Improving patient outcomes through the implementation of a person-centred leg ulcer pathway.

OBJECTIVE: To develop a holistic pathway for leg ulcer assessment and management, implemented within a local community organisation. The primary aim for this pathway was to reduce time-to-healing. METHOD: A leg ulcer pathway was designed to be used in all care settings to support continuity, and contains quality of life (QoL) assessment tools, a treatment algorithm, guidance for use, a leg ulcer assessment form, and a wound treatment chart. RESULTS: Data analysis, carried out 12 months after implementation, compared pre- and post-averages for ulcer time-to-healing: 123.7 days (median: 84 days), n=46 pre-implementation, versus 69.1 days (median: 46 days), n=30 post-implementation, respectively, which demonstrated a minimum 44% reduction in time. Cost saving analysis demonstrated a minimum cost reduction of 45% in nursing time. CONCLUSION: The implementation of a structured, person-centred leg ulcer pathway has provided many benefits to patients, clinicians and the hospital and community trust. Enhancing correct dressing product placement by ensuring the right dressing is used at the right time, in tandem with the correct compression regime, improved healing outcomes. The patient journey has become more streamlined providing the best chance to achieve full healing quickly.

Gender, intoxication and the developing brain: Problematisations of drinking among young adults in Australian alcohol policy.

In this article, we draw on recent scholarly work in the poststructuralist analysis of policy to consider how policy itself functions as a key site in the constitution of alcohol 'problems', and the political implications of these problematisations. We do this by examining Australian alcohol policy as it relates to young adults (18-24 years old). Our critical analysis focuses on three national alcohol policies (1990, 2001 and 2006) and two Victorian state alcohol policies (2008 and 2013), which together span a 25-year period. We argue that Australian alcohol policies have conspicuously ignored young adult men, despite their ongoing over-representation in the statistical 'evidence base' on alcohol-related harm, while increasingly problematising alcohol consumption amongst other population subgroups. We also identify the development of a new problem representation in Australian alcohol policy, that of 'intoxication' as the leading cause of alcohol-related harm and rising hospital admissions, and argue that changes in the classification and diagnosis of intoxication may have contributed to its prioritisation and problematisation in alcohol policy at the expense of other forms of harm. Finally, we draw attention to how preliminary and inconclusive research on the purported association between binge drinking and brain development in those under 25 years old has been mobilised prematurely to support calls to increase the legal purchasing age from 18 to 21 years. Our critical analysis of the treatment of these three issues - gender, intoxication, and brain development - is intended to highlight the ways in which policy functions as a key site in the constitution of alcohol 'problems'.

An observational evaluation of a new foam adhesive dressing.

Following the work of Winter demonstrating the benefits of moist wound healing, there has been a constant stream of wound care products launched into the market to support this concept. This article will describe the findings of an observational evaluation to observe, document and analyse the clinical effectiveness of a new foam adhesive dressing, UrgoTul® Absorb Border (Urgo Medical). The main objective of the evaluation was to define the parameters to allow data capture that would demonstrate the clinical effectiveness of the dressing. Parameters studied and analysed included atraumatic pain-free dressing changes; ease of dressing application; comfort and conformability; exudate management; ability of the dressing to stay in place; and peri-wound skin management. A total of 25 patients with wounds suitable to be dressed using the evaluation product were recruited following a full documented wound assessment by the tissue viability nurse. Participants were selected across the organisation from acute hospital wards and outpatient departments, care homes, wound care clinics and the participants' own homes. Digital photography was used to demonstrate improvement or deterioration of the wound bed and surrounding skin, and images were assessed by non-participating clinicians to confirm documented observations made within the evaluation. The dressing was found to be clinically effective in both chronic and acute wound types, and had an excellent level of participant acceptance.

The effects of random breath testing and lowering the minimum legal drinking age on traffic fatalities in Australian states.

OBJECTIVE: This study aims to apply time series analysis techniques to examine the effects of random breath testing (RBT) on three age-specific traffic fatalities in four Australian states while considering the effects of lowering the minimum legal drinking age (MLDA). METHODS: Long-term time series of age-specific traffic crash deaths in four Australian states were used to analyse the impact of RBT implementation while considering the population growth, increase in motor vehicle registrations and the effects of lowering the MLDA. RESULTS: The results of intervention analysis indicate that RBT has substantially reduced traffic fatalities in all four states since it was introduced, particularly among the 17-year-olds to 20-year-olds and 21-year-olds to 30-year-olds. New South Wales received the biggest total net effect from RBT implementation on traffic deaths. By contrast, RBT produced only a modest reduction in traffic fatalities among 30-year-olds to 39-year-olds. Lowering the MLDA was associated with significant increases in traffic fatalities among 17-year-olds to 39-year-olds in Queensland and Western Australia. CONCLUSIONS: Controlling for the declining trend in traffic fatalities, the effects of changes in the MLDA law, the implementation of RBT has generated a huge effect, preventing an estimated 5279 traffic crash deaths in four Australian states. This provides further evidence that the implementation of RBT and increases in the MLDA are effective policies for reducing traffic fatalities.

Geographies of exclusion: street drinking, gentrification and contests over public space.

BACKGROUND: Laws prohibiting the consumption of alcohol on the street have proliferated in Australia over the past 15 years. It is no coincidence that these laws have been implemented at the same time that significant advancements in urban renewal and gentrification have occurred in metropolitan cities. METHODS: This paper draws on observational research as well as interviews and/or focus groups with street drinkers, residents and service providers (police, council workers, health workers and traders). RESULTS: Environmental economic and social changes that have occurred through gentrification are central to ongoing debates around the use of public space in urban areas. CONCLUSION: The geographical exclusion of street drinkers that has occurred as a result of these laws warrants the consideration of a more socially responsible strategy than the current legislative approach.