ORCID Profile
0000-0002-5203-0557
Current Organisations
Western Sydney Local Health District
,
University of Sydney
,
Griffith University
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Veterinary Sciences | Veterinary Microbiology (excl. Virology) | Veterinary Epidemiology | Veterinary Sciences not elsewhere classified
Livestock Product Traceability and Quality Assurance | Food Safety |
Publisher: SAGE Publications
Date: 29-12-2010
Abstract: Purpose: Samoan communities in Australia exhibit a disproportionate rate of kidney disease compared with other Australians. This article describes a research project that used a culturally sensitive framework, Fa’afaletui, to help reduce the barriers of language and culture and increase our understanding of the factors contributing to kidney disease, in one Samoan community in Australia. Design: Semistructured group interviews were undertaken with Samoan community families and groups. The interviews were analyzed according to key concepts embedded in the Fa’afaletui framework. Findings: Four factors associated with health risks in this Samoan community emerged: diet and exercise, issues related to the collective (incorporating the village, church, and family), tapu or cultural protocols, and the importance of language. Conclusions: The findings suggest that future kidney health promotion initiatives within this Samoan community will be more effective if they are sensitive to Samoan cultural norms, language, and context.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.JHIN.2017.09.002
Abstract: Surveillance of healthcare-associated infections is fundamental for infection prevention. The methods and practices for surveillance have evolved as technology becomes more advanced. The availability of electronic surveillance software (ESS) has increased, and yet adoption of ESS is slow. It is argued that ESS delivers savings through automation, particularly in terms of human resourcing and infection prevention (IP) staff time. To describe the findings of a systematic review on the impact of ESS on IP resources. A systematic search was conducted of electronic databases Medline and the Cumulative Index to Nursing and Allied Health Literature published between January 1 In all, 2832 articles were reviewed, of which 16 studies met the inclusion criteria. IP resources were identified as time undertaken on surveillance. A reduction in IP staff time to undertake surveillance was demonstrated in 13 studies. The reduction proportion ranged from 12.5% to 98.4% (mean: 73.9%). The remaining three did not allow for any estimation of the effect in terms of IP staff time. None of the studies demonstrated an increase in IP staff time. The results of this review demonstrate that adopting ESS yields considerable idends in IP staff time relating to data collection and case ascertainment while maintaining high levels of sensitivity and specificity. This has the potential to enable reinvestment into other components of IP to maximize efficient use of scarce IP resources.
Publisher: Wiley
Date: 17-11-2021
DOI: 10.1111/JOCN.16115
Abstract: To determine if the use of an emergency nursing framework improves the accuracy of clinical documentation. Accurate clinical documentation is a nursing professional responsibility essential for high‐quality and safe patient care. The use of the emergency nursing framework “HIRAID” (History, Identify Red flags, Assessment, Interventions, Diagnostics, reassessment and communication) improves emergency nursing care by reducing treatment delays and improving escalation of clinical deterioration. The effect of HIRAID on the accuracy of nursing documentation is unknown. A quasi‐experimental pre‐post study was conducted and the report was guided by the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. HIRAID was implemented in four regional/rural Australian emergency departments (ED) using a range of behaviour change strategies. The blinded electronic healthcare records of 120 patients with a presenting problem of shortness of breath, abdominal pain or fever were reviewed. Quantity measures of completeness and qualitative measures of completeness and linguistic correctness of documentation adapted from the D‐Catch tool were used to assess accuracy. Differences between pre‐post groups were analysed using Wilcoxon rank‐sum and two‐s le t ‐tests for continuous variables. Pearson's Chi‐square and Fisher exact tests were used for the categorical data. The number of records containing the essential assessment components of emergency care increased significantly from pre‐ to post‐implementation of HIRAID. This overall improvement was demonstrated in both paediatric and adult populations and for all presentation types. Both the quantitative and qualitative measures of documentation on patient history and physical assessment findings improved significantly. Use of HIRAID improves the accuracy of clinical documentation of the patient history and physical assessment in both adult and paediatric populations. The emergency nursing framework “HIRAID” is recommended for use in clinical practice to increase the documentation accuracy performed by emergency nurses.
Publisher: Wiley
Date: 31-03-2023
DOI: 10.1002/HPJA.599
Abstract: High levels of testing are crucial for minimising the spread of COVID‐19. The aim of this study is to investigate what prevents people from getting a COVID‐19 test when they are experiencing respiratory symptoms. Semi‐structured, qualitative interviews were conducted with 14 purposively s led adults between 20 November 2020 and 3 March 2021 in two capital cities of Australia and analysed thematically. The analysis included people who reported having respiratory symptoms but who did not undergo a COVID‐19 test. Participants appraised risks of having COVID‐19, of infecting others or being infected whilst attending a testing site. They often weighed these appraisals against practical considerations of knowing where and how to get tested, inconvenience or financial loss. Clear public health messages communicating the importance of testing, even when symptoms are minor, may improve testing rates. Increasing the accessibility of testing centres, such as having them at transport hubs is important, as is providing adequate information about testing locations and queue lengths. The findings of our study suggest that more needs to be done to encourage people to get tested for COVID‐19, especially when symptoms are minor. Clear communication about the importance of testing, along with easily accessible testing clinics, and financial support for those concerned about financial impacts may improve testing rates.
Publisher: Elsevier BV
Date: 11-2008
Publisher: Wiley
Date: 08-08-2011
DOI: 10.1111/J.1742-6723.2011.01461.X
Abstract: The aim of the present study was to examine the impact of Pandemic (H(1)N(1)) 2009 Influenza on the Australian emergency nursing and medicine workforce, specifically absenteeism and deployment. Data were collected using an online survey of 618 members of the three professional emergency medicine or emergency nursing colleges. Despite significant increases in emergency demand during the Pandemic (H(1)N(1)) 2009 Influenza, 56.6% of emergency nursing and medicine staff reported absenteeism of at least 1 day and only 8.5% of staff were redeployed. Staff illness with influenza-like illness was reported by 37% of respondents, and 87% of respondents who became ill were not tested for the Pandemic (H(1)N(1)) 2009 Influenza. Of the respondents who became ill, 43% (n= 79) reported missing no days of work and only 8% of respondents (n= 14) reported being absent for more than 5 days. The mean number of days away from work was 3.73 (standard deviation = 3.63). Factors anecdotally associated with staff absenteeism (caregiver responsibilities, concern about personal illness, concern about exposing family members to illness, school closures, risk of quarantine, stress and increased workload) appeared to be of little or no relevance. Redeployment was reported by 8% of respondents and the majority of redeployment was for operational reasons. Future research related to absenteeism, redeployment during actual pandemic events is urgently needed. Workforce data collection should be an integral part of organizational pandemic planning.
Publisher: Elsevier BV
Date: 05-2008
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.IDH.2017.10.002
Abstract: Australian hospitals routinely screen for multi-resistant organisms (MRO) to prevent the spread of healthcare-associated infection. The results of positive MRSA screening typically include: informing patient of their MRSA, single accommodation and contact precautions within the health care facility. These actions are associated with both negative and positive psychosocial effects, but also bring economic and human resource costs. MRSA clearance, however, is a less routine practice, and it is typically conducted only while patients are admitted. This paper reports the results of a study implementing a MRSA clearance program that included giving patients the opportunity to continue the clearance swabbing regime once discharged from hospital. Retrospective cohort study of MRSA clearance between 2013 and 2016 at a private hospital in Australia. The MRSA clearance program was successful in increasing the MRSA clearance rate from 0 patients in 2013 to 13% (n12) in 2014, 11% (n10) in 2015, and 18% (n14) in 2016. Allowing patients to continuing participation in MRSA clearance following discharge has increased the clearance rate of MRSA. Clearing patients of MRSAs is advantageous to patients, the health system and society, reducing health economic costs and the negative psychosocial effects associated with contact precautions.
Publisher: Public Library of Science (PLoS)
Date: 12-2022
DOI: 10.1371/JOURNAL.PONE.0278479
Abstract: Health care workers’ (HCWs) lived experiences and perceptions of the pandemic can prove to be a valuable resource in the face of a seemingly persistent Novel coronavirus disease 2019 (COVID-19)–to inform ongoing efforts, as well as identify components essential to a crisis preparedness plan and the issues pertinent to supporting relevant, immediate change. We employed a phenomenological approach and, using purposive s ling, conducted 39 semi-structured interviews with senior healthcare professionals who were employed at a designated COVID-19 facility in New South Wales (NSW), Australia during the height of the pandemic in 2020. Participants comprised administrators, heads of department and senior clinicians. We obtained these HCWs’ (i) perspectives of their lived experience on what was done well and what could have been done differently and (ii) recommendations on actions for current and future crisis response. Four themes emerged: minimise the spread of disease at all times maintain a sense of collegiality and informed decision-making plan for future crises and promote corporate and clinical agility. These themes encapsulated respondents’ insights that should inform our capacity to meet current needs, direct meaningful and in situ change, and prepare us for future crises. Respondents’ observations and recommendations are informative for decision-makers tasked with mobilising an efficacious approach to the next health crisis and, in the interim, would aid the governance of a more robust workforce to effect high quality patient care in a safe environment.
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 02-2020
DOI: 10.1016/J.IDH.2019.10.001
Abstract: Behavioural theories are crucial to the development and success of effective hand hygiene interventions. Research demonstrates that hand hygiene behaviours can also be influenced by religious and cultural beliefs. In this paper we detail the processes undertaken to develop a valid and reliable questionnaire to examine healthcare workers' beliefs and behaviours related to the use of alcoholbased hand rub (ABHR), with particular emphasis on associated religious and cultural factors. Using the Theory of Planned Behaviour, an existing questionnaire was modified and pilot-tested on 35 staff in the Quality Department. Cronbach's alpha values and mean inter-item correlations of the scale items were the main outcome measures. A Pearson correlation was conducted to assess for social desirability response bias. The questionnaire demonstrated high content and face validity and satisfactory internal consistency in most scales, except for the religious beliefs, cultural beliefs and perceived behavioural control scales, where the inter-item correlations were 0.10, 0.13, and 0.14, respectively. There was a significant correlation between scores on the social desirability scale and the attitude scale. Partial correlation should be used to control the effect of social desirability responding when analysing data from the attitudes scale. A validation process allowed the introduction and subsequent modification of religious and cultural belief scales to an existing questionnaire examining behavioural and attitudinal influences on hand hygiene using ABHR. Such processes should be considered for questionnaire development and modification when considering religious and cultural factors as drivers of behaviour.
Publisher: Elsevier BV
Date: 11-2020
Publisher: MDPI AG
Date: 13-08-2022
DOI: 10.3390/TROPICALMED7080182
Abstract: This study estimates the point prevalence of symptomatic respiratory tract infections (RTIs) among returned Hajj pilgrims and their contacts in 2021. Using the computer-assisted telephone interview (CATI) technique, domestic pilgrims were invited to participate in this cross-sectional survey two weeks after their home return from Hajj. Of 600 pilgrims approached, 79.3% agreed to participate and completed the survey. Syndromic definitions were used to clinically diagnose possible influenza-like illnesses (ILI) and COVID-19. Median with range was applied to summarise the continuous data, and frequencies and proportions were used to present the categorical variables. Simple logistic regression was carried out to assess the correlations of potential factors with the prevalence of RTIs. The majority of pilgrims (88.7%) reported receiving at least two doses of the COVID-19 vaccine before Hajj. Eleven (2.3%) pilgrims reported respiratory symptoms with the estimated prevalence of possible ILI being 0.2%, and of possible COVID-19 being 0.4%. Among those who were symptomatic, five (45.5%) reported that one or more of their close contacts had developed similar RTI symptoms after the pilgrims’ home return. The prevalence of RTIs among pilgrims who returned home after attending the Hajj 2021 was lower compared with those reported in the pre-pandemic studies however, the risk of spread of infection among contacts following Hajj is still a concern.
Publisher: Elsevier BV
Date: 11-2012
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1071/HI13026
Publisher: Elsevier BV
Date: 06-2011
DOI: 10.1071/HI11001
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.AJIC.2017.06.025
Abstract: We report an outbreak of Burkholderia cenocepacia bacteremia and infection in 11 patients predominately in intensive care units caused by contaminated ultrasound gel used in central line insertion and sterile procedures within 4 hospitals across Australia. Burkholderia cenocepacia was first identified in the blood culture of a patient from the intensive care unit at the Gold Coast University Hospital on March 26, 2017, with 3 subsequent cases identified by April 7, 2017. The outbreak response team commenced investigative measures. The outbreak investigation identified the point source as contaminated gel packaged in sachets for use within the sterile ultrasound probe cover. In total, 11 patient isolates of B cenocepacia with the same multilocus sequence type were identified within 4 hospitals across Australia. This typing was the same as identified in the contaminated gel isolate with single nucleotide polymorphism-based typing, demonstrating that all linked isolates clustered together. Arresting the national point-source outbreak within multiple jurisdictions was critically reliant on a rapid, integrated, and coordinated response and the use of informal professional networks to first identify it. All institutions where the product is used should look back at Burkholderia sp blood culture isolates for speciation to ensure this outbreak is no larger than currently recognized given likely global distribution.
Publisher: Elsevier BV
Date: 09-2016
DOI: 10.1016/J.NEPR.2016.08.003
Abstract: Clinical facilitation is critical to successful student clinical experience. The research reported in this paper used an interpretive case study to explore perspectives of clinical facilitators on what constitutes best practice in clinical facilitation of undergraduate nursing students. Eleven clinical facilitators from South East Queensland, Australia, participated in focus groups, interviews and a concept mapping exercise to gather their perspectives on best practice. The data gathered information regarding their prior and current experiences as registered nurses and facilitators, considering reasons they became clinical facilitators, their educational background and self-perceived adequacy of their knowledge for clinical facilitation. Analysis was through constant comparison. Findings of the study provided in-depth insight into the role of clinical facilitators, with best practice conceptualised via three main themes 'assessing', 'learning to facilitate' and 'facilitating effectively'. While they felt there was some autonomy in the role, the clinical facilitators sought a closer liaison with academic staff and feedback about their performance, in particular their assessment of the students. Key strategies identified for improving best practice included educational support for the clinical facilitators, networking, and mentoring from more experienced clinical facilitators. When implemented, these strategies will help develop the clinical facilitators' skills and ensure quality clinical experiences for undergraduate nursing students.
Publisher: Elsevier BV
Date: 05-2018
DOI: 10.1016/J.AUEC.2018.03.001
Abstract: Research is vital to responding to contemporary challenges of providing safe, high quality emergency nursing care, yet the research priorities for emergency nursing practice in Australia are unknown. This study aimed to establish research priorities for emergency nursing in Australia. A two-stage descriptive, exploratory study was conducted. First, research themes were identified through a survey of 232 emergency nurses the Delphi Technique (2 rounds) was used to rank and prioritise the research themes. There were five research themes with a CVI≥0.90: (i) recognising and responding to deteriorating ED patients (ii) effect of access block on clinical care of admitted ICU patients (iii) effects of ED overcrowding on clinical care (iv) scope of practice of specialist emergency nurses and (v) effect of access block on clinical care of admitted ward patients. These are reflected in four broad research priority areas: professional issues, patient safety, emergency care of vulnerable populations, and healthcare system issues. Future research should focus on these priority areas in partnership with other emergency disciplines to enable safe, high quality emergency care, and, to inform the practice of emergency nursing in Australia.
Publisher: SAGE Publications
Date: 28-02-2020
Abstract: In this paper, the authors describe a way of doing phenomenology using exemplars drawn from a doctoral study of Australian nurses’ lived experiences following a disaster. Phenomenology is concerned with the essence of things as they are appearing in the conscious awareness of the first person. This paper emphasises a way of doing phenomenology based on maintaining orientation to the uniqueness of the ‘thingness’ of the phenomena being uncovered. While there is no one way to do phenomenology, this paper shows a way of doing phenomenology from obtaining in idual narrative and moving to an intersubjective lived-experience description.
Publisher: Informa UK Limited
Date: 10-2011
Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) is now the leading antimicrobial-resistant organism of concern to clinicians worldwide. Preventing and controlling the increase and spread of MRSA within the health-care environment is therefore an important function of the infection control team. The prevention and control of MRSA requires strict use of both Standard and Additional Precautions, which include good hand hygiene practices, judicious antimicrobial prescribing, and source isolation. While few would dispute the need for these precautions for preventing the spread of MRSA and other infections, their use may result in adverse physical and psychological effects for the patient. In an age of quality and safety of health care, ensuring infection control practice such as source isolation and contact precautions adhere to fundamental human rights is paramount. This paper presents a review of the literature on the patient experience of source isolation for MRSA or other infectious diseases. The review yielded five major interconnected themes: (1) psychological effects of isolation (2) coping with isolation (3) social isolation (4) communication and information provision and (5) physical environment and quality of care. It found that the experience of isolation by patients has both negative and positive elements. Isolation may result in detrimental psychological effects including anxiety, stress and depression, but may also result in the patient receiving less or substandard care. However, patients may also benefit from the quietness and privacy of single rooms. Nurses and other healthcare workers must look for ways to improve the experience of isolation and contact precautions of patients in source isolation. Opportunities exist in particular in improving the environment and the patient's self-control of the situation and in providing adequate information.
Publisher: Elsevier BV
Date: 03-2018
Publisher: Elsevier BV
Date: 06-2016
Publisher: Elsevier BV
Date: 05-2016
Publisher: Elsevier BV
Date: 03-2020
DOI: 10.1016/J.IDH.2019.12.002
Abstract: Hand hygiene is universally recognised as the primary measure to reduce healthcare-associated infections. Studies have convincingly demonstrated a link between increased hand hygiene compliance and reductions in rates of healthcare-associated infections. Direct observation is considered the gold standard method for monitoring hand hygiene compliance. Despite the acknowledged benefits of this approach, recent literature has highlighted a range of issues impacting on the reliability and validity of this data collection technique. The rise of technology in healthcare provides opportunity for alternative methods that promise advantages over direct human observation. There have been no published ex les of systems that are able to capture data consistent with all the WHO '5 Moments for Hand Hygiene'. In this paper we explore current human-based auditing practises for monitoring hand hygiene compliance and raise for discussion and debate video-based technologies to monitor hand hygiene compliance. We raise questions regarding hybrid approaches that incorporate both direct human observation and indirect video-based surveillance, and the possible advantages and disadvantages therein for monitoring hand hygiene compliance. We suggest that such methods have the potential to ameliorate, or minimise, the inherent biases associated with direct observation, notably the Hawthorne Effect. Future research into the utility of a hybrid approach to auditing, including the technical specifications, efficacy, cost effectiveness and acceptability of such a model is warranted.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 05-2020
DOI: 10.1016/J.INJURY.2020.01.003
Abstract: The availability and implementation of evidence-based care is essential to achieving safe, quality trauma patient outcomes. Little is documented, however, about the challenges trauma clinicians face in their day-to day practice, or their views on the availability of evidence. This paper presents the most significant clinical practice challenges reported by multidisciplinary trauma care professionals in Australia and New Zealand, in particular those that may be resolved with focussed research or enhanced implementation activity. An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted between September 2018 and February 2019 using the Snowballing Method. Participants were recruited via a non-random s ling technique to complete an online survey. Thematic analyses were conducted. There were nine significant clinical practice challenge themes in trauma care, arising from 287 in idual clinical practice challenges reported. The most reported being clinical management (bleeding, spinal, older patients) and operationalisation of the trauma system. There was no consensus as to the availability of evidence to guide each theme. Future research should seek to address the clinical practice challenge of Australian and New Zealand trauma community to enable safe, quality trauma patient outcomes.
Publisher: Elsevier BV
Date: 09-2021
Publisher: AMPCo
Date: 03-2011
Publisher: Elsevier BV
Date: 09-2017
DOI: 10.1016/J.IDH.2017.07.001
Abstract: Central to all efforts to control and prevent healthcare associated infections (HAIs) is the inherent need to measure the burden of infection and disease, classically referred to as surveillance. Australia does not have a national HAI surveillance system making it very difficult to systematically assess and report on the burden of hospital-acquired HAIs. This systematic review reports the incidence burden of HAIs in Australian hospitals as reported in the peer-reviewed literature from 2010 to 2016. Systematic review of the peer-reviewed literature reporting the incidence of HAIs in Australian hospitals between from 2010 to 2016 was identified using MEDLINE and CINAHL databases. The study protocol is registered with PROSPERO (registration number: CRD42016052997). Of the 844 articles identified in the search, 24 articles were included in this review. Overall, these data suggest 83,096 HAIs per year in Australia, comprising 71,186 urinary tract infections, 4902 Clostridium difficile infections, 3946 surgical site infections, 1962 respiratory infections in acute stroke patients and 1100 hospital-onset Staphylococcus aureus bacteraemia. This is very large underestimate given the lack of or incomplete data on common infections such as pneumonia, gastroenterological and bloodstream infection, thus potentially missing up to 50%-60% of infections. If that is the case, the incidence of HAIs in Australia may be closer to 165,000 per year. There is a dearth of peer-reviewed literature reporting the incidence of HAIs in Australian hospitals, making it very difficult to an accurate burden of infection. On the eve of a global 'post antibiotic era', the need for national consensus on definitions, surveillance methodology and reporting is paramount.
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1016/J.AJIC.2015.04.199
Abstract: Existing research has consistently demonstrated poor compliance by health care workers with hand hygiene standards. This study examined the extent to which incorrect hand hygiene occurred as a result of the inability to easily distinguish between different hand hygiene solutions placed at washbasins. A direct observational method was used using ceiling-mounted, motion-activated video camera surveillance in a tertiary referral emergency department in Australia. Data from a 24-hour period on day 10 of the recordings were collected into the Hand Hygiene-Technique Observation Tool based on Feldman's criteria as modified by Larson and Lusk. A total of 459 episodes of hand hygiene were recorded by 6 video cameras in the 24-hour period. The observed overall rate of error in this study was 6.2% (27 episodes). In addition an overall rate of hesitation was 5.8% (26 episodes). There was no statistically significant difference in error rates with the 2 hand washbasin configurations. The amelioration of causes of error and hesitation by standardization of the appearance and relative positioning of hand hygiene solutions at washbasins may translate in to improved hand hygiene behaviors. Placement of moisturizer at the washbasin may not be essential.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.IJOTN.2015.03.001
Abstract: The management of fragility hip fractures requires a collaborative multi-disciplinary approach to care to ensure optimal patient outcomes. It is important to rigorously evaluate the model of care and enable the delivery of evidence based optimal patient care. The aim of this study was to document an orthogeriatric model of care (OGMOC) at a major tertiary hospital: assessing how particular indicators within the patient's admission were influenced by the OGMOC. A retrospective case analysis of all patients with fragility hip fracture from two pre-intervention groups and three post-intervention groups was undertaken. Data from (i) length of stay in the emergency department (ii) length of stay in the orthopaedic unit (iii) time from admission to surgery and (iv) time from surgery to admission to rehabilitation were used. Implementation of the OGMOC resulted in: reduced time in the emergency department, quicker access to surgery, reduced length of acute hospital stay and an increase in the number of patients accessing the rehabilitation unit. This study contributes to the increasing body of evidence for best practice in the management of fragility hip fracture within an OGMOC.
Publisher: Elsevier BV
Date: 06-2021
Publisher: Springer Science and Business Media LLC
Date: 22-12-2013
DOI: 10.1007/S00520-013-2095-X
Abstract: This study investigated the efficacy and safety of cryotherapy, in the form of frozen gel gloves, in relation to docetaxel-induced hand and fingernail toxicities. After piloting with 21 patients, a consecutive series s le of patients (n=53) prescribed docetaxel every 3 weeks, for a minimum of three cycles, was enrolled in this randomised control trial. Participants acted as their own control, with the frozen gel glove worn on one randomised hand for 15 min prior to infusion, for the duration of the infusion, and for 15 min of after completion of treatment. Hand and nail toxicities were evaluated by two blinded assessors according to CTCAE.v4 criteria. To assess the potential for cross-infection of multi-use gloves, microbial culture and sensitivity swabs were taken of each glove at every tenth use. Of the 53 participants enrolled in the main study, 21 provided evaluable data. There was a 60 % withdrawal rate due to patient discomfort with the intervention. The mean incidence and severity of toxicities in all evaluable cycles in control and intervention hands respectively were erythroderma grade 1 (5/5 %), nail discolouration grade 1 (81/67 %), nail loss grade 1 (19/19 %) and nail ridging grade 1 (57/57 %). No significant differences were determined between hand conditions in terms of time to event, nor in terms of toxicity in gloved and non-gloved hands. While cryotherapy in the form of frozen gloves for the cutaneous toxicities associated with docetaxel is safe, its limited efficacy, patient discomfort and some logistical issues preclude its use in our clinical setting.
Publisher: Elsevier BV
Date: 05-2017
DOI: 10.1016/J.IENJ.2017.02.001
Abstract: The purpose of research is to discover new knowledge. All good research starts with a clear, answerable question that addresses an important and significant problem or phenomenon of interest. In this paper, emergency nurses and other clinicians will be provided with a practical guide to successfully developing a quality research question as the basis of quality research. In this paper, how to plan and prepare question development using the PICO Framework, develop a literature search strategy, and perform a search, extracting and analysing information will be detailed.
Publisher: Elsevier BV
Date: 09-2018
Publisher: Elsevier BV
Date: 2020
Publisher: BMJ
Date: 19-01-2021
DOI: 10.1136/BMJ.N109
Publisher: Elsevier BV
Date: 11-2021
Publisher: Elsevier BV
Date: 11-2019
DOI: 10.1016/J.IDH.2019.06.004
Abstract: In iduals in residential and aged care facilities (RACFs) are at risk of developing health care-associated infections (HAIs) due to factors such as age-related changes in physiology, immunity, comorbid illness and functional disability. The recent establishment of an Australian Royal Commission into the Quality of Residential and Aged Care Services highlights the challenges of providing care in this sector. This national study identified infection prevention and control (IPC) services, practice and priorities in Australian RACFs. A cross-sectional study of 158 Australian RACFs comprising a 42-question survey incorporating five key domains relating to IPC namely governance, education, practice, surveillance, competency and capability was undertaken in 2018. Of the 131 respondents, the majority 92.4% of respondents reported having a documented IPC program, 22.9% (n = 30) operated with a dedicated infection control committee The majority of RACFs reported lacking specialist and qualified experienced IPC professionals (n = 67). The majority of RACFs (90.1%, n = 118) reported the existence of a designated employee with IPC responsibilities. Of these 118 staff members with IPC responsibilities, 42.5% had a qualification in IPC. The reported average funded hours per month for IPC professional or an external provider of IPC activities was 14 (95% CI 9.6-18.9 h). The overwhelming majority of RACFs deliver IPC services and report doing so in ways that meet the needs of their own specific contexts in the absence of the lack of formal guidelines when compared to the hospital sector. Quality residential and aged care free from HAIs requires formal structure and organization strategies.
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.AJIC.2013.05.022
Abstract: Preventing health care-associated infections is essential to the safety and quality of health care. Although patients' experience of care under isolation is well established, little is known of health care workers' experiences when providing such care. This study explored the health professionals lived experience of caring for patients under transmission-based precautions. Interpretive phenomenology was used to examine 12 health care professionals' lived experience of providing care under transmission-based precautions in 3 health care facilities in Australia. Data were obtained from in-depth interviews and observations of health professionals. The essential phenomena of "recognizing rapport" represented the health professionals' lived experience. Three themes emerged starting with (1) relationships with others, their rapport and communication with patients, patients' families and visitors, and colleagues. These relationships are influenced by (2) barriers to practice, such as personal level of comfort when wearing personal protective equipment, physical limitations of the environment, and management of workload and resources. Such barriers influence (3) patient outcomes, namely the quality of the care provided and adverse events. In the context of caring for patients under transmission-based precautions, the relationships between health professionals and their patients are critical to the quality and safety of health care with respect to infection prevention and control.
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.AENJ.2013.05.003
Abstract: The type of disaster, in idual demographic factors, family factors and workplace factors, have been identified in the international, multidisciplinary literature as factors that influence a person's willingness to attend and assist in their workplace during a disaster. However, it is unknown if these factors are applicable to Australasian emergency nurses. The research aims to determine the extent to which Australasian emergency nurses are willing to attend their workplace in a disaster. This research was exploratory and descriptive study design, using online and paper based surveys as a means of data collection. Australasian emergency nurses from two Australasian emergency nursing colleges and four Australian hospitals were recruited to participate. Data analysis was conducted using both descriptive and inferential statistics. In total, 451 Australasian emergency nurses participated in this research. Participants were more willing to attend their workplace during a conventional disaster (p ≤ 0.001), if they worked full-time (p = 0.01), had received formal education pertaining to disasters (p ≤ 0.001), had a family disaster plan (p = 0.008), did not have children (p = 0.001) and worked in an environment in which they perceived their colleagues, managers and organisation to be prepared. The factors that influenced Australasian emergency nurses to attend their workplace in a disaster were similar to that described in the international multidisciplinary literature. Of particular note, improving disaster knowledge and skills, having a family disaster plan and improving the perceptions of the nurses' workplace preparedness can enhance the nurses' willingness to assist in a disaster.
Publisher: Elsevier BV
Date: 08-2013
DOI: 10.1016/J.AENJ.2013.05.004
Abstract: Much of the literature about emergency nurses willingness to work during disasters has been from a non-Australian perspective. Despite the many recent disasters, little is known of Australian nurse's willingness to participate in disaster response. This paper presents findings from a study that explored nurses willingness to attend work during a disaster and the factors that influenced this decision. Data were collected consecutively using a combination of focus group and interview methods. Participants in this study, registered nurses from emergency departments, were recruited through convenience s ling from four hospitals in Australia. Participant narrative was electronically recorded, transcribed and thematically analysed. The participants for both the focus groups and interviews compromised a mix of ages, genders and years of experience as emergency nurses from across four jurisdictions within Australia. Three major themes that influenced willingness emerged with a number of subthemes. Theme one reflected the uncertainty of the situation such as the type of disaster. The second theme surrounded the preparedness of the workplace, emergency nurse and colleagues, and the third theme considered personal and professional choice based on home and work circumstances and responsibilities. The decision to attend work or not during a disaster, includes a number of complex personal, work-related and professional factors that can change, depending on the type of disaster, preparedness of the work environment and the emergency nurses' personal responsibilities at that time.
Publisher: Elsevier BV
Date: 09-2021
Publisher: Springer Science and Business Media LLC
Date: 20-06-2023
DOI: 10.1186/S43058-023-00452-0
Abstract: Emergency department (ED) overcrowding is a global problem and a threat to the quality and safety of emergency care. Providing timely and safe emergency care therein is challenging. To address this in New South Wales (NSW), Australia, the Emergency nurse Protocol Initiating Care—Sydney Triage to Admission Risk Tool (EPIC-START) was developed. EPIC-START is a model of care incorporating EPIC protocols, the START patient admission prediction tool, and a clinical deterioration tool to support ED flow, timely care, and patient safety. The aim of this study is to evaluate the impact of EPIC-START implementation across 30 EDs on patient, implementation, and health service outcomes. This study protocol adopts an effectiveness-implementation hybrid design (Med Care 50: 217-226, 2012) and uses a stepped–wedge cluster randomised control trial of EPIC-START, including uptake and sustainability, within 30 EDs across four NSW local health districts spanning rural, regional, and metropolitan settings. Each cluster will be randomised independently of the research team to 1 of 4 dates until all EDs have been exposed to the intervention. Quantitative and qualitative evaluations will be conducted on data from medical records and routinely collected data, and patient, nursing, and medical staff pre- and post-surveys. Ethical approval for the research was received from the Sydney Local Health District Research Ethics Committee (Reference Number 2022/ETH01940) on 14 December 2022. Australian and New Zealand Clinical trial, ACTRN12622001480774p. Registered on 27 October 2022.
Publisher: Elsevier BV
Date: 03-2018
DOI: 10.1016/J.IENJ.2016.09.004
Abstract: Older persons aged over 65years represent up to 41% of Australian Emergency Department (ED) presentations. Older persons present with acute and/or chronic conditions, have more Emergency Department visits, hospital admissions and readmissions than other age groups. However, little is known about the characteristics and trends of acute illness and chronic presentations and whether frailty changes these dimensions within this cohort. A 12-month retrospective medical record audit of persons over 65years presenting to four EDs. Data from 44,774 (26.6%) patients aged 65years and over were analysed. Patients with acute conditions presented more frequently (n=30,373 67.8%), received more urgent triage categories (n=13,471 30.1%) and had higher admission rates (n=18,332 61%). Chronic conditions presented less frequently (n=14,396 32.1%) and had higher discharge rates (n=9302 65%). Patients over 80years were allocated more urgent triage categories and commonly presented with falls (n=3814 8.5%). Patients between 65 and79years had a higher discharge rate (n=10,397 46.1%). Older persons with acute illnesses were more likely to be admitted than those with chronic conditions and who were more likely to be discharged home. There is scope for further investigation of new models of care to better manage older persons with chronic conditions and ED discharge practices.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 10-2023
Publisher: Elsevier BV
Date: 11-2013
Publisher: Elsevier BV
Date: 12-2020
Publisher: Elsevier BV
Date: 12-2013
DOI: 10.1016/J.COLEGN.2012.09.004
Abstract: Women who experience cancer treatment-induced menopause are at risk of long-term chronic morbidity. This risk can be prevented or offset with adherence to health promotion and risk reduction guidelines. The purpose of this study was to explore health behaviours in younger female survivors of cancer and the variables (quality of life and psychological distress) believed to moderate health behaviours. Cross-sectional survey of a convenience s le of women (n=85) in southeast Queensland. Health behaviour and health status were elicited with items from the Australian Health Survey and the Behavioural Risk Factor Surveillance System. The WHO Quality of Life (Brief) measured participants' self-reported quality of life and their satisfaction with their health. The Brief Symptom Inventory-18 measured psychological distress. Higher self-reported health status was associated with regular exercise and better quality of life. However, a substantial proportion of participants did not engage in the physical activity, dietary or cervical screening practices recommended by Australian guidelines. The participants require education regarding the benefits of diet, exercise, weight loss and decreased alcohol intake, as well as information on future health risks and possible comorbidities. These education sessions could be addressed by a nurse-led health promotion model of care at the time of discharge or in the community.
Publisher: Elsevier BV
Date: 12-2018
Publisher: Elsevier BV
Date: 11-2017
DOI: 10.1016/J.AENJ.2017.07.002
Abstract: Patients arriving at the Emergency Department (ED) via ambulance can experience a delay in receiving definitive care. In Australia, this phenomenon is referred to as 'Ambulance R ing', 'Patient Off Stretcher Time Delay' or 'Offload Delay'. As a direct consequence of crowding, and in the context of a worldwide increase in ED and ambulance usage, hospital and ambulance service function is h ered. The aim of this review was to synthesize the literature with respect to the conceptualisation, meaning, antecedents and consequences of Ambulance R ing. This was a scoping review and synthesis of the literature. Six search terms were employed: emergency medical technician paramedic ambulance hospital emergency services delay and ambulance r ing. Journal articles that discussed Ambulance R ing (or similar terms), and were published in English between 1983 and March 2015 were included. PubMed and CINAHL Plus databases were searched, with secondary searches of reference lists and grey literature also undertaken. Thirteen papers were selected and inform this review. Several terms are used internationally to describe phenomena similar to Ambulance R ing, where there is a delay in patient handover from paramedics to ED clinicians. Antecedents of Ambulance R ing included reduction/limitation of ambulance ersion, patient acuity, the time of day, the day of the week, insufficient ED staff, insufficient ED beds, and high ED workload. Consequences of Ambulance R ing include: further delays in patients' ability to receive definitive care and workforce stressors such as missed meal breaks, sick leave and staff attrition. While the existing research literature indicates that Ambulance R ing is problematic, little is known about the patient's experience of Ambulance R ing this is required so that an enhanced understanding of its implications, including those for emergency nurses, can be identified.
Publisher: Emerald
Date: 07-08-2017
DOI: 10.1108/JHLSCM-02-2017-0003
Abstract: Whilst there is a growing body of research which discusses the use of remotely piloted aircraft systems (RPAS) (otherwise known as “drones”) to transport medical supplies, almost all reported cases employ short range aircraft. The purpose of this paper is to consider the advantages and challenges inherent in the use of long endurance remotely piloted aircraft systems (LE-RPAS) aircraft to support the provision of medical supplies to remote locations – specifically “medical maggots” used in maggot debridement therapy (MDT) wound care. After introducing both MDT and the LE-RPAS technology, the paper first reports on the outcomes of a case study involving 11 semi-structured interviews with in iduals who either have experience and expertise in the use of LE-RPAS or in the provision of healthcare to remote communities in Western Australia. The insights gained from this case study are then synthesised to assess the feasibility of LE-RPAS assisted delivery of medical maggots to those living in such geographically challenging locations. No insuperable challenges to the concept of using LE-RPAS to transport medical maggots were uncovered during this research – rather, those who contributed to the investigations from across the spectrum from operators to users, were highly supportive of the overall concept. The paper offers an assessment of the feasibility of the use of LE-RPAS to transport medical maggots. In doing so, it highlights a number of infrastructure and organisational challenges that would need to be overcome to operationalise this concept. Whilst the particular context of the paper relates to the provision of medical support to a remote location of a developed country, the core benefits and challenges that are exposed relate equally to the use of LE-RPAS in a post-disaster response. To this end, the paper offers a high-level route map to support the implementation of the concept. The paper proposes a novel approach to the efficient and effective provision of medical care to remote Australian communities which, in particular, reduces the need to travel significant distances to obtain treatment. In doing so, it emphasises the importance in gaining acceptance of both the use of MDT and also the operation of RPAS noting that these have previously been employed in a military, as distinct from humanitarian, context. The paper demonstrates how the use of LE-RPAS to support remote communities offers the potential to deliver healthcare at reduced cost compared to conventional approaches. The paper also underlines the potential benefits of the use of MDT to address the growing wound burdens in remote communities. Finally, the paper expands on the existing discussion of the use of RPAS to include its capability to act as the delivery mechanism for medical maggots.
Publisher: MDPI AG
Date: 17-08-2023
DOI: 10.3390/TROPICALMED8080418
Abstract: This systematised review aims to compare the epidemiological patterns of Hajj-acquired airborne infections among pilgrims from low and middle-income countries (LMIC) versus those from high-income countries (HIC). A PubMed search was carried out for all published articles before February 2023, using a combination of MeSH terms and text words. The Newcastle–Ottawa Scale (NOS) was used to assess data quality. From a total of 453 titles identified, 58 studies were included in the review (LMIC = 32, and HIC = 26). In the pooled s le, there were 27,799 pilgrims aged 2 days to 105 years (male: female = 1.3:1) from LMIC and 70,865 pilgrims aged 2 months to 95 years (male: female = 1:1) from HIC. Pilgrims from both HIC and LMIC had viral and bacterial infections, but pilgrims from HIC tended to have higher attack rates of viral infections than their LMIC counterparts. However, the attack rates of bacterial infections were variable: for instance, pilgrims from LMIC seemed to have higher rates of meningococcal infections (0.015–82% in LMIC vs. 0.002–40% in HIC) based on the study population, but not Mycobacterium tuberculosis (0.7–20.3% in LMIC vs. 38% in HIC). Targeted measures are needed to prevent the spread of airborne infections at Hajj.
Publisher: Wiley
Date: 2021
DOI: 10.1111/IMJ.15105
Publisher: Elsevier BV
Date: 05-2009
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.AENJ.2015.08.003
Abstract: Internationally, the workload of emergency departments (ED) has increased, resulting in overcrowding and frequent delays in the offloading of patients arriving via ambulance--referred to in Australia as 'ambulance r ing'. Using interpretive phenomenology, this study sought to understand the experience of ambulance r ing from the perspective of patients. Semi-structured interviews were undertaken with seven patients who presented to a regional Queensland ED via ambulance, and experienced an ambulance offload delay of >30 min. Ambulance r ing in the ED was described as 'Being a patient, patient', and three major themes emerged: Understanding the emergency healthcare system Making do within the emergency healthcare system and Being 'in the dark' during ambulance r ing. Most participants did not understand the antecedents to ambulance r ing, but understood some of the consequences. Most were happy to wait with paramedics for a bed and, although without privacy, felt safe. However, most participants felt 'in the dark' during ambulance r ing, due to communication difficulties regarding bed availability, and this led to frustration. In light of the Australian Charter of Healthcare Rights, service improvement opportunities exist for patients arriving to the ED by ambulance to ensure delays are minimised and quality care is delivered.
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.AENJ.2015.08.002
Abstract: Presentations to emergency departments (EDs) and patient acuity continue to increase. Whilst strategies to deliver safe patient care in the ED are evolving, emergency nurses need to be well educated through specialist qualifications to enable delivery of advanced patient care. This paper presents a comparative analysis of available international practice and competency standards for nurses graduating from emergency nursing courses in Australia, Canada, New Zealand, the United Kingdom, and the United States. CINAHL, Scopus, Ovid MEDLINE, and Embase were searched for papers, published in English, using the terms: 'emergency', 'accident and emergency', 'nursing', 'competency', 'practice standards', 'scope of practice', 'regulation', and 'specialist standards'. Secondary sources from relevant reference lists and professional websites were also searched. The standards from the five countries were common across five domains: clinical expertise, communication, teamwork, resources and environment, and legal. None of the standards were specific to the emergency nursing graduate, and there was variability in the level of expertise required for which the standards apply. The available practice standards demonstrated some commonality. Consideration of the utility of a universal framework for informing the development of emergency nursing practice standards and emergency nursing curriculum for nurses wishing to specialise is needed.
Publisher: Elsevier BV
Date: 11-2020
Publisher: RCN Publishing Ltd.
Date: 05-2013
DOI: 10.7748/NR2013.05.20.5.21.E324
Abstract: To provide an overview of governance issues relating to medical-device trials and practical advice for nurses wishing to initiate or lead them. Medical-device trials, which are formal research studies that examine the benefits and risks of therapeutic medical devices, have traditionally been the domain of physicians and scientists. The role of nurses in these trials has historically been as data collectors or co-ordinators rather than as principal investigators. However, nurses have more recently played an increasing role in initiating and leading medical device trials. A review article of nurse-led trials of medical devices. DISCUSION: Central to the quality and safety of all clinical trials is adherence to the International Conference on Harmonisation Guidelines for Good Clinical Practice, which is the interationally agreed standard for the ethically and scientifically sound design, conduct and monitoring of a medical-device trial, as well as the analysis, reporting and verification of the data derived from that trial. Considerations include the class of the medical device, type of trial, regulatory status of the device, implementation of standard operating procedures, obligations of the trial sponsor, indemnity of relevant parties, scrutiny of the trial conduct, trial registration, and reporting and publication of the results. Nurse-led trials of medical devices are demanding but rewarding research enterprises. As nursing practice and research increasingly embrace technical interventions, it is vital that nurse researchers contemplating such trials understand and implement the principles of good clinical practice to protect study participants and the research team.
Publisher: Elsevier BV
Date: 09-2011
DOI: 10.1071/HI11001_CO
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1071/HI15007
Publisher: Elsevier BV
Date: 02-0011
Publisher: Elsevier BV
Date: 08-2019
Publisher: Elsevier BV
Date: 09-2015
DOI: 10.1071/HI15008
Publisher: Elsevier BV
Date: 08-2019
DOI: 10.1016/J.IDH.2019.01.002
Abstract: Hand hygiene with ABHR is more effective, time-saving and skin-friendly than traditional handwashing. However, alcohol-based hand rub (ABHR) use can be an obstacle for specific religions. The study aimed to test the effect of a modified hand hygiene program featuring religion-relevant, culturally-specific interventions on compliance and beliefs about ABHR use. A cohort study design was employed between August and November 2017 at a large tertiary hospital in the United Arab Emirates. Hand hygiene audit data and a cross-sectional survey were used to measure the impact of the modified hand hygiene program on compliance with, and beliefs about, ABHR use. The intervention group had higher mean compliance with overt (p = 0.002) and covert (p = 0.04) ABHR use post-intervention, and higher mean compliance with overt ABHR use (p = 0.002) than the control group. The intervention group had more positive religious beliefs (p = 0.01) about ABHR use than the control group. Implementing a hand hygiene program featuring tailored religion-relevant interventions in a culturally appropriate way had a positive effect on compliance with, and beliefs about, ABHR use.
Publisher: Wiley
Date: 10-02-2012
DOI: 10.1111/J.1742-6723.2011.01519.X
Abstract: To describe the reported impact of Pandemic (H(1)N(1) ) 2009 on EDs, so as to inform future pandemic policy, planning and response management. This study comprised an issue and theme analysis of publicly accessible literature, data from jurisdictional health departments, and data obtained from two electronic surveys of ED directors and ED staff. The issues identified formed the basis of policy analysis and evaluation. Pandemic (H(1)N(1) ) 2009 had a significant impact on EDs with presentation for patients with 'influenza-like illness' up to three times that of the same time in previous years. Staff reported a range of issues, including poor awareness of pandemic plans, patient and family aggression, chaotic information flow to themselves and the public, heightened stress related to increased workloads and lower levels of staffing due to illness, family care duties and redeployment of staff to flu clinics. Staff identified considerable discomfort associated with prolonged times wearing personal protective equipment. Staff believed that the care of non-flu patients was compromised during the pandemic as a result of overwork, distraction from core business and the difficulties associated with accommodating infectious patients in an environment that was not conducive. This paper describes the breadth of the impact of pandemics on ED operations. It identifies a need to address a range of industrial, management and procedural issues. In particular, there is a need for a single authoritative source of information, the re-engineering of EDs to accommodate infectious patients and organizational changes to enable rapid deployment of alternative sources of care.
Publisher: Elsevier BV
Date: 02-2009
Publisher: Elsevier BV
Date: 06-2012
DOI: 10.1071/HI12017
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.INJURY.2022.04.024
Abstract: Blunt chest injury in older adults, aged 65 years and older, leads to significant morbidity and mortality. The aim of this study was to evaluate the effect of a multidisciplinary chest injury care bundle (ChIP) on patient and health service outcomes in older adults with blunt chest injury. ChIP comprised multidimensional implementation guidance in three key pillars of care for blunt chest injury: respiratory support, analgesia, and complication prevention. Implementation was guided using the Behaviour Change Wheel. This proof-of-concept controlled pre- and post-test study with two intervention and two control sites in Australia was conducted from July 2015 to June 2019. The primary outcomes were non-invasive ventilation (NIV) use, unplanned Intensive Care Unit (ICU) admissions, and in-hospital mortality. Secondary outcomes were health service and costing outcomes. There were 1122 patients included in the analysis, with 673 at intervention sites (331 pre-test and 342 post-test) and 449 at control sites (256 pre-test and 193 post-test). ChIP was associated with unplanned ICU admissions and in NIV use with a reduction of the odds in the post vs the pre periods in the intervention sites when compared to the controls (ratio of OR=0.13, 95%CI=0.03-0.55) and (ratio of OR=0.14, 95%CI=0.02-0.98) respectively. There was no significant change in mortality. Implementing ChIP was also associated with health service team reviews with an increased odds in the post vs pre periods in the intervention sites in comparison to the controls for surgical review (ratio of OR =6.93, 95%CI=4.70-10.28), ICU doctor (ratio of OR =5.06, 95%CI=2.26-9.25), ICU liaison (ratio of OR =14.14, 95%CI=3.15-63.31), and pain (ratio of OR =5.59, 95%CI=3.25-9.29). ChIP was also related to incentive spirometry (ratio of OR=6.35, 95%CI= 3.15-12.82) and overall costs (ratio of mean ratio=1.34, 95%CI=1.09-1.66) with a higher ratio for intervention sites. Implementation of ChIP using the Behaviour Change Wheel was associated with reduced unplanned ICU admissions and NIV use and improved health care delivery. ANZCTR: ACTRN12618001548224, approved 17/09/2018.
Publisher: Elsevier BV
Date: 05-2021
Publisher: Elsevier BV
Date: 2020
Publisher: Elsevier BV
Date: 02-2011
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.AENJ.2017.01.002
Abstract: Generating knowledge through quality research is fundamental to the advancement of professional practice in emergency nursing and care. There are multiple paradigms, designs and methods available to researchers to respond to challenges in clinical practice. Systematic reviews, randomised control trials and other forms of experimental research are deemed the gold standard of evidence, but there are comparatively few such trials in emergency care. In some instances it is not possible or appropriate to undertake experimental research. When exploring new or emerging problems where there is limited evidence available, non-experimental methods are required and appropriate. This paper provides the theoretical foundations and an exemplar of the use of case study and case-based research to explore a new and emerging problem in the context of emergency care. It examines pre-hospital clinical judgement and decision-making of mental illness by paramedics. Using an exemplar the paper explores the theoretical foundations and conceptual frameworks of case study, it explains how cases are defined and the role researcher in this form of inquiry, it details important principles and the procedures for data gathering and analysis, and it demonstrates techniques to enhance trustworthiness and credibility of the research. Moreover, it provides theoretically and practical insights into using case study in emergency care.
Publisher: Elsevier BV
Date: 06-2020
Publisher: SAGE Publications
Date: 21-11-2016
Abstract: Hand hygiene at key moments during patient care is considered an important infection prevention and control measure to reduce healthcare-associated infections. While there is extensive research in Western settings, there is little in the United Arab Emirates where particular cultural and religious customs are thought to influence hand hygiene behaviour. To examine the hand hygiene knowledge and beliefs of health professionals at a tertiary care hospital in the United Arab Emirates. A mixed methods design employed a survey followed by focus groups with nurses and doctors. A total of 109 participants (13.6%) completed the survey: 96 nurses (88%) and 13 doctors (12%). Doctors’ hand hygiene knowledge was slightly higher than that of nurses (78.5% versus 73.5%). There was no significant difference in scores on the hand hygiene beliefs scale between nurses (M = 103.06 SD = 8.0) and doctors (M = 99.00 SD = 10.53 t (80) = 1.55 p = 0.13, two-tailed). Seven categories emerged following transcript analysis. Hand hygiene knowledge scores suggest further hand hygiene education is required, especially on alcohol-based hand rub use. Addressing doctors’ beliefs is particularly important given the leadership roles that doctors play in healthcare settings.
Publisher: Elsevier BV
Date: 02-2017
DOI: 10.1016/J.AENJ.2017.01.001
Abstract: Research questions require specific data collection techniques to appropriately explore and understand the phenomena of interest. Observation as a term features commonly in the literature as a way to describe both the design of a study and methods deployed within procedures. Observation as a data collection method is a mode of inquiry to systematically collect information about different settings and groups. However, the objective of observation in data collection is to better understand the phenomena of interest situated in context. Specifically, observation data collection can improve understanding of practice, processes, knowledge, beliefs, and attitudes embedded in clinical work and social interactions. This pragmatic paper will assist emergency nurses and other clinicians to understand how observation can be used as a data collection method within clinical practice.
Publisher: Elsevier BV
Date: 04-2021
Publisher: Wiley
Date: 14-08-2012
DOI: 10.1111/J.1525-1446.2012.01045.X
Abstract: To investigate the health promotion and risk reduction behaviors of younger women previously treated for cancer. Guided by the "Precede-Proceed" framework, a mixed-method descriptive investigation of the health behaviors of younger women with cancer treatment-induced menopause in one health jurisdiction in Australia was undertaken. This article reports the results of the qualitative interview component of the study. Of the 85 women who responded to surveys that quantified their health behaviors, 22 consented to interviews that explored how and why these behaviors might occur. Several predisposing, enabling and reinforcing factors that influenced participants' will or ability to engage with health-promoting behaviors after cancer treatment were identified in the interviews. These include entrenched precancer diagnosis health behaviors, the disabilities resulting from cancer treatments, perceptions of risk, focused intervention by health professionals and the nature of participants' social support. The results indicate a need for flexibility when planning public health initiatives to prepare this cohort for a healthy life after cancer, which accounts for their developmental, knowledge and posttreatment needs.
Publisher: AMPCo
Date: 12-2012
DOI: 10.5694/MJA12.11460
Publisher: Wiley
Date: 06-2009
Publisher: Elsevier BV
Date: 05-2011
Publisher: Elsevier BV
Date: 02-2018
Publisher: Elsevier BV
Date: 04-2021
Publisher: Elsevier BV
Date: 08-2021
Publisher: Wiley
Date: 22-11-2016
DOI: 10.1111/JOCN.13586
Publisher: Elsevier BV
Date: 05-2013
DOI: 10.1016/J.AENJ.2013.04.002
Abstract: Emergency nurses play a pivotal role in disaster relief during the response to, and recovery of both in-hospital and out-of-hospital disasters. Postgraduate education is important in preparing and enhancing emergency nurses' preparation for disaster nursing practice. The disaster nursing content of Australian tertiary postgraduate emergency nursing courses has not been compared across courses and the level of agreement about suitable content is not known. To explore and describe the disaster content in Australian tertiary postgraduate emergency nursing courses. A retrospective, exploratory and descriptive study of the disaster content of Australian tertiary postgraduate emergency nursing courses conducted in 2009. Course convenors from 12 universities were invited to participate in a single structured telephone survey. Data was analysed using descriptive statistics. Ten of the twelve course convenors from Australian tertiary postgraduate emergency nursing courses participated in this study. The content related to disasters was varied, both in terms of the topics covered and duration of disaster content. Seven of these courses included some content relating to disaster health, including types of disasters, hospital response, nurses' roles in disasters and triage. The management of the dead and dying, and practical application of disaster response skills featured in only one course. Three courses had learning objectives specific to disasters. The majority of courses had some disaster content but there were considerable differences in the content chosen for inclusion across courses. The incorporation of core competencies such as those from the International Council of Nurses and the World Health Organisation, may enhance content consistency in curriculum. Additionally, this content could be embedded within a proposed national education framework for disaster health.
Publisher: Wiley
Date: 22-06-2020
DOI: 10.1111/JOCN.15365
Publisher: Elsevier BV
Date: 03-2020
Publisher: MDPI AG
Date: 16-10-2020
DOI: 10.3390/TROPICALMED5040160
Abstract: This study examined Hajj pilgrims’ knowledge and reported practice of hand hygiene. In Hajj 2019, a cross-sectional survey was undertaken in Mina, Makkah, Saudi Arabia, of domestic Saudi pilgrims aged ≥18 years by using a self-administered Arabic questionnaire that captured data on pilgrims’ socio-demographics, hand hygiene knowledge, and reported practices of hand cleaning following certain actions. A total of 348 respondents aged 18 to 63 (median 32) years completed the survey, of whom 200 (57.5%) were female. The mean (±standard deviation (SD)) hand hygiene knowledge score was 6.7 (±SD 1.9). Two hundred and seventy one (77.9%) and 286 (82.2%) of respondents correctly identified that hand hygiene can prevent respiratory and gastrointestinal infections respectively, but 146 (42%) were not aware that it prevents hand-foot-mouth disease. Eighty-eight (25.3%) respondents erroneously reported that hand hygiene prevents HIV. Washing hands with water and soap was the most preferred method practiced before a meal (67.5% (235/348)), after a meal (80.2% (279/348)), after toilet action (81.6% (284/348)), when hands were visibly soiled (86.2% (300/348)), and after waste disposal (61.5% (214/348)). Hajj pilgrims demonstrated a good knowledge and practice of hand hygiene, but there are gaps that are vital to control outbreaks such as COVID-19.
Publisher: Cambridge University Press (CUP)
Date: 09-12-2015
DOI: 10.1017/S1049023X15005427
Abstract: When disaster strikes, the number of patients requiring treatment can be overwhelming. In low-income countries, resources to assist the injured in a timely fashion may be limited. As a consequence, necrosis and wound infection in disaster patients is common and frequently leads to adverse health outcomes such as utations, chronic wounds, and loss of life. In such compromised health care environments, low-tech and cheap wound care options are required that are in ready supply, easy to use, and have multiple therapeutic benefits. Maggot debridement therapy (MDT) is one such wound care option and may prove to be an invaluable tool in the treatment of wounds post-disaster. This report provides an overview of the wound burden experienced in various types of disaster, followed by a discussion of current treatment approaches, and the role MDT may play in the treatment of complex wounds in challenging health care conditions. Maggot debridement therapy removes necrotic and devitalized tissue, controls wound infection, and stimulates wound healing. These properties suggest that medicinal maggots could assist health care professionals in the debridement of disaster wounds, to control or prevent infection, and to prepare the wound bed for reconstructive surgery. Maggot debridement therapy-assisted wound care would be led by health care workers rather than physicians, which would allow the latter to focus on reconstructive and other surgical interventions. Moreover, MDT could provide a larger window for time-critical interventions, such as fasciotomies to treat compartment syndrome and utations in case of life-threatening wound infection. There are social, medical, and logistic hurdles to overcome before MDT can become widely available in disaster medical aid. Thus, research is needed to further demonstrate the utility of MDT in Disaster Medicine. There is also a need for reliable MDT logistics and supply chain networks. Integration with other disaster management activities will also be essential. In the aftermath of disasters, MDT could play an important role facilitating timely and efficient medical treatment and improving patient outcomes. Existing social, medical, and logistic barriers will need to be overcome for MDT to be mainstreamed in Disaster Medicine. Stadler F , Shaban RZ , Tatham P . Maggot debridement therapy in Disaster Medicine . Prehosp Disaster Med . 2016 31 ( 1 ): 79 – 84 .
Publisher: SAGE Publications
Date: 02-02-2004
DOI: 10.33151/AJP.2.1.263
Abstract: Summary Paramedic judgment and decision-making, not unlike much of ambulance practice, have not been the subject of systematic, sustained research. There exists a paucity of research or inquiry that examines the mechanics of human error in paramedic practice, ambulance or pre-hospital settings. Little is known of how paramedics make judgments and decisions, and how paramedics deal with risk and uncertainty they commonly face in their tasks and the environment in which they work in. The literature and theories on judgment and decisionmaking are as extensive as they are controversial and the scientific community is yet to obtain a comprehensive understanding of the risk and uncertainty in judgment and decisionmaking. The following paper provides an introduction to the concepts of error, risk, and uncertainty in the context of paramedic judgment and decision-making, discussion of two analytic frameworks that examine such error, risk, and uncertainty, and commentary on their application to the paramedic setting.
Publisher: Cambridge University Press (CUP)
Date: 22-05-2020
DOI: 10.1017/ICE.2020.184
Abstract: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). Integrative review. A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). In total, we reviewed 125 documented outbreaks of Burkholderia cepacia –related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93 74.4%) they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.
Publisher: Springer Science and Business Media LLC
Date: 22-05-2021
DOI: 10.1186/S13049-021-00882-6
Abstract: Assessing and managing the risk of clinical deterioration is a cornerstone of emergency care, commencing at triage and continuing throughout the emergency department (ED) care. The aim of this scoping review was to assess the extent, range and nature of published research related to formal systems for recognising and responding to clinical deterioration in emergency department (ED) patients. We conducted a scoping review according to PRISMA-ScR guidelines. MEDLINE complete, CINAHL and Embase were searched on 07 April 2021 from their dates of inception. Human studies evaluating formal systems for recognising and responding to clinical deterioration occurring after triage that were published in English were included. Formal systems for recognising and responding to clinical deterioration were defined as: i) predefined patient assessment criteria for clinical deterioration (single trigger or aggregate score), and, or ii) a predefined, expected response should a patient fulfil the criteria for clinical deterioration. Studies of short stay units and observation wards deterioration during the triage process system or score development or validation and systems requiring pathology test results were excluded. The following characteristics of each study were extracted: author(s), year, design, country, aims, population, system tested, outcomes examined, and major findings. After removal of duplicates, there were 2696 publications. Of these 33 studies representing 109,066 patients were included: all were observational studies. Twenty-two aggregate scoring systems were evaluated in 29 studies and three single trigger systems were evaluated in four studies. There were three major findings: i) few studies reported the use of systems for recognising and responding to clinical deterioration to improve care of patients whilst in the ED ii) the systems for recognising clinical deterioration in ED patients were highly variable and iii) few studies reported on the ED response to patients identified as deteriorating. There is a need to re-focus the research related to use of systems for recognition and response to deteriorating patients from predicting various post-ED events to their real-time use to improve patient safety during ED care.
Publisher: Elsevier BV
Date: 05-2020
Publisher: Elsevier BV
Date: 2015
DOI: 10.1016/J.IENJ.2014.04.004
Abstract: Effective assessment and resuscitation of trauma patients requires an organised, multidisciplinary team. Literature evaluating leadership roles of nurses in trauma resuscitation and their effect on team performance is scarce. To assess the effect of allocating the most senior nurse as team leader of trauma patient assessment and resuscitation on communication, documentation and perceptions of leadership within an Australian emergency department. The study design was a pre-post-test survey of emergency nursing staff (working at resuscitation room level) perceptions of leadership, communication, and documentation before and after the implementation of a nurse leader role. Patient records were audited focussing on initial resuscitation assessment, treatment, and nursing clinical entry. Descriptive statistical analyses were performed. Communication trended towards improvement. All (100%) respondents post-test stated they had a good to excellent understanding of their role, compared to 93.2% pre-study. A decrease (58.1-12.5%) in 'intimidating personality' as a negative aspect of communication. Nursing leadership had a 6.7% increase in the proportion of those who reported nursing leadership to be good to excellent. Accuracy of clinical documentation improved (P = 0.025). Trauma nurse team leaders improve some aspects of communication and leadership. Development of trauma nurse leaders should be encouraged within trauma team training programmes.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 10-2019
Publisher: MDPI AG
Date: 14-01-2021
Abstract: This study aimed to assess hand hygiene knowledge, perception, and practices of visitors to the Prophet’s Mosque in Al Madinah City, Saudi Arabia. Using a self-administered electronic questionnaire, a cross-sectional survey was conducted among domestic residents, who visited the mosque between 31 July and 3 August 2020. Participants’ demographic data, hand hygiene knowledge, perception, and practices were collected. Four hundred participants aged 18–65 (median 36) years completed the survey, of which 215 (53.8%) were female. The visitors’ mean knowledge score about hand hygiene was 6.4 (± standard deviation (SD) 1.35) of total 12. Most participants (392, 98%) were aware of the role of hand hygiene in preventing Coronavirus Disease 2019 (COVID-19) nevertheless, 384 (96%) said hand hygiene lowers body immunity and 316 (79%) thought % alcohol is sufficient for hand disinfection. Males had a higher knowledge score than females (6.46 (±1.41) vs. 6.14 (±1.27), p = 0.02) and, visitors who had no formal education scored higher than those with post-graduate education (6.88 (±1.45) vs 5.73 (±1.12), p = 0.01). Washing hands with soap and water was the predominant method practiced after a meal (365, 91.7%), after toilet visit (354, 88.5%), after touching a surface (262, 65.7%), after waste disposal (332, 83.2%), and when hands were visibly dirty (357, 89.5%). Al Madinah visitors had moderate knowledge about hand hygiene, but demonstrated some knowledge gaps and negligence in practice that are crucial to curb the spread of COVID-19.
Publisher: Elsevier BV
Date: 08-2010
Publisher: Mark Allen Group
Date: 02-09-2015
DOI: 10.12968/BJCN.2015.20.9.451
Abstract: The aim of this case study was to explore the environmental challenges nurses experience with infection control practice, and the strategies they use to overcome those challenges. An exploratory case study was conducted in four home visiting nursing organisations in southeast Queensland, Australia, using data triangulation (document review, in idual interviews, and focus groups). Data were analysed using a framework approach to identify themes. Three major infection prevention and control challenges were experienced in the community context. The first challenge is the nature of the work environment, including: poor cleanliness in clients' home environments, pets or vermin, inadequate hand-washing facilities, and a lack of appropriate storage space for clinical materials. The second challenge occurs when nurses lack access to appropriate infection control equipment, including wound-management materials and sharps containers. The third challenge is dealing with clients' poor personal hygiene and health status. Participants addressed these issues by offering assistance, using clean surfaces at clients' homes, applying an alcohol-based hand rub, providing client education, and reducing the cost of purchasing equipment for clients. It is imperative that policy is developed to support nurses' decision making and practices as they address infection control challenges in the community environment. Ensuring staff are well-supported with resources, education, policy, and guidelines to address these challenges is important for the delivery of safe and high-quality care in community settings.
Publisher: Elsevier BV
Date: 04-2022
Publisher: Elsevier BV
Date: 03-2022
DOI: 10.1016/J.AUCC.2021.04.003
Abstract: Ineffective intervention for patients with blunt chest wall injury results in high rates of morbidity and mortality. To address this, a blunt chest injury care bundle protocol (ChIP) was developed, and a multifaceted plan was implemented using the Behaviour Change Wheel. The purpose of this study was to evaluate the reach, fidelity, and dose of the ChIP intervention to discern if it was activated and delivered to patients as intended at two regional Australian hospitals. This is a pretest and post-test implementation evaluation study. The proportion of ChIP activations and adherence to ChIP components received by eligible patients were compared before and after intervention over a 4-year period. S le medians were compared using the nonparametric median test, with 95% confidence intervals. Differences in proportions for categorical data were compared using the two-s le z-test. Over the 19-month postimplementation period, 97.1% (n = 440) of eligible patients received ChIP (reach). The median activation time was 134 min there was no difference in time to activation between business hours and after-hours time to activation was not associated with comorbidities and injury severity score. Compared with the preimplementation group, the postimplementation group were more likely to receive evidence-based treatments (dose), including high-flow nasal cannula use (odds ratio [OR] = 6.8 [95% confidence interval {CI} = 4.8-9.6]), incentive spirometry in the emergency department (OR = 7.5, [95% CI = 3.2-17.6]), regular analgesia (OR = 2.4 [95% CI = 1.5-3.8]), regional analgesia (OR = 2.8 [95% CI = 1.5-5.3]), patient-controlled analgesia (OR = 1.8 [95% CI = 1.3-2.4]), and multiple specialist team reviews, e.g., surgical review (OR = 9.9 [95% CI = 6.1-16.1]). High fidelity of delivery was achieved and sustained over 19 months for implementation of a complex intervention in the acute context through a robust implementation plan based on theoretical frameworks. There were significant and sustained improvements in care practices known to result in better patient outcomes. Findings from this evaluation can inform future implementation programs such as ChIP and other multidisciplinary interventions in an emergency or acute care context.
Publisher: Elsevier BV
Date: 2023
DOI: 10.1016/J.AJIC.2022.03.010
Abstract: Hand hygiene is key to preventing health care-associated infections. Human observation is the gold standard for measuring compliance, but its utility is increasingly being questioned with calls for the use of video monitoring approaches. The utility of video-based systems to measure compliance according to the WHO 5 moments is largely unexamined, as is its acceptability amongst health care workers (HCW) and patients. This study examined HCW acceptability of video monitoring for hand hygiene auditing. Following trial of a video monitoring system (reported elsewhere), 5 participating HCW attended 2 in-depth group interviews where they reviewed the footage and explored responses to the approach. Transcripts were analyzed using thematic analysis. Four themes were identified: 1) Fears 2) Concerns for patients 3) Changes to feedback and 4) Behavioral responses to the cameras. HCWs expressed fears of punitive consequences, data security, and confidentiality. For patients, HCWs raised issues regarding invasion of privacy, ethics, and consent. HCWs suggested that video systems may result in less immediate feedback but also identified potential to use the footage for feedback. They also suggested that the Hawthorne Effect was less potent with video systems than human observation. The acceptability of video monitoring systems for hand hygiene compliance is complex and has the potential to complicate practical implementation. Additionally, exploration of the acceptability to patients is warranted. COREQ.
Publisher: Elsevier BV
Date: 2022
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AENJ.2011.11.003
Abstract: It is well established that pain is the most common presenting complaint in Emergency Departments. Despite great improvements in available pain management strategies, patients are left waiting for longer than 60min for pain relief on arrival to the emergency department. The aim of this study was to describe interventions that lead to successful implementation of the National Health and Medical Research Council approved guidelines Acute Pain Management: Scientific Evidence (2nd Edition) that include specific recommendations for best practice pain management. A two-phased, mixed-method, exploratory study of all 52 Australian hospital emergency departments participating in the National Emergency Care Pain Management Initiative incorporating interview and document analysis was undertaken. Interventions used by clinicians to improve pain management included nurse initiated analgesia, intranasal fentanyl for paediatric patients and lignocaine, and facio illiaca block. Education formed a major part of the intervention and the development of a working group of key stakeholders was critical in the successful implementation of change. Staff perceptions of patients' pain level and attitudes toward pain assessment and pain management were identified as barriers. This study highlighted how an effective framework to plan and implement practice change and tailored interventions, including education and training systems and products using the best available evidence, best equipped clinicians to manage pain in the ED.
Publisher: Elsevier BV
Date: 09-2020
Publisher: Elsevier BV
Date: 2020
DOI: 10.1016/J.INJURY.2019.09.033
Abstract: The Australia New Zealand Trauma Registry enables the collection and analysis of standardised data about trauma patients and their care for quality improvement, injury prevention and benchmarking. Little is known, however, about the needs of providers and clinicians in relation to these data, or their views on trauma quality improvement priorities. As clinical experts, trauma clinicians should have input to these as ultimately their practice may be influenced by report findings. This paper presents the perspectives of multidisciplinary trauma care professionals in Australia and New Zealand about the use of the Australia New Zealand Trauma Registry data and trauma quality improvement priorities. An exploratory survey of trauma professionals from relevant Australia and New Zealand professional organisations was conducted using the Snowballing Method between September 2018 and February 2019. Participants were recruited via a non-random s ling technique to complete an online survey. Descriptive statistical and content analyses were conducted. The data use priorities identified by 102 trauma professionals from a range of locations participated were clinical improvement and system rocess improvement (86.3%). Participants reported that access to trauma data should primarily be for clinicians (93.1%) and researchers (87.3%). Having a standardised approach to review trauma cases across hospitals was a priority in trauma quality improvement. Trauma registry data are under-utilised and their use to drive clinical improvement and system rocess improvement is fundamental to trauma quality improvement in Australia and New Zealand.
Publisher: Springer Science and Business Media LLC
Date: 08-2020
DOI: 10.1186/S13643-020-01426-2
Abstract: Psychological stress is a prevalent factor in inflammatory bowel disease (IBD) with detrimental effects on patients’ quality of life and possibly disease course. Although the aetiology of symptom exacerbation in IBD has been explored, determining any causation between psychological stress and symptom worsening remains challenging and requires a methodologically rigorous approach. The aim of this systematic review with meta-analysis was to determine a causal relationship between psychological stress and symptom exacerbation in IBD, subsequently utilising Bradford Hill’s criteria (approach never used in this topic area before) to evaluate the likelihood of causal associations. Medline, EMBASE, CINAHL and PsycInfo were searched for relevant studies up to July 20, 2019. Data extraction and quality appraisal were performed by two independent reviewers. Results of all retained papers were presented as a narrative synthesis. A random-effect meta-analysis was conducted on studies meeting the criteria for meta-analysis. Bradford Hill criteria were applied to assess the causality of the relationship between all psychological factors and symptom exacerbation. The searches yielded 2472 potential articles. Nineteen clinical prospective cohort studies were eligible for the narrative review with five suitable for the meta-analysis. Meta-analysis showed depression, anxiety and perceived stress did not have a statistically significant association with an increased risk of symptom exacerbation. Four of the Bradford Hill criteria were met which indicates that there is weak to moderate evidence of a causal association between all the psychological factors and disease activity. Inconsistent results and a dearth of studies using the same tools for measuring psychological factors suggest the need for more research to be done to facilitate more conclusive findings. This original review utilising Bradford Hill criteria in addition to meta-analysis to evaluate the causality of relationship between psychological factors and symptom exacerbation in IBD provides evidence that psychological factors have a weak to moderate causal involvement in IBD symptom exacerbation. However, when combining this finding with the outcomes of the meta-analysis, we can say that the results were inconclusive . Interventions to reduce the associated psychological impact should be part of the treatment plan for patients with IBD. PROSPERO CRD42012003143
Publisher: Elsevier BV
Date: 03-2012
DOI: 10.1071/HI12001
Start Date: 2017
End Date: 07-2018
Amount: $510,000.00
Funder: Australian Research Council
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