendations. Cohorts included international and domestic travellers who experienced home, hotel, and facility quarantine iterations. Other cohorts, such as humanitarian evacuations, diplomats, airline crews, community close contacts, and people experiencing homelessness, had distinctive quarantine journeys. CONCLUSIONS: This whole-of-system quarantine cohort map furthers the case for governments and policymakers to update pandemic plans to include the 22 identified cohorts and test plans through pandemic exercises. Recommendations from inquiries should be acquitted to reduce the risk of viral escape and to strengthen national preparedness if quarantine systems are required in future pandemic responses.

Post implementation quarantine recommendations that support preparedness: A systematic review and quarantine implementation capability framework.

BACKGROUND: During COVID-19, countries utilised various quarantine systems to achieve specific outcomes. At different stages and durations, voluntary and mandatory quarantine occurred in homes, hotels and facilities based on local and national elimination strategies. Countries are incorporating quarantine lessons from COVID-19 into revising pandemic plans as part of the World Health Organization's Preparedness and Resilience for Emerging Threats (PRET) activities. This review aimed to amalgamate quarantine post implementation recommendations from a whole-of-system perspective. METHODS: This review utilised MEDLINE, Embase, CINAHL, APA, and PsycINFO. To capture all pandemics, no date restriction was applied. Recommendations were synthesised and inductively grouped into quarantine capability categories. This review was registered in PROSPERO (CRD42023420765). RESULTS: A total of 449 published articles were screened, with 51 articles included and 156 recommendations extracted. Recommendations were grouped into 15 quarantine capability categories, comprising governance, preparation, infection prevention and control, ventilation, compliance, data, information and technology, safety-quality-risk, communication, healthcare model, home quarantine, hotel quarantine, facility quarantine, workforce, and resident considerations. The capability categories were further consolidated into strategic, structural, and operational domains to support the whole-of-system perspective. CONCLUSION: The quarantine implementation capability framework generated provides comprehensive and deeper insights into the essential capabilities required for quarantine systems to support governments in PRET activities, including reviewing and revising pandemic plans and developing quarantine preparedness exercises.

Forecasting pandemic quarantine in New Zealand and Australia: A scoping review of quarantine characteristics and capabilities within preparedness plans and pandemic exercise reports from 2002 to 2019.

BACKGROUND: This scoping review aims to identify and critically review quarantine preparedness in New Zealand and Australia pre-COVID-19 by categorising, comparing, and evaluating quarantine information contained within pandemic plans and exercises from both countries. METHODS: Parliamentary websites, including Archives New Zealand, ParlInfo and Google Scholar, were searched for publicly available plans and exercise reports from 2002 to 2019. Data were extracted from documents meeting the inclusion criteria and analysed using directive content analysis based on the Australian Disaster Preparedness Framework categories. This scoping review followed the Joanna Briggs Institute methodology for scoping reviews, which guided the data extraction, analysis, and presentation of results. RESULTS: A total of 16 documents mentioned quarantine and were included in this scoping review. The emphasis and level of detail regarding quarantine characteristics and capabilities varied between New Zealand's five documents (one plan and four exercise reports) and Australia's 11 documents (one Influenza pandemic plan, eight state plans and two exercise reports). New Zealand's plan forecasted the need for both voluntary quarantine at home and involuntary quarantine in facilities for incoming travellers, whilst the Australian Influenza pandemic plan and state plans primarily considered voluntary quarantine within private residences. Capability gaps identified during exercises were not consistently incorporated into revised plans. Some government documents containing information on quarantine may not be publicly available, limiting the available evidence for this review. CONCLUSION: This scoping review highlights the need to incorporate a range of possible quarantine options into plans and preparation activities to test and identify gaps in government and responsible agencies' capabilities. Pandemic preparedness will be strengthened by incorporating quarantine scale and duration variables into exercise scenarios.

Loneliness in older age: What is it, why is it happening and what should we do about it in Australia?

Loneliness is an important health issue facing older people due to its association with poor quality of life and poor health outcomes. This paper aimed to clarify key issues around loneliness among older adults and draw attention to innovative programs and the translation of emerging research into practice. Loneliness is a mismatch between a person's actual and desired social connections, experienced as negative emotions. Older adults are vulnerable to loneliness because of changes associated with ageing. As such, identifying as older is often seen as a burden, negatively impacting self-esteem, sense of purpose and relevance, culminating in loneliness. Interventions combatting loneliness can target individuals, relationships, communities or societies. We advocate for an intersectoral approach to support healthy ageing and reduce loneliness. This will require further research to evaluate new approaches with loneliness as the primary outcome, and additional funding to translate evidence into an integrated multi-level approach to addressing loneliness.

Developing and evaluating Robocare; an innovative, nurse-led robotic prostatectomy care pathway.

PURPOSE: A Robotic Prostatectomy Care Pathway ("Robocare"), aiming to prepare men for robotic-assisted radical prostatectomy (RARP) and manage side-effects and long-term follow-up in a multidisciplinary fashion was established. The pathway enhances patient care by providing adequate information and support and optimizes efficiency by reducing length of stay and minimizing hospital visits. Our study assesses the pathway for patient satisfaction, co-ordination of care between disciplines, length of stay and readmission rates. METHOD: We analysed our database of all patients undergoing RARP with Robocare between July 2012 and December 2013 at Peter MacCallum Cancer Centre, Australia (PMCC). Compliance, Length of Stay and Postoperative Course were analysed. Patient satisfaction was assessed. RESULTS: Overall 124 patients underwent RARP with 105 (85%) being discharged day 1 post-op (mean 1.3 days). Post-operative support phone calls were received by >95% of patients. Thereafter, 74 patients (60%) were followed in the long-term follow-up phone clinic. Twenty-nine complications were identified of which 19 (66%) were resolved by the nurse specialist. Eighteen patients had psychologist, 44 sexual health and 44 physiotherapist referral. Patient satisfaction in 74 (60%) returned surveys revealed 71 (96%) being well/very well supported. CONCLUSIONS: The Robocare pathway is safe with high patient satisfaction. It contributes to reducing post-operative length of stay and readmission rates as well as the outpatient follow-up. A true multidisciplinary approach that is nurse-led likely improves care and outcomes for RARP patients and may lower impact on hospital resources.

HIV is rare among low-risk heterosexual men and significant potential savings could occur through phone results.

BACKGROUND: The legislation in Victoria requires HIV-positive results to be given in person by an accredited health professional. Many sexual health clinics require all men to receive HIV results in person. Our aim was to determine the proportion of low-risk heterosexual men at a sexual health centre who tested HIV-positive. METHODS: The electronic data on all HIV tests performed between 2002 and 2008 on heterosexual men at the Melbourne Sexual Health Centre (MSHC) was reviewed. The individual client files of all heterosexual men who tested HIV-positive were reviewed to determine their risks for HIV at the time that the HIV test was ordered. RESULTS: Over the 6 years there were 33 681 HIV tests performed on men, of which 17 958 tests were for heterosexual men. From these heterosexual men, nine tested positive for the first time at MSHC (0.05%, 95% confidence interval (CI): 0.01%, 0.09%). These nine cases included six men who had had sex with a female partner from the following countries: Thailand, Cambodia, China, East Timor, Botswana and South Africa. Two men had injected drugs and one had a HIV-positive female partner. Of the 17 958 test results for heterosexual males, 14 902 (83% 95% CI: 84%, 86%) test results were for men who did not have a history of intravenous drug use or had sexual contact overseas. Of these 14 902 low-risk men, none tested positive (0%, 95% CI: 0, 0.00025). CONCLUSION: Asking the 83% of heterosexual men who have an extremely low risk of HIV to return in person for their results is expensive for sexual health clinics and inconvenient for clients. We have changed our policy to permit heterosexual men without risk factors to obtain their HIV-negative results by phone.

Men who have sex with men prefer rapid testing for syphilis and may test more frequently using it.

Most Australian men who have sex with men who underwent rapid testing for syphilis using the Determine Syphilis TP immunoassay indicated a preference for rapid testing over conventional serology. Most also indicated that they would test for syphilis more frequently if rapid syphilis testing was available in a clinic setting.