Latest Australian research

Pawlik O, Cowan T, Miller A.

Abstract: Generalised Bullous Fixed Drug Eruption (GBFDE) is a subtype of Fixed Drug Eruption (FDE) characterised by the development of generalised blisters on the background of dusky macules. There is no gold standard treatment, but the condition is conventionally managed with supportive care, topical and oral steroids and occasionally ciclosporin. We describe the case of a 75-year-old female with GBFDE, who demonstrated a rapid halt in disease progression and re-epithelialisation following a single dose of etanercept. This case highlights the potential role of etanercept in the management of GBFDE.

Plazina J, Melville M, Collie LA, Cooke L, August D. 

Background: Newborn infants represent a significant percentage of childhood deaths (>60%) with over 90% of newborn end-of-life care taking place in an acute hospital setting. This is in direct contrast to adults and children where specialised hospital or hospice care is used during their palliative care experience. To support family choice, a neonatal retrieval service developed a new model of care to transfer babies from a hospital to a hospice, a hospital closer to home or a private residence for palliative care while being cuddled by a parent.

Aim: Identify and evaluate (i) service workflows, (ii) clinical characteristics of babies, (iii) safe and effective experiences, (iv) processes required and (v) personnel for kangaroo cuddle transport for end-of-life care.

Study design: Service evaluation utilising the Plan-Do-Study-Act (PDSA) cycle with outcomes grouped in five pragmatic domains: (i) workflow establishment, (ii) service population (clinical characteristics), (iii) safe and effective experiences, (iv) process and equipment and (v) personnel. Safety measures were assessed with individual PDSA cycles after each transfer, including referring and receiving service acceptability. Outcomes were reported in descriptive frequency.

Results: Of 21 cases, 13 families elected to cuddle for transfer. Most neonates were term gestation (n = 9, 69%) and were greater than 1200 g (n = 13, 100%). Care provided included Paediatric Acute Resuscitation Plans (100%), mechanical ventilation (n = 7, 54%), oxygen supplementation (n = 4, 31%) and subcutaneous vascular access devices (n = 9, 69%). No adverse events occurred. Qualitative staff feedback was universally positive. Median preparation time was 0.5 h (range: 0.25-1.4), and transport time was 4 h (range: 2.75-12).

Conclusion: Babies being transferred for palliative care can be safely managed while receiving kangaroo cuddle, with the support of an experienced neonatal transfer team.

Relevance to clinical practice: This model of transport demonstrates an effective and meaningful additional service for neonatal patients requiring end-of-life care. Further evaluation is required for more preterm neonates, as transport and service requirements may be increasingly complex for this population.

Reymond L, Cooper K, Taylor G, Tait P, Aylmer K, Christie L, et al.

Background: Australians with life-limiting conditions can, with appropriate support, have a home death, if that is their choice. General practitioners (GPs) are essential for coordinating care and managing symptoms. Necessary medicines must be quickly available to provide responsive symptom management in the terminal phase. GPs can facilitate prompt availability of medicines by working collaboratively with pharmacists who have a shared understanding of the required medicines.

Objective: This article explains the development of, and provides information about, the National Core Community Palliative Care Medicines List.

Discussion: A group of healthcare professionals with community palliative care expertise (Expert Group) compared the medicines to manage terminal phase symptoms against a set of criteria, choosing four core medicines based on their ability to manage symptoms, cost and ease of use. Creating a standardised National Core Community Palliative Care Medicines List supports clinical communication by providing an accepted baseline for symptom management; however, it should not replace communication between prescribers and pharmacists; rather, it should support collaborative practices.

Zhai J, Mooney C, Hamilton O, Vesty G, Millar R, Runacres F, et al. 

Aim: To describe patient outcomes for patients at high risk of mortality (with a prognosis of three months or less to live) where a Palliative Care Nurse Consultant (PCNC) was embedded in a General Medicine team. To explore patients and/or their carers feedback and allied health, nursing professionals' perspectives on integrating a palliative care approach in the General Medicine ward.

Design: Prospective exploratory study.

Methods: SQUIRE reporting guidelines was adopted for the study reporting. This study was conducted over six weeks in a general medicine ward at Monash Medical Centre in Melbourne, Australia. Participants were 20 patients aged > 65 years with non-malignant, chronic conditions at high risk of mortality within three months and had 18 nursing and allied health professionals involved in their care. Quantitative data were analysed descriptively and qualitative survey data were analysed thematically.

Results: Twenty patients participated, with an average age of 87 years. 55% spoke a language other than English. PCNC interventions, focused on care coordination and family liaison, were found to facilitate timely referrals to other support services, improve communication and better address end-of-life care needs. Healthcare professionals recognised the benefits of PCNC involvement; however, a key qualitative theme was staff reluctance to raise palliative care needs due to perceived role boundaries and limited confidence. While PCNC presence improved communication and advocacy, barriers included time constraints and patient/family resistance.

Conclusion: Embedding a PCNC in a general medicine team appears to enhance care coordination and support timely palliative care integration. Addressing barriers and optimising workflow can improve patient, carer and clinician experience as well as improve resource utilisation.

Implications for the profession and/ or patient care: The model has the potential to enhance patient-centred care and clinician support in acute general medicine settings.

Impact: The research will have an impact on acute care settings, particularly general medicine units, by informing models of integrated palliative care for patients with complex needs and enhancing staff capability and confidence in providing timely, person-centred care.

Patient or public contribution: Patients or members of the public were not involved in the design, conduct, analysis or manuscript preparation of this study. The project was a prospective observational study with limited scope and resources, which did not include a formal patient or public involvement component.

Lamba G, Vellar K, Burgess CP, La Brooy C, Komesaroff PA.

Abstract: Voluntary assisted dying (VAD) legislation has now been passed in all Australian jurisdictions, except for the Northern Territory. The Voluntary Assisted Dying Independent Expert Advisory Panel led public consultations in the NT to inform development of NT VAD legislation, submitting their report to the Chief Minister in July 2024, which has been publicly released. This perspective article reflects on the VAD implementation challenges highlighted in this public report. We discuss the unique demographics of the NT, including a significant Aboriginal population living in remote areas coupled with a high burden of chronic disease, which poses difficulties for equitable access to end-of-life services (respecting NT cultural protocols, “First Nations” in this perspective article are referred to as “Aboriginal peoples”, which is inclusive of Torres Strait Islanders). “Cultural safety” is critical for Aboriginal peoples but application is contextual. Telehealth, which may help increase access, also presents challenges.