Canterbury Hospital

Abstract CSR efforts can increase profitability and market value through improved company reputation, competitive position, customer behavior, and CS. CSR initiatives can increase profitability and market value by enhancing corporate reputation, competitive positioning, customer behavior, and customer service. This study looks into the impact of CSR on corporate profitability (CP). It also looks at the interaction between CSR and CP via the prism of customer loyalty (CL). It explores the link between CSR and CP, with customer satisfaction (CS) acting as a mediator. Primary data were gathered from 457 selected professionals from Indian SMEs, including executives, managers, and specialists. They gathered the data using a non‐probability snowball sampling method. The framework was tested using a PLS‐SEM technique. As a consequence, the study discovered that corporate social responsibility (CSR) and its linked areas, such as economics, law, and charity, improved business profitability. It also found an association.

Anterior cruciate ligament (ACL) injury account for the majority of sport related knee ligament injuries and ACL reconstruction surgery is one of the most performed operations in the young adult population. Various graft types have been used to reconstruct the ACL, however there is no consensus on the best option. Concerns about quality and size of the graft and its effects on success of the reconstruction remain. Synthetic grafts have also been used for a long time as a substitute or to augment biological grafts however, concerns about early failure and particle related synovitis have limited their intra-articular use. The most common synthetic graft option still in use is the Ligament Augmentation and Reconstruction System (LARS). The study is a case controlled retrospective comparison of 102 consecutive cases reporting 8-11 year results in relation to clinical outcomes revision rates and synovitis of ACL reconstruction surgery using LARS synthetic grafts as an augment when compared with hamstring graft alone. The study found a mean follow up was 9 years and one month (8-11 years) and revision rate was 5.7% for the LARS augmented group and 12.5% for the Hamstring group, but not significantly different, odds ratio 0.4 (C.I: 0.1179-1.555, p=0.255). LARS augmented autograft ACL reconstruction had similar results at 8-11 years when compared to autograft only reconstructions. No synovitis was noted in either group. LARS ensures an appropriately sized graft, is safe and not associated with synovitis in our cohort at 8-11 year follow up.

IntroductionChronic kidney disease (CKD) causes significant morbidity and mortality. Medical therapies can reduce the progression of disease by up to 50%. CKD is undiagnosed in the majority of people who have it, resulting in undertreatment. CKD Stewardship (CKD-S) aims to identify hospital inpatients with undiagnosed mid-stage to late-stage CKD with the goal of facilitating diagnosis and initiating guideline-based therapies.Methods and analysisThis prospective, multicentre, cohort study compares two models of care, CKD-S and standard care, for identification and management of CKD, across six public hospitals in metropolitan Sydney, Australia. CKD-S entails active case finding using the electronic medical record, with nephrologist outreach to admitting teams and kidney nurse provided patient education. Adult inpatients with an admission estimated glomerular filtration rate (eGFR)<45 mL/min/1.73 m2 and not known to a nephrologist will be eligible, excluding those with short life expectancy or advanced age (>80 years). Participants will be enrolled between 1 March 2024 and 1 March 2025. Baseline and demographic data will be collected after discharge from the hospital. Participants will be followed up 12 months after discharge using Pharmaceutical Benefits Schedule and Medical Benefits Schedule data, linked via the Australian Institute of Health and Welfare Hub. We will report the proportion of all adults admitted to the hospital who are not already known to a nephrologist, in which a diagnosis of stage 3b–5 CKD is recognised by the CKD-S intervention team, compared with standard care. We will then compare the proportion in each cohort who have an eGFR or urine albumin:creatinine ratio measured, are referred to a nephrologist, and are prescribed guideline-directed therapies over the 12 months following discharge from the hospital.Ethics and disseminationThe study has ethics approval from the Sydney Local Health District’s Ethics Committee (Concord Hospital Zone). The results of the CKD-S study will be published in peer-reviewed journals and presented at academic conferences.Trial registration numberACTRN12624000452594.

Low back pain was the sixth most common reason for an ED visit in 2022-2023 in Australia, one-third of these patients were subsequently admitted to hospital. Therefore, we have assessed whether some patients could be diverted to alternate clinical pathways, via admission to a virtual hospital (rpavirtual), and be cared for remotely in their own homes. Ethics approval was granted for protocols X21-0278 & 2021/ETH10967 and X21-0094 & 2021/ETH00591. We conducted a mixed-method process evaluation, using the RE-AIM framework (reach, effectiveness, adoption, implementation and maintenance) to answer key questions regarding the Back@Home model of care. This preliminary evaluation describes a cohort of the first 50 patients who received care between 13 February and 31 July 2023. The service had high levels of reach and adoption, very low levels of ED representation, and no AEs. Virtual care cost a median of AU$2215 (interquartile range = AU$1724-AU$2855) per admission. Patients admitted virtually had the same high satisfaction with care as traditionally admitted patients and reported less pain and better physical function. Preliminary findings suggest that this model of care is a safe, acceptable, and feasible alternative to hospitalisation for non-serious low back pain, in a select cohort of patients meeting inclusion criteria. Further data collection will inform whether Back@Home has had an impact on length of stay or traditional admission rates.

Background: Current trends amongst otolaryngologists managing recurrent acute tonsillitis favour interval “cold” tonsillectomy over acute “hot” tonsillectomy. However, patients experience significant morbidity awaiting interval tonsillectomy, exacerbated by growing waitlist times in the context of COVID-19. The aim of this cross-sectional pilot study was to determine the feasibility of “hot” plasma-mediated ablation (PMA) tonsillectomy for acute recurrent tonsillitis. Methods: A single-centre cross-sectional study with ethics approval was undertaken where patients over 16 years of age presenting with recurrent acute tonsillitis were offered PMA tonsillectomy. Patients who did not satisfy the Paradise criteria, were pregnant, had suspected tonsillar malignancy, bleeding diathesis, or significant comorbidities were excluded. Institutional electronic medical records and telephone follow-up at 1 month informed the following outcomes: post-tonsillectomy haemorrhage (PTH), operating time, length of stay, re-admission rate at 30 days, and post-operative infection. Statistical analysis of differences in operating time and length of stay for patients with and without peritonsillar abscess at time of surgery was performed using independent samples t-tests. Results: Twenty patients were recruited, with an equal distribution of males and females. The mean age was 33.3±13.6 years, operating time was 37.5±15 minutes, and length of stay 3.4±1.3 days. There were no readmissions or cases of PTH requiring return to hospital. Statistically significant difference was not found in those with and without peritonsillar abscess with respect to operating time (40.25±17.3 vs. 32.71±8.81 minutes, P=0.305) and length of stay (3±1.08 vs. 4±1.53 days, P=0.104). Conclusions: This pilot study concluded “hot” PMA tonsillectomy may be a feasible alternative to interval “cold” tonsillectomy that could reduce recurrent hospital admissions and waitlist times for patients with acute recurrent tonsillitis.

Alternate "hospital avoidance" models of care are required to manage the increasing demand for acute inpatient beds. There is currently a knowledge gap regarding the perspectives of hospital clinicians on barriers and facilitators to a transition to virtual care for low back pain. We plan to implement a virtual hospital model of care called "Back@Home" and use qualitative interviews with stakeholders to develop and refine the model. We aim to explore clinicians' perspectives on a virtual hospital model of care for back pain (Back@Home) and identify barriers to and enablers of successful implementation of this model of care. We conducted semistructured interviews with 19 purposively sampled clinicians involved in the delivery of acute back pain care at 3 metropolitan hospitals. Interview data were analyzed using the Theoretical Domains Framework. A total of 10 Theoretical Domains Framework domains were identified as important in understanding barriers and enablers to implementing virtual hospital care for musculoskeletal back pain. Key barriers to virtual hospital care included patient access to videoconferencing and reliable internet, language barriers, and difficulty building rapport. Barriers to avoiding admission included patient expectations, social isolation, comorbidities, and medicolegal concerns. Conversely, enablers of implementing a virtual hospital model of care included increased health care resource efficiency, clinician familiarity with telehealth, as well as a perceived reduction in overmedicalization and infection risk. The successful implementation of Back@Home relies on key stakeholder buy-in. Addressing barriers to implementation and building on enablers is crucial to clinicians' adoption of this model of care. Based on clinicians' input, the Back@Home model of care will incorporate the loan of internet-enabled devices, health care interpreters, and written resources translated into community languages to facilitate more equitable access to care for marginalized groups.

BackgroundKnowledge gaps exist around diagnostic and treatment approaches for patients admitted to hospital with low back pain.MethodsMedical record review of patients admitted to three Sydney teaching hospitals with a provisional emergency department diagnosis of non‐serious low back pain, from 2016 to 2020. Data on demographic variables, hospital costs, length of stay (LOS), diagnostic imaging and analgesic administration were extracted. Logistic regression was used to identify predictors of longer hospital stay, advanced imaging, and concomitant use of sedating medicines.ResultsMedian inpatient LOS for non‐specific low back pain was 4 days (interquartile range [IQR] 2‐7), and for radicular low back pain was 4 days (IQR 3‐10). Older patients with non‐serious low back pain were more likely to stay longer, as were arrivals by ambulance. Plain lumbar radiography was used in 8.3% of admissions, whereas 37.6% of patients received advanced lumbar imaging (computed tomography or magnetic resonance imaging). Opioids were administered in ~80% of admissions; 49% of patients with radicular low back pain were given an antiepileptic in addition to an opioid. In all, 18.4% of admissions resulted in at least one hospital‐acquired complication, such as an accidental fall (3.1%) or a medication‐related adverse effect (13.3%). Physiotherapists saw 82.6% of low back pain admissions. Costs of inpatient care were estimated at a mean of AU$ 14 000 per admission.ConclusionsWe noted relatively high rates of concomitant use of sedating pain medicines and referrals for advanced lumbar imaging and laboratory tests. Strategies to address these issues in inpatient care of low back pain are needed.

Purpose of ReviewThe current COVID-19 pandemic has challenged the international paediatric otolaryngology community: we review its impact in clinical, resource, and human settings.Recent FindingsThe SARS-CoV-2 virus, while generally mild in paediatric populations, has caused an increased incidence in severe croup, invasive fungal sinus disease, and multi system inflammatory syndrome (MIS-C). The incidence of other common otolaryngology presentations such as otitis media and tonsillitis has decreased due to quarantine measures. The pandemic has also changed the way in which we work: guidelines for aerosol-generating procedures (AGPs) have changed, digital technology and videoconferencing platforms have flourished, and new pathways of providing healthcare have been developed to minimise footfall and avoid overcrowded waiting rooms. Finally, the importance of personal protective equipment (PPE) to protect healthcare workers and patients cannot be understated, although the mental and physical toll is considerable.SummaryThere has been a tectonic shift in paediatric otolaryngology and healthcare globally. Continued adaptability and resilience are required to face these challenges in the coming months. With lessons learnt from managing SARS-CoV-2, we are hopefully well equipped to combat any future pandemics.