Royal Australasian College of Medical Administrators

Older adults with type 2 diabetes mellitus (T2DM) and cognitive impairment present significant challenges for safe glycaemic management in residential aged care settings. We describe the case of a 73-year-old woman with T2DM, vascular dementia, ischaemic heart disease and chronic kidney disease, who experienced marked glycaemic variability and poor adherence to capillary blood glucose monitoring (BGM). Her diabetes was managed with linagliptin and basal insulin; however, refusal of finger-prick testing, dietary non-adherence, and monitoring-related anxiety limited detection of hypo- and hyperglycaemia. Blood glucose levels fluctuated widely from 4.8 to 27.8 mmol/L, contributing to fatigue, anxiety, hyperglycaemia-related polyuria, and increased falls risk. Continuous glucose monitoring (CGM) devices are commonly used for type 1 diabetes mellitus in Australia as they are fully subsidised through the National Diabetes Service Scheme (NDSS). However, usage is low in T2DM due to limited subsidies. Therefore, a novel use of a CGM device, FreeStyle Libre 2 Plus sensorTM, was introduced following multidisciplinary consultation involving the patient, general practitioner, nursing staff, and family. Nursing staff were trained in device use and alarm-based responses, with thresholds set for hypoglycaemia and hyperglycaemia. CGM trend data enabled safer medication titration, including addition of modified release gliclazide, resulting in reduced hyperglycaemic episodes and improved time within target glucose range. Nursing staff reported increased confidence and timely interventions, while the patient experienced improved energy and confidence. Despite funding barriers and limited evidence, CGM proved a feasible and minimally intrusive strategy for improving glycaemic control in a poorly adherent aged care resident.

PurposeThe study aims to assess medical engagement levels at two teaching hospitals and a 500 bed private hospital in two states operated by the same health care provider and to describe individual and organisational factors that influence and change medical engagement.Design/methodology/approachA survey was emailed to all junior and senior medical staff, seeking responses to 30 pre-determined items. The survey used a valid and reliable instrument which provided an overall index of medical engagement. Qualitative data were also collected by including an open ended question.FindingsDoctors (n = 810) working at all sites are in the top 20-40 percentile when compared to Australia and the United Kingdom. Two sites in one state were in the highest relative engagement band with the other being in the high relative range when compared to the (UK) and the medium relative band when compared to sites in Australia. Senior doctors working at all three were less engaged on feeling valued and empowered, when compared to having purpose and direction or working in a collaborative culture. This appears to be related to work satisfaction and whether they feel encouraged to develop their skills and progress their careers. Junior doctors at 1 site are much less engaged than colleagues working at another. Since their formal training pathways are identical the informal training experience appears to be an engagement factor.Originality/valueDespite medical engagement being recognised as crucial, little is known about individual and organisational factors that support doctors to be engaged, particularly for juniors and in the private sector.

Medical leadership: development and practice edition twoTo us -as editors -this special edition is even more special!This second journal edition dedicated to medical leadership highlights a strong movement, world-wide, to explore, investigate, and improve the role of the medical profession in shaping health reformand what needs to be done in order to prepare members of the profession for an enhanced role in that regard.Regardless of whether a doctor is in residence, beginning their career in a community or hospital, or well along in their clinical journey, there is a growing expectation that they will become involved -or as some of the literature says, engaged -in improvement, reform, or innovation of health service delivery.Government efforts to reform health care ultimately creates expectations that health regions, hospitals, primary care offices, and all the supporting casts, will change aspects of what they are doing to accommodate those "patient-centred" policy shifts.To do so means that all doctors, whether in clinical roles or administrative ones, will be affected.Many authors from the very countries represented by the articles in this special edition, have presented compelling arguments, accompanied by research, to validate the importance of engaging physicians in health reform.Some of the most compelling arguments have been found in earlier editions of the Leadership in Health Services journal.Most suggest that for physicians to become more actively involved in organizational decision making, they must develop leadership skills.These skills -regardless of whether they are for a CEO with a medical background, a doctor in a rural community, a specialist working in a hospital setting, or a salaried doctor in a hospital -position the physician to be most effective at ensuring good medical practice is imbued in service delivery changes.Or, for that matter, in the design of new capital projects dedicated to improved patient care.The articles in this special "special edition" highlight key efforts that are being made to grow and develop leadership within the medical community.Anne Matlow, Ming-Ka Chan and Jamiu Busari are part of an international team that is aiming at developing new leadership curriculum for residents in training.Anne outlines the international effort -called the Toronto Summit for Leadership Education for Physicians (TISLEP)where it came from, what it is doing, and how it is doing it.Ming-Ka Chan's article describes the rationale for the competency-based approach for this initiative: essentially spurred on by a major change in the Can Meds framework (used by 26 countries to guide medical education).In this change, the competency of "manager" is replaced by the competency of "leader".As a consequence, these three articles grapple with the changes required in resident education to embody developmental opportunities in leadership competency development.Jamui Busari's article, for example, explores the challenges in assessing leadership growth and development.Six other articles explore the challenges of growing leadership capability after medical school graduation.Colleen Grady examines the phenomenon of complexity and its implications for physician leaders -a valuable perspective for anyone seeking to LHS 29,

Medical Journal of AustraliaVolume 2, Issue 2 p. 108-108 Correspondence PSYCHOLOGISTS AND PSYCHIATRISTS J. Shaw, J. Shaw Health Commission of Victoria, Malvern Clinic, 321 Glenferrie Road, Malvern, Vic., 3144Search for more papers by this author J. Shaw, J. Shaw Health Commission of Victoria, Malvern Clinic, 321 Glenferrie Road, Malvern, Vic., 3144Search for more papers by this author First published: 01 July 1981 https://doi.org/10.5694/j.1326-5377.1981.tb100818.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue2July 1981Pages 108-108 RelatedInformation

Medical Journal of AustraliaVolume 2, Issue 12 p. 271-271 Report of Case A FATAL CASE OF POISONING BY β-EUCAINE Judah Leon Jona D.Sc., M.D., B.S., Judah Leon Jona D.Sc., M.D., B.S. Malvern, VictoriaSearch for more papers by this author Judah Leon Jona D.Sc., M.D., B.S., Judah Leon Jona D.Sc., M.D., B.S. Malvern, VictoriaSearch for more papers by this author First published: 01 September 1915 https://doi.org/10.5694/j.1326-5377.1915.tb16883.xAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume2, Issue12September 1915Pages 271-271 RelatedInformation