Tuwhera Research Repository

The Tuwhera Research Repository provides sustainable open access and archiving to a broad range of AUT produced research - theses, research outputs and datasets.

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Recent Submissions

Access status: Open Access ,
Intelligent Palliative Care Based on Patient-Reported Outcome Measures
(Elsevier, 2022-01-10) Sandham, Margaret; Hedgecock, Emma Alice; Siegert, Richard; Narayanan, Ajit; Hocaoglu, Mevhibe B; Higginson, Irene
CONTEXT: The growth of patient reported outcome measures data in palliative care provides an opportunity for machine learning to identify patterns in patient responses signifying different phases of illness. OBJECTIVES: The study will explore if machine learning and network analysis can identify phases in patient palliative status through symptoms reported on the Integrated Palliative Care Outcomes Scale (IPOS). METHODS: A partly cross-sectional and partially longitudinal observational study was undertaken using the Australasian Karnofsky Performance Scale (AKPS); Integrated Palliative Care Outcome Scale (IPOS); Phase of Illness (POI). Patient palliative records (n=1507, 65% stable, 20% unstable, 9% deteriorating, 2% terminal) from 804 adult patients enrolled in a New Zealand palliative care service were analysed using a combination of statistical, machine learning and network analysis techniques. RESULTS: Data from IPOS showed considerable variation with phase. Also, network analysis showed clear associations between items by phase. Six machine learning techniques identified the most important variables for predicting possible transition between phases of illness. Network analysis for all patients showed that Poor Appetite and Loss of Energy were central IPOS items, with Loss of Energy linked to Drowsiness, Shortness of Breath and Lack of Mobility on the one hand, and Poor Appetite linked to Nausea, Vomiting, Constipation and Sore and Dry Mouth on the other. CONCLUSIONS: These preliminary results, when coupled with the latest technological developments in mobile apps and wearable technology, could point the way to increased use of digital therapeutics in continuous palliative care monitoring.
Access status: Open Access ,
Closing the Rural Diabetes Research Gap: A Case for Coordinated International Collaboration
(Informa UK Limited, 2026-09-21) Murfet, Giuliana; Wang, Wenyong; Barmanray, Rahul D; Ng, Ashley H; Rothmann, Mette Juel; Wischer, Natalie; Mold, Freda; Brinkworth, Grant D; Peng, Wenbo; Pearce, Karen; Carey, Nicola
Rural, regional and remote communities experience a disproportionate burden of diabetes and persistent barriers to specialist care, including workforce shortages, geographic isolation, transport costs, fragmented services and uneven digital infrastructure. However, much of the evidence guiding diabetes service design is derived from urban settings, while rural studies are often localised, short-term and difficult to compare or scale. This article argues that addressing rural diabetes inequity requires coordinated international research rather than isolated projects or the transfer of urban models into rural contexts. It introduces the International Consortium for Rural Diabetes Research (ICRDR), an international collaboration of clinicians, researchers, health service leaders and diabetes stakeholders established to align research priorities, develop shared methodologies and outcome measures, and support multicentre and cross-jurisdictional studies. The ICRDR will initially develop community-informed research priorities involving people with lived experience, clinicians, researchers, policymakers and funders. Its longer-term agenda includes evaluating contextually appropriate models of care, digital health approaches, workforce capability and connections between primary and specialist care and supporting research capacity in low- and middle-income countries. Coordinated international research infrastructure can strengthen the relevance, implementation and scalability of rural diabetes research and support the translation of evidence into more equitable and sustainable models of care.
Access status: Open Access ,
IMPACT: Integrated Model for Patient Acuity, Care, and Triage Efficiency in Emergency Department
(Springer Science and Business Media LLC, 2026-09-23) Rasouli Panah, Hamidreza; Ijadi Maghsoodi, Abtin; Madanian, Samaneh; Yu, Jian
Adverse patient outcomes in Emergency Departments (ED) are shaped by a complex interplay of clinical, demographic, and operational factors, yet existing approaches often fail to account for these dimensions in an integrated and actionable manner. This study introduces the Integrated Model for Patient Acuity, Care, and Triage Efficiency (IMPACT), a comprehensive framework developed to identify key predictors of mortality and generate individual adverse outcome risk scores across multiple clinical timeframes using a retrospective analytical approach. A retrospective analysis was conducted using 593,673 de-identified ED presentations from a tertiary hospital in the Waikato region in New Zealand, between 2016 and 2024. The modelling strategy involved a two-step approach, starting with Generalised Linear Models (GLM) for inferential analysis, followed by multiple regularised logistic regressions to enhance predictive accuracy and mitigate multicollinearity. The results indicated that advanced age, greater clinical complexity, and longer ED stays were associated with increased adverse outcomes, while longer waiting times were inversely associated with adverse outcomes, a finding consistent with triage-induced prioritisation effects whereby the most acutely unwell patients are seen first and also face the highest mortality risk, an associational pattern rather than a causal relationship. Based on the final model, an adverse outcome scoring system was derived, translating patient-level data into individual probability scores. The IMPACT model demonstrated high discriminative performance, with AUROC values of 0.9532 for ED mortality, 0.9183 for 10-days mortality, and 0.8999 for 28-days mortality. By combining robust statistical inference with a clinically interpretable scoring system, IMPACT provides a scalable and practical tool for retrospective risk stratification, service evaluation, and equitable decision-making in emergency care settings.
Access status: Open Access ,
Amharic Adaptation of the OHIP-14 and WHO Oral Health Tools
(New Zealand Dental Association, 2026-07-05) Ketema, Betelehem; Lansdown, Karen; Al Naasan, Zeina; Han, Heuiwon; Trafford, Julie
Objective: To translate, culturally adapt, and preliminarily validate the English versions of the OHIP-14 and WHO Oral Health Assessment tools into Amharic for Ethiopian refugees in Aotearoa New Zealand. Methods: Following the five-stage cross-cultural adaptation framework proposed by Beaton et al. (2000), forward and backward translation, expert committee review, and pilot testing were conducted. Content validity was assessed by a bilingual panel using Likert-scale ratings and qualitative feedback. Face validity was evaluated through semi-structured interviews with five Amharic-speaking adults of Ethiopian refugee background. Quantitative data were analysed descriptively; qualitative feedback was thematically analysed. Cronbach’s alpha assessed internal consistency. Results: The adapted tools showed strong semantic and cultural equivalence. Key changes included gender-neutral pronouns (~~~ ), culturally resonant expressions (e.g., “~~~,~~~ ?” for “self-conscious”), and inclusion of traditional hygiene practices (mefakia, sintir, charcoal). Expert panel ratings confirmed clarity (M = 4.9), cultural appropriateness (M = 5.0), and semantic accuracy (M = 4.8). All OHIP-14 items scored ≥ 4 by participants, with mean clarity = 4.96 and cultural relevance = 5.0. Internal consistency was excellent (Cronbach’s α = 0.90). Participants found the modified tools respectful, understandable, and reflective of their experiences. Qualitative data from post-completion semi-structured interviews further confirmed the clarity, cultural alignment, and emotional safety of the adapted tool. Conclusion: The Amharic OHIP-14 and WHO Oral Health Assessment tools demonstrated strong face and content validity. These findings support the value of culturally and linguistically adapted tools for equitable oral health assessment in refugee populations and provide a foundation for future large-scale validation.
Access status: Open Access ,
Nothing About Us Without Us: Research Methods Enabling Participation for Aged Care Residents Who Have Dementia
(SAGE Publications, 2021-12-07) Shannon, Kay; Montayre, Jed; Neville, Stephen
The voices of people living with dementia are rarely included in primary data collection due to cognitive challenges and the concerns of researchers and others about limitations associated with informed consent. This article presents a successfully implemented, step-by-step process enabling effective participation of aged care residents with dementia using a case study approach. Three methodological and critical steps in data collection were identified that led to the successful participation of residents with dementia in research. The process corresponds with, yet is uniquely different from the common elements in the qualitative research process. These are active participation during data collection, researcher familiarization with participants, and their set interval and time-lapse considerations (timeline). The process of involvement of people with dementia in research should proceed at a pace that is guided by the participants. It is important to consider participant interview pace, pattern, and the conversation time points when interruptions occur, to restart the whole interview process. Researchers need to facilitate active engagement by building and maintaining authentic relationships with the participants.