ORCID Profile
0000-0002-8879-0486
Current Organisations
University of Wollongong
,
South Western Sydney Local Health District
,
Liverpool Hospital
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Related Links
Publications
Value of Web-Based Learning Activities for Nursing Students Who Speak English as a Second Language
Publisher: SLACK, Inc.
Date: 07-2011
DOI: 10.3928/01484834-20110331-02
Abstract: There is an increasing need to address the educational needs of students with English as a second language. The authors assessed the value of a Web-based activity to meet the needs of students with English as a second language in a bioscience subject. Using telephone contact, we interviewed 21 Chinese students, 24 non-Chinese students with English as a second language, and 7 native English-speaking students to identify the perception of the value of the intervention. Four themes emerged from the qualitative data: (1) Language is a barrier to achievement and affects self-confidence (2) Enhancement intervention promoted autonomous learning (3) Focusing on the spoken word increases interaction capacity and self-confidence (4) Assessment and examination drive receptivity and sense of importance. Targeted strategies to promote language acculturation and acquisition are valued by students. Linking language acquisition skills to assessment tasks is likely to leverage improvements in competence.
Central venous catheter insertion by a clinical nurse consultant or anaesthetic medical staff: a single-centre observational study
Publisher: Elsevier BV
Date: 06-2010
Importance of Predictors of Rehospitalisation in Heart Failure: A Survey of Heart Failure Experts
Publisher: Elsevier BV
Date: 03-2013
DOI: 10.1016/J.HLC.2012.05.008
Abstract: We investigated the opinion of clinical experts and researchers involved in chronic heart failure disease management regarding the ranking of patient, provider and system factors that predict the risk of rehospitalisation. Item generation for the online survey was informed by a literature review and current risk prediction models. Consultation with experts was undertaken via a secure online survey platform. Invitations to participate in the 10 question online survey were sent through Listserves of professional nursing and medical associations within Australia and New Zealand. Data were collected in August 2011. A total of 119 respondents completed the survey. Respondents ranged from researchers, registered nurses, cardiologists and allied health personnel. A mean importance score was used to rank risk factors for rehospitalisation. Risk factors that scored high for predicting the risk for rehospitalisation included poor adherence to medications (9.04) and prior hospitalisation for heart failure (8.33). Having private health insurance (4.8) and being female (4.9) scored lower in influencing rehospitalisation for adults with heart failure. No new risk factors were identified from the experts in predicting the risk of rehospitalisation. The survey results will contribute to the development of a nomogram to convey prognostic information related to adults with heart failure that will guide clinicians in management decisions.
The ACCELERATE Plus (assessment and communication excellence for safe patient outcomes) Trial Protocol: a stepped-wedge cluster randomised trial, cost-benefit analysis, and process evaluation
Publisher: Springer Science and Business Media LLC
Date: 21-08-2023
DOI: 10.1186/S12912-023-01439-X
Abstract: Nurses play an essential role in patient safety. Inadequate nursing physical assessment and communication in handover practices are associated with increased patient deterioration, falls and pressure injuries. Despite internationally implemented rapid response systems, falls and pressure injury reduction strategies, and recommendations to conduct clinical handovers at patients’ bedside, adverse events persist. This trial aims to evaluate the effectiveness, implementation, and cost–benefit of an externally facilitated, nurse-led intervention delivered at the ward level for core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication. We hypothesise the trial will reduce medical emergency team calls, unplanned intensive care unit admissions, falls and pressure injuries. A stepped-wedge cluster randomised trial will be conducted over 52 weeks. The intervention consists of a nursing core physical assessment, structured patient-centred bedside handover and improved multidisciplinary communication and will be implemented in 24 wards across eight hospitals. The intervention will use theoretically informed implementation strategies for changing clinician behaviour, consisting of: nursing executive site engagement a train-the-trainer model for cascading facilitation embedded site leads nursing unit manager leadership training nursing and medical ward-level clinical ch ions ward nurses’ education workshops intervention tailoring and reminders. The primary outcome will be a composite measure of medical emergency team calls (rapid response calls and ‘Code Blue’ calls), unplanned intensive care unit admissions, in-hospital falls and hospital-acquired pressure injuries these measures in idually will also form secondary outcomes. Other secondary outcomes are: i) patient-reported experience measures of receiving safe and patient-centred care, ii) nurses’ perceptions of barriers to physical assessment, readiness to change, and staff engagement, and iii) nurses’ and medical officers’ perceptions of safety culture and interprofessional collaboration. Primary outcome data will be collected for the trial duration, and secondary outcome surveys will be collected prior to each step and at trial conclusion. A cost–benefit analysis and post-trial process evaluation will also be undertaken. If effective, this intervention has the potential to improve nursing care, reduce patient harm and improve patient outcomes. The evidence-based implementation strategy has been designed to be embedded within existing hospital workforces if cost-effective, it will be readily translatable to other hospitals nationally. Australian New Zealand Clinical Trials Registry ID: ACTRN12622000155796. Date registered: 31/01/2022.
An Absolute Risk Prediction Model to Determine Unplanned Cardiovascular Readmissions for Adults with Chronic Heart Failure
Publisher: Elsevier BV
Date: 11-2015
DOI: 10.1016/J.HLC.2015.04.168
Abstract: Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF. An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed. Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age living alone (HR 1.09, 95% CI 0.74-1.59) those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to in iduals with one documented co-morbidity). The C-statistic of the final model was 0.80. We have developed a practical model for in idualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.
Determination of future health status expectation in rheumatoid arthritis
Publisher: Elsevier BV
Date: 04-1997
DOI: 10.1016/S0022-3999(96)00358-3
Abstract: While examining the relationship between, neuroticism, somatic factors and future health status expectation in rheumatoid arthritis (RA) patients, the present study found a considerable level of pessimism in patients, which may be related to perceived limitation of the quality of life. However, psychosocial disposition (i.e., neuroticism) did not prove to be a crucial factor by which RA patients assessed their future health status expectation. These results may be important in future treatment procedures.
Unique Layer-Doping-Induced Regulation of Charge Behavior in Metal-Free Carbon Nitride Photoanodes for Enhanced Performance
Publisher: Wiley
Date: 13-12-2020
Abstract: Photoinduced charge carrier behavior is critical in determining photoelectrocatalytic activity. In this study, a unique layer-doped metal-free polymeric carbon nitride (C
Uncertain effects of calcium and vitamin D supplementation on fracture risk reduction
Publisher: Springer Science and Business Media LLC
Date: 30-03-2016
Risk factors for in-hospital post-hip fracture mortality.
Publisher: Elsevier BV
Date: 09-2011
Long term trends in medical emergency team activations and outcomes
Publisher: Elsevier BV
Date: 08-2014
DOI: 10.1016/J.RESUSCITATION.2014.04.010
Abstract: . To analyze long-term medical emergency team (MET) operational trends including number of MET calls, trigger criteria for activation and clinical outcomes at a tertiary level, university hospital with a mature MET system. The characteristics of 19,030 MET calls between 2000 and 2012 were analyzed in a single-centre, retrospective observational study. Rates indexed per 1000 hospital admissions for MET calls, cardiac arrests, unplanned admissions to the intensive care unit (ICU) and hospital mortality were used as performance measures of the MET. Descriptive statistics (mean±standard deviation) were applied and trends analyzed by one-way ANOVA with year 2000 set as the baseline using Dunn's correction for multiple comparisons, p<0.05. Activations of the MET increased between 2000 and 2012 (19±3-30±4) and there were changes in reasons for activations over time. Clinical concern (worried) was the most common (22%) trigger criterion in 2000 followed by hypotension (21%) and decreased level of consciousness (17%). In 2012, hypotension was the most common trigger (32%), followed by decreased level of consciousness (19%) and clinical concern (15%). Rates of cardiorespiratory arrest (1.4±0.7-1.1±0.4) and unplanned ICU admission (5.0±1.2-5.9±1.0) did not change between 2000 and 2012. Hospital mortality decreased from 2005 onwards (15±3.4-12±2.2). MET activity progressively increased during the study period and there was a change in pattern of specific triggering criteria. The sustained decrease in hospital mortality independent of cardiac arrest and unplanned ICU admissions rates suggests patient benefit from the MET system.
Target temperature management following cardiac arrest: a systematic review and Bayesian meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 12-03-2022
DOI: 10.1186/S13054-022-03935-Z
Abstract: Temperature control with target temperature management (TTM) after cardiac arrest has been endorsed by expert societies and adopted in international clinical practice guidelines but recent evidence challenges the use of hypothermic TTM. Systematic review and Bayesian meta-analysis of clinical trials on adult survivors from cardiac arrest undergoing TTM for at least 12 h comparing TTM versus no TTM or with a separation 2 °C between intervention and control groups using the PubMed/MEDLINE, EMBASE, CENTRAL databases from inception to 1 September 2021 (PROSPERO CRD42021248140). All randomised and quasi-randomised controlled trials were considered. The risk ratio and 95% confidence interval for death (primary outcome) and unfavourable neurological recovery (secondary outcome) were captured using the original study definitions censored up to 180 days after cardiac arrest. Bias was assessed using the updated Cochrane risk-of-bias for randomised trials tool and certainty of evidence assessed using the Grading of Recommendation Assessment, Development and Evaluation methodology. A hierarchical robust Bayesian model-averaged meta-analysis was performed using both minimally informative and data-driven priors and reported by mean risk ratio (RR) and its 95% credible interval (95% CrI). In seven studies (three low bias, three intermediate bias, one high bias, very low to low certainty) recruiting 3792 patients the RR by TTM 32–34 °C was 0.95 [95% CrI 0.78—1.09] for death and RR 0.93 [95% CrI 0.84—1.02] for unfavourable neurological outcome. The posterior probability for no benefit (RR ≥ 1) by TTM 32–34 °C was 24% for death and 12% for unfavourable neurological outcome. The posterior probabilities for favourable treatment effects of TTM 32–34 °C were the highest for an absolute risk reduction of 2–4% for death (28–53% chance) and unfavourable neurological outcome (63–78% chance). Excluding four studies without active avoidance of fever in the control arm reduced the probability to achieve an absolute risk reduction 2% for death or unfavourable neurological outcome to ≤ 50%. The posterior probability distributions did not support the use of TTM at 32–34 °C compared to 36 °C also including active control of fever to reduce the risk of death and unfavourable neurological outcome at 90–180 days. Any likely benefit of hypothermic TTM is smaller than targeted in RCTs to date.
Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis.
Publisher: Wiley
Date: 08-03-2022
DOI: 10.1111/AJAG.13051
Abstract: To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients. A systematic search of health-care databases was undertaken. Given the frequency of small s le sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels. Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively. The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients.
Frailty, delirium and hospital mortality of older adults admitted to intensive care, a mediation analysis: the Delirium (Deli) in ICU study.
Publisher: Research Square Platform LLC
Date: 05-08-2020
DOI: 10.21203/RS.3.RS-52423/V1
Abstract: Background As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of frail patients an acute episode of delirium is also common, and both frailty and delirium increase the risk of mortality. However, the complex relationship between frailty, delirium and mortality has not been extensively explored in the intensive care setting. Therefore, the aim of this study was to explore the relationship between clinical frailty, acute delirium and hospital mortality of older adults admitted to intensive care. Methods This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the South Western Sydney Local Health District, between May 2019 and April 2020. During the initial 6-month baseline period, clinical frailty status on admission to ICU, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of ICU and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty, delirium and risk of hospital death. Results During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63–79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio ( adj RR) = 1.61, 95% Confidence Interval (CI) 1.14–2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adj RR = 2.43, 95% CI 1.68–3.57, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the ICU had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU ( p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2–24%). Conclusion This study has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the ICU did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the ICU setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.
Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.
Publisher: Research Square Platform LLC
Date: 02-09-2020
DOI: 10.21203/RS.3.RS-52423/V2
Abstract: Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1 st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Mediation analysis was used to assess the relationship between frailty and increased risk of hospital death and delirium. Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio ( adj RR) = 1.61, 95% Confidence Interval (CI) 1.14 – 2.28, p = 0.007), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adj RR = 2.43, 95% CI 1.68 – 3.57, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU ( p = 0.034, for interaction between frailty, delirium and hospital mortality). The proportion of the effect of frailty and risk of hospital mortality mediated by an acute episode of delirium in the ICU was estimated to 9.4% (95% CI 2 – 24%). Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.
Higher nurse staffing levels associated with reductions in unplanned readmissions to intensive care or operating theatre, and in postoperative in-hospital mortality in heart surgery patients
Publisher: BMJ
Date: 09-11-2012
Abstract: Implications for practice and research: Higher nurse staffing levels for postoperative care of cardiac surgery patients reduces the risk of unplanned re-admission to the intensive care or operating theatre and in-hospital mortality. Larger international studies are needed to assess the effect of nurse staffing levels and risk of hospital-wide adverse events.
Daily intra-abdominal pressure, Sequential Organ Failure Score and fluid balance predict duration of mechanical ventilation
Publisher: Wiley
Date: 05-07-2018
DOI: 10.1111/AAS.13211
Abstract: Elevated intra-abdominal pressure (IAP) is a common occurrence in mechanically ventilated patients in the intensive care unit (ICU). This study was undertaken to determine the relationship between IAP, pulmonary compliance and the duration of mechanical ventilation. A prospective study of 220 consecutively enrolled mechanically ventilated patients admitted to a mixed surgical-medical ICU in a tertiary referral hospital. The IAP was measured at least twice daily, benchmarked against consensus guidelines. Dynamic pulmonary compliance was calculated together with admission Acute Physiology and Chronic Health Evaluation (APACHE III) score and daily Sequential Organ Failure Assessment (SOFA) score. No relationship between highest IAP for the day and pulmonary compliance (P = 0.61) was found. For each 5 mm Hg increase in IAP, the risk of remaining intubated increased 19% (HR = 1.19, 95% CI: 0.98-1.44) for each standard deviation increase in SOFA score (3.7 points), the risk of remaining intubated increased by 14% (HR = 1.14, 95% CI: 0.98-1.33) and for each 1 L increase in fluid balance, the risk of remaining intubated increased by 11% (HR = 1.11, 95% CI: 1.04-1.19). A nomogram was developed to predict the probability of extubation based on daily highest IAP for the day, SOFA score and fluid balance. IAPs did not correlate with pulmonary compliance in critically ill patients. Increased IAP was associated with a longer duration of mechanical ventilation. A nomogram integrating daily IAP, SOFA score and fluid balance may be used to predict the duration of mechanical ventilation.
Early fluid bolus in adults with sepsis in the emergency department: a systematic review, meta-analysis and narrative synthesis
Publisher: Springer Science and Business Media LLC
Date: 11-01-2022
DOI: 10.1186/S12873-021-00558-5
Abstract: Early intravenous fluids for patients with sepsis presenting with hypoperfusion or shock in the emergency department remains one of the key recommendations of the Surviving Sepsis C aign guidelines to reduce mortality. However, compliance with the recommendation remains poor. While several interventions have been implemented to improve early fluid administration as part of sepsis protocols, the extent to which they have improved compliance with fluid resuscitation is unknown. The factors associated with the lack of compliance are also poorly understood. We conducted a systematic review, meta-analysis and narrative review to investigate the effectiveness of interventions in emergency departments in improving compliance with early fluid administration and examine the non-interventional facilitators and barriers that may influence appropriate fluid administration in adults with sepsis. We searched MEDLINE Ovid/PubMed, Ovid EMBASE, CINAHL, and SCOPUS databases for studies of any design to April 2021. We synthesised results from the studies reporting effectiveness of interventions in a meta-analysis and conducted a narrative synthesis of studies reporting non-interventional factors. We included 31 studies out of the 825 unique articles identified in the systematic review of which 21 were included in the meta-analysis and 11 in the narrative synthesis. In meta-analysis, interventions were associated with a 47% improvement in the rate of compliance [(Random Effects (RE) Relative Risk (RR) = 1.47, 95% Confidence Interval (CI), 1.25–1.74, p -value 0.01)] an average 24 min reduction in the time to fluids [RE mean difference = − 24.11(95% CI − 14.09 to − 34.14 min, p value 0.01)], and patients receiving an additional 575 mL fluids [RE mean difference = 575.40 (95% CI 202.28–1353.08, p value 0.01)]. The compliance rate of early fluid administration reported in the studies included in the narrative synthesis is 48% [RR = 0.48 (95% CI 0.24–0.72)]. Performance improvement interventions improve compliance and time and volume of fluids administered to patients with sepsis in the emergency department. While patient-related factors such as advanced age, co-morbidities, cryptic shock were associated with poor compliance, important organisational factors such as inexperience of clinicians, overcrowding and inter-hospital transfers were also identified. A comprehensive understanding of the facilitators and barriers to early fluid administration is essential to design quality improvement projects. CRD42021225417.
Experience of pain in rheumatoid arthritis - An empirical evaluation of the contribution of developmental psychosocial stress
Publisher: Wiley
Date: 06-1996
DOI: 10.1111/J.1600-0447.1996.TB10681.X
Abstract: Using a structured biographical history we evaluated the relationship between aspects of development and reports of pain experience (i.e. intensity of pain, affective and affective-evaluative dimensions of pain according to the McGill pain questionnaire, and effectiveness of medication) in 66 patients with rheumatoid arthritis. It was postulated that higher loading with regard to developmental stress would have a negative influence on reports of pain experience. Multiple regression analysis showed that (i) the intensity of pain was significantly correlated with the functional stage of the illness, (ii) affective and affective-evaluative dimensions of pain experience correlated with the interviewer's scoring of nurture and the patient's relationship with his or her partner, and (iii) the effectiveness of medication was significantly associated with the partner's understanding of the patient's pain and duration of illness. However, independent variables could explain only part of the variance (i.e. 12% for pain intensity, 17% for affective and affective-evaluative dimensions of pain experience and 26% for the effectiveness of medication). These results suggest that the previously assumed importance of developmental psychosocial stress as a factor in chronic intractable pain may require careful reassessment.
Hospital outcomes associated with introduction of a two-tiered response to the deteriorating patient
Publisher: Elsevier BV
Date: 06-2015
Dietary patterns associated with obesity outcomes in adults: An umbrella review of systematic reviews
Publisher: Cambridge University Press (CUP)
Date: 22-02-2021
DOI: 10.1017/S1368980021000823
Abstract: The aim of this umbrella review was to summarise the evidence from existing systematic reviews on the association between different dietary patterns (DP) and overweight or obesity outcomes in adults. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and searched the MEDLINE, EMBASE, CINAHL, Cochrane, Scopus, and Web of Science for systematic reviews reporting on DP and weight gain or overweight/obesity outcomes. We identified 16 systematic reviews with 143 unique studies published between 2001 and 2019. Overall quality scores ranged from 4 to 10. Six reviews in 2/11 cohort and 6/19 cross-sectional studies reported (statistically significant) decreased OR for obesity (range: 0·53 to 0·73 and 0·35 to 0·88, respectively) associated with the Mediterranean diet. Five reviews in 5/15 cohort and 10/45 cross-sectional studies reported an inverse association between diet quality and weight gain or BMI ( β range: –1·3 to –0·09). Two reviews in 1/3 cohort and 1/2 cross-sectional studies reported a decreased risk of obesity (OR = 0·76) and weight gain (OR = 0·26), respectively, with fruit and vegetable intake. Five reviews of mixed DP in 3/40 cross-sectional studies reported an increased prevalence of obesity (OR = 1·19) or abdominal obesity (OR range: 1·07 to 1·27) with the Korean diet pattern. Our umbrella review confirms the hypothesis that Mediterranean-type DP reduce the risk of obesity in adults. Although population-specific evidence of effective interventions is needed, characteristics of Mediterranean-type DP are important considerations for national obesity prevention strategies.
Prognostic Implications of High-Sensitivity Troponin T Levels Among Patients Attending Emergency Departments and Evaluated for an Acute Coronary Syndrome
Publisher: Elsevier BV
Date: 08-2021
Procedural characteristics and outcomes of three intensive care based, nurse-led catheter placement services
Publisher: Elsevier BV
Date: 05-2012
Development of prognostic nomograms for individualizing 5-year and 10-year fracture risks
Publisher: Springer Science and Business Media LLC
Date: 07-03-2008
DOI: 10.1007/S00198-008-0588-0
Abstract: We have developed clinical nomograms for predicting 5-year and 10-year fracture risks for any elderly man or woman. The nomograms used age and information concerning fracture history, fall history, and BMD T-score or body weight. Although many fracture risk factors have been identified, the translation of these risk factors into a prognostic model that can be used in primary care setting has not been well realized. The present study sought to develop a nomogram that incorporates non-invasive risk factors to predict 5-year and 10-year absolute fracture risks for an in idual man and woman. The Dubbo Osteoporosis Epidemiology Study was designed as a community-based prospective study, with 1358 women and 858 men aged 60+ years as at 1989. Baseline measurements included femoral neck bone mineral density (FNBMD), prior fracture, a history of falls and body weight. Between 1989 and 2004, 426 women and 149 men had sustained a low-trauma fracture (not including morphometric vertebral fractures). Two prognostic models based on the Cox's proportional hazards analysis were considered: model I included age, BMD, prior fracture and falls and model II included age, weight, prior fracture and fall. Analysis of the area under the receiver operating characteristic curve (AUC) suggested that model I (AUC = 0.75 for both sexes) performed better than model II (AUC = 0.72 for women and 0.74 for men). Using the models' estimates, we constructed various nomograms for in idualizing the risk of fracture for men and women. If the 5-year risk of 10% or greater is considered "high risk", then virtually all 80-year-old men with BMD T-scores < -1.0 or 80-year-old women with T-scores < -2.0 were predicted to be in the high risk group. A 60-year-old woman's risk was considered high risk only if her BMD T-scores < or = -2.5 and with a prior fracture however, no 60-year-old men would be in the high risk regardless of their BMD and risk profile. These data suggest that the assessment of fracture risk for an in idual cannot be based on BMD alone, since there are clearly various combinations of factors that could substantially elevate an in idual's risk of fracture. The nomograms presented here can be useful for in idualizing the short- and intermediate-term risk of fracture and identifying high-risk in iduals for intervention to reduce the burden of fracture in the general population.
Being non-frail and having an elective procedure are the strongest predictors associated with functional recovery among older survivors of major surgery
Publisher: BMJ
Date: 07-09-2020
Time is precious: Person-centred end of life care in an emergency department. A quality improvement project
Publisher: RCN Publishing Ltd.
Date: 10-07-2019
Understanding relationships between general self-efficacy and the healthy ageing of older people: An integrative review
Publisher: Wiley
Date: 29-10-2021
DOI: 10.1111/JOCN.16104
Abstract: The aim of this integrative review was to investigate current literature exploring relationships between general self‐efficacy and the healthy ageing of older people. Enhancing the health and well‐being of older adults, while mitigating consequences of illness and frailty are important priorities in healthy ageing. General self‐efficacy is closely associated with human behaviour and has been linked with improved health and well‐being. An integrative review using the five‐stage method described by Whittemore and Knafl (Journal of Advanced Nursing, 2005, 52, 546). Academic databases CINAHL, MEDLINE and APA PsycInfo were searched between 2010 and 2020 for original, peer‐reviewed papers, published in English that investigated general self‐efficacy and factors associated with the healthy ageing of older people. Included papers were critically appraised using the Appraisal tool for Cross‐Sectional Studies (AXIS tool) and Critical Appraisal Skills Programme, and underwent data abstraction and synthesis via a constant comparative method. This review was also evaluated using the PRISMA checklist. Twenty‐one papers were included in this review. Two main themes emerged. The first highlights positive relationships between general self‐efficacy and health and ageing perceptions, with subsequent influence on health behaviours. The second includes two sub‐themes, which explores general self‐efficacy’s role in maintaining well‐being through its effects on psychological health and overcoming physical decline through adaption to changing physical and health conditions. Promoting general self‐efficacy has potential benefits for the healthy ageing of older people through positive effects on ageing and health perceptions, health behaviours, psychological health and overcoming physical decline. Understanding how general self‐efficacy facilitates healthy ageing can guide nursing practices that reduce or mitigate consequences of illness and physical decline on the health and well‐being of older people. Strategies aimed at increasing older people’s general self‐efficacy can help to facilitate subsequent positive effects on factors that promote healthy ageing.
Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide
Publisher: Wiley
Date: 05-2018
DOI: 10.12788/JHM.3039
Abstract: Peripheral intravenous catheter (PIVC) use in health care is common worldwide. Failure of PIVCs is also common, resulting in premature removal and replacement. To investigate the characteristics, management practices, and outcomes of PIVCs internationally. Cross‐sectional study. Hospitalized patients from rural, regional, and metropolitan areas internationally. Hospital, device, and inserter characteristics were collected along with assessment of the catheter insertion site. PIVC use in different geographic regions was compared. We reviewed 40,620 PIVCs in 51 countries. PIVCs were used primarily for intravenous medication ( n = 28,571, 70%) and predominantly inserted in general wards ( n = 22,167, 55%). Two‐thirds of all devices were placed in non‐recommended sites such as the hand, wrist, or antecubital veins. Nurses inserted most PIVCs ( n = 28,575, 71%) although there was wide regional variation (26% to 97%). The prevalence of idle PIVCs was 14% ( n = 5,796). Overall, 10% ( n = 4,204) of PIVCs were painful to the patient or otherwise symptomatic of phlebitis a further 10% ( n = 3,879) had signs of PIVC malfunction and 21% of PIVC dressings were suboptimal ( n = 8,507). Over one‐third of PIVCs ( n = 14,787, 36%) had no documented daily site assessment and half ( n = 19,768, 49%) had no documented date and time of insertion. In this study, we found that many PIVCs were placed in areas of flexion, were symptomatic or idle, had suboptimal dressings, or lacked adequate documentation. This suggests inconsistency between recommended management guidelines for PIVCs and current practice.
Frailty and risk of subsequent fracture among older adults presenting to hospital with a minimal trauma fracture
Publisher: Springer Science and Business Media LLC
Date: 06-12-2023
Patient, provider and system factors influencing rehospitalisation in adults with heart failure
Publisher: Informa UK Limited
Date: 02-2013
DOI: 10.5172/CONU.2013.43.2.244
Abstract: To identify patient, provider and system factors predicting rehospitalisation in adults with heart failure (HF). The electronic data bases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase and PsychInfo were searched from 1996-2008 to identify studies identifying predictors of rehospitalisation from which the factors of patient, provider and systems were extracted. A total of 62 elements were identified. These elements were then sorted into patient, provider and system categories. Risk factors identified for rehospitalisation were predominantly related to clinical factors. There were less factors identifying risk from the perspective of provider and health care systems. In people with HF it is likely that non-clinical factors including provider and system play an important role in rehospitalisation. There is a need to identify in iduals at risk of rehospitalisation and tailor disease management programmes accordingly.
World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting.
Publisher: Research Square Platform LLC
Date: 13-04-2020
DOI: 10.21203/RS.3.RS-21718/V1
Abstract: Background Delirium is an acute change in cognition, common among older hospitalized patients, however, patients of all ages are at risk of delirium during a hospital stay. The International Federation of Delirium Societies promotes, each year, a World Delirium Awareness Day , to raise the awareness of, not just recognizing delirium in the hospital setting, but ensuring interventions are in place to prevent the development of delirium. Hospitalized patients with delirium have increased risk of adverse events such as falls, pressure injury, malnutrition, increased length of stay, increased health care costs, and mortality. This clinical audit aimed to estimate the risk of a subsequent fall, following an acute episode of in-hospital delirium, across a broad cross-sectional of clinical settings.Methods Seventeen adult acute inpatient wards across the South Western Sydney, Local Health District, undertook an audit of the number of admitted patients who had had at least one episode of delirium since being admitted to hospital. Using the hospital-based incident management reporting system, the rates of subsequent falls was compared between delirium and non-delirium patients.Results Fifty of the 473 patients (11.4%) were identified by the nursing staff to have had at least one episode of delirium since admission. The proportion of fallers among the delirium and non-delirium patients were 10% and 2%, respectively (p = 0.004). The rate of falls per 1000 patient days was 6.45 (95% confidence interval (CI) 2.1 to 15.1) among delirium patients, compared to 2.12 (95% CI 1.0 to 4.0) among patients without delirium. The risk of falling among delirium patients was 4.25 higher compared to non-delirium patients (adjusted hazard ratio (HR) = 4.25, 95% CI 1.26 to 14.39).Conclusion This clinical audit has been able to show that an acute episode of delirium increases the risk of an in-hospital fall fourfold. Importantly, these results have highlighted the need for a hospital wide approach, to not just in identifying delirium, but the need to have interventions in place to reduce the risk of delirium. In other words, delirium prevention should be ‘core business’ of all nursing care, across the acute hospital setting.
A survey of critical care nurses’ knowledge of intra-abdominal hypertension and abdominal compartment syndrome
Publisher: Elsevier BV
Date: 2017
DOI: 10.1016/J.AUCC.2016.02.001
Abstract: Intra-abdominal hypertension and abdominal compartment syndrome are potentially life threatening conditions. Critical care nurses need to understand the factors that predispose patients to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Predicting and managing IAH and ACS are important to improve health outcomes. The aim of this paper was to (1) assess the knowledge of Australian critical care nurses about current IAH and ACS practice guidelines, measurement techniques, predictors for the development of IAH and ACS and (2) identify barriers in recognizing IAH, ACS and measuring IAP. Between October 2014 and April 2015 86 registered nurses employed in the area of critical care were recruited via the form to participate in an on-line, 19-item questionnaire. The survey was distributed to critical care nurses via the Australian College of Critical Care Nurses (ACCCN) mailing list and directly to intensive care units via The majority of participants were women (n=62) all participants were registered nurses employed in critical care the response rate was 3.2%. The study design was used to establish demographic data, employment data, and in iduals' knowledge related to IAH and ACS. Participants had the option to write hand written responses in addition to selecting a closed question response. The results showed that most survey participants were able to identify some obvious causes of IAH. However, less than 20% were able to recognize less apparent indices of risk. A lack of education related to IAP monitoring was identified by nearly half (44.2%) of respondents as the primary barrier to monitoring IAP. Critical care clinicians' knowledge of IAH and ACS is generally low in the areas of presentation and outcomes of IAH and ACS requiring tailored and targeted educational interventions.
Five-year and 10-year absolute risk of clinical vertebral fracture for individuals
Publisher: Elsevier BV
Date: 05-2009
A clinical pathway for the management of difficult venous access
Publisher: Springer Science and Business Media LLC
Date: 17-11-2017
A randomised trial of intracavitary electrocardiography versus surface landmark measurement for central venous access device placement
Publisher: SAGE Publications
Date: 08-04-2022
DOI: 10.1177/11297298221085228
Abstract: Malpositioned central venous access devices (CVADs) can lead to significant patient injury including central vein thrombosis and dysrhythmias. Intra-cavitary electrocardiography (IC ECG) has been recommended by peak professional bodies as an accurate alternative for bedside CVAD insertion, to reduce risk of malposition and allowing immediate use of the device. Our objective was to compare the effect of IC ECG on CVAD malposition compared to traditional institutional practice for CVAD placement. Randomised controlled trial of IC ECG CVAD insertion verses traditional CVAD insertion (surface landmark measurement with post insertion x ray). Patient recruitment was from December 2016 to July 2018. The setting was a 900-bed tertiary referral hospital based in South Western Sydney, Australia. Three hundred and forty-four adult patients requiring CVAD insertion for intravenous therapy, were enrolled and randomly allocated (1:1 ratio) to either IC-ECG ( n = 172) or traditional ( n = 172) CVAD insertion. Our primary outcome of interest was the rate of catheters not requiring repositioning after insertion (ready for use). Secondary outcomes were comparison of procedure time and cost. Of the 172 patients allocated to the IC ECG method, 170 (99%) were ready for use immediately compared to 139 of the 172 (81%) in the traditional insertion group (difference, 95% confidence interval (CI): 18%, 11.9–24.1%). The total procedure time was mean 15 min (SD 8 min) for IC ECG and mean 36 min (SD 17 min) for traditional CVAD insertion (difference–19.9 min (95% CI–14.6 to −34.4). IC ECG guided CVAD insertion had a cost reduction of AUD $62.00 per procedure. Using IC-ECG resulted in nearly no requirement for post-insertion repositioning of CVADs resulting in savings in time and cost and virtually eliminating the need for radiographic confirmation. This trial is registered at the Australian New Zealand Clinical Trials Registry ( www.anzctr.org.au ). The registration number is ACTRN12620000919910.
Frailty among older surgical patients and risk of hospital acquired adverse events: The South‐Western Sydney frailty and nurse sensitive indicators study
Publisher: Wiley
Date: 24-02-2022
DOI: 10.1111/JOCN.16259
Abstract: While advances in healthcare mean people are living longer, increasing frailty is a potential consequence of this. The relationship between frailty among older surgical patients and hospital acquired adverse events has not been extensively explored. We sought to describe the relationship between increasing frailty among older surgical patients and the risk of hospital acquired adverse events. We included consecutive surgical admissions among patients aged 70 years or more across the SWSLHD between January 2010 and December 2020. This study used routinely collected ICD‐10‐AM data, obtained from the government maintained Admitted Patient Data Collection. The relationships between cumulative frailty deficit items and risk of hospital acquired adverse events were assessed using Poisson regression modelling. This study followed the RECORD/STROBE guidelines. During the study period, 44,721 (57% women) older adults were admitted, and 41% (25,306) were planned surgical admissions. The risk of all adverse events increased with increasing number of frailty deficit items, the highest deficit items group (4–12 deficit items) compared with the lowest deficit items group (0 or 1 deficit item): falls adjusted rate ratio (adj RR) = 15.3, (95% confidence interval (CI) 12.1, 19.42) pressure injury adj RR = 21.3 (95% CI 12.53, 36.16) delirium adj RR = 40.9 (95% CI 31.21, 53.55) pneumonia adj RR = 16.5 (95% CI 12.74, 21.27) thromboembolism adj RR = 17.3 (95% CI 4.4, 11.92) and hospital mortality adj RR = 6.2 (95% CI 5.18, 7.37). The increase in number of cumulative frailty deficit items among older surgical patients was associated with a higher risk of adverse hospital events. The link offers an opportunity to clinical nursing professionals in the surgical setting, to develop and implement targeted models of care and ensure the best outcomes for frail older adults and their families.
Hybrid ultramicroporous materials (HUMs) with enhanced stability and trace carbon capture performance
Publisher: Royal Society of Chemistry (RSC)
Date: 2017
DOI: 10.1039/C7CC02289A
Abstract: Fine-tuning of HUMs through pillar substitution can significantly enhance trace CO 2 sorption performance and stability.
A review of the nursing role in central venous cannulation: implications for practice policy and research
Publisher: Wiley
Date: 13-05-2010
DOI: 10.1111/J.1365-2702.2009.02910.X
Abstract: Aims and objectives. The aim of this article is to review published studies about central vein cannulation to identify implications for policy, practice and research in an advanced practice nursing role. Design. Modified integrative literature review. Methods. Searches of the electronic databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Medline, Embase, and the World Wide Web were undertaken using MeSH key words. Hand searching for relevant articles was also undertaken. All studies relating to the nurses role inserting central venous cannulae in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Results. Ten studies met the inclusion criteria for the review, all reported data were from the UK. There were disparate models of service delivery and study populations and the studies were predominantly non experimental in design. The results of this review need to be considered within the methodological caveats associated with this approach. The studies identified did not demonstrate differences in rates of adverse events between a specialist nurse and a medical officer. Conclusions. There were only a small number of studies found in the literature review and the limited availability of clinical outcome data precluded formal analysis from being generated. Relevance to clinical practice. Central vein cannulation is potentially an emerging practice area with important considerations for policy practice and research. Training specialist nurses to provide such a service may facilitate standardising of practice and improving surveillance of lines, and possibly improve the training and accreditation process for CVC insertions for junior medical officers. For this to occur, there is a need to undertake well‐conducted clinical studies to clearly document the value and efficacy of this advanced practice nursing role.
Cultural and linguistic appropriateness of a web-based breastfeeding educational resource for Saudi women: Consensus development conference approach
Publisher: Elsevier BV
Date: 08-2023
Central Venous Catheter Placement by Advanced Practice Nurses Demonstrates Low Procedural Complication and Infection Rates—A Report From 13 Years of Service*
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2014
Development of a nomogram for individualizing hip fracture risk in men and women
Publisher: Springer Science and Business Media LLC
Date: 17-03-2007
DOI: 10.1007/S00198-007-0362-8
Abstract: Until now there has been no published prognostic tool available for predicting of hip fracture to primary care settings. We have developed a nomogram for predicting the absolute risk of hip fracture for any in idual by using clinical factors, including age, prior fracture and fall, in addition to BMD that was based on a 15-year follow-up cohort study. Bone mineral density or clinical risk factors alone are useful but limited tools for the identification of in iduals with high-risk of hip fracture. It is hypothesized that the combination of clinical risk factors and BMD can improve the accuracy of fracture prediction. This study was aimed at developing a nomogram which combines these factors for predicting 5-year and 10-year risk of hip fracture for an in idual. The study, designed as a epidemiologic, community-based prospective study, included 1,208 women and 740 men aged 60+ years with median duration of follow-up of 13 years (inter-quartile range, IQR: 6-14) for both women and men, yielding 10,523 and 7,586 person-years of observation, respectively. Main outcome measures were incidence of hip fractures and risk factors were femoral neck bone mineral density (FNBMD), prior fracture, history of fall, postural sway and quadriceps strength. Femoral neck BMD was measured by DXA (GE-LUNAR Corp, Madison, Wisconsin, USA). Cox's proportional hazards model was used to estimate the risk of fracture for in iduals, and a nomogram was constructed for predicting hip fracture risk. Between 1989 and 2004, 127 in iduals (96 women) sustained a hip fracture. Advancing age, low femoral neck BMD, prior fracture and history of falls were independent predictors of hip fracture. The area under the receiver operating characteristic curve for the model was 0.85 for both sexes. A nomogram was constructed for predicting hip fracture risk for an in idual. Among those aged 75 or older with BMD T-scores < or = -2.5, the risk of hip fracture in men was comparable to or higher than in women however, in younger age groups, the risk was higher in women than in men. The combination of BMD and non-invasive clinical risk factors in a nomogram could be useful for identifying high-risk in iduals for intervention to reduce the risk of hip fracture.
Healthy ageing status and risk of readmission among acutely hospitalised older people
Publisher: Elsevier BV
Date: 06-2023
What are the factors in risk prediction models for rehospitalisation for adults with chronic heart failure?
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.AUCC.2011.07.004
Abstract: Risk prediction models can assist in identifying in iduals at risk of adverse events and also the judicious allocation of scare resources. Our objective was to describe risk prediction models for the rehospitalisation of in iduals with chronic heart failure (CHF) and identify the elements contributing to these models. The electronic data bases MEDLINE, PsychINFO, Ovid Evidence-Based Medicine Reviews and Scopus (1950-2010), were searched for studies that describe models to predict all-cause hospital readmission for in iduals with CHF. Search terms included: patient readmission risk chronic heart failure, congestive heart failure and heart failure. We excluded non-English studies, pediatric studies, and publications without original data. Only 1 additional model was identified since the review undertaken by Ross and colleagues in 2008. All models were derived from data sets collected in the United States and patients were followed from 60 days to 18 months. The only common predictors of re-hospitalisation in the models identified by Ross and colleagues were a history of diabetes mellitus and a history of prior hospitalisation. The additional model extends its scope to include the non clinical factors of social instability and socioeconomic status as predictors of rehospitalisation. In spite of the burden of hospitalisation in CHF, there are limited tools to assist clinicians in assessing risk. Developing risk prediction models, based on patient, provider and system characteristics may assist in identifying in iduals in the community at greatest risk and in need of targeted interventions to improve outcomes.
Characteristics and Outcomes of Patients Receiving Hospital in the Home Services in South West of Sydney.
Publisher: Research Square Platform LLC
Date: 24-06-2020
DOI: 10.21203/RS.3.RS-37649/V1
Abstract: Background Hospital in the home (HiTH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HiTH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HiTH care in the South Western Sydney Local Health District (SWSLHD) has not been well described. Aim This project aimed to describe the characteristics and outcomes of HiTH services across the SWSLHD. Methods The characteristics of patients referred to HiTH between January 2017 and December 2019, the indications for HiTH, and representation rates to hospital emergency department (ED) will be presented. Findings Between January 2017 and December 2019 there was 7,118 referrals to the LHDs HiTH services, among 6,083 patients (3,094 females, 51%), median age 56 years (IQR, 40 - 69). The majority of indications for HiTH were for IV medications (78%, n = 5,552), followed by post-operative drain management (11%, n = 789), rehab in the home (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HiTH only occurred on 172 (2%) of occasions. The average length of HiTH treatment was 7-days (IQR 4 - 16). Rates of presentation to ED for HiTH patients has decreased since 2017, 3.4% (95% CI 2.7 – 4.2%), 2018 2.1% (95% CI 1.5 – 2.8%), and 2019 1.8% (95% CI 1.3 – 2.4 %), p for trend 0.001. Discussion Hospital in the Home Services across the SWSLHD are predominately for administration of IV medications, but include management of post-operative drains, bridging of anticoagulant therapy, and rehab in the home. Importantly, only a very small proportion (3%) of HiTH episodes will results in an unplanned presentation to the ED. Conclusion Hospital in the Home is well established, erse, and safe clinical service to shorten or avoid hospitalisation for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.
Excess of post-fracture mortality among men and women: A relative survival analysis
Publisher: Elsevier BV
Date: 05-2009
BONEcheck: a digital tool for personalized bone health assessment
Publisher: Cold Spring Harbor Laboratory
Date: 11-05-2023
DOI: 10.1101/2023.05.10.23289825
Abstract: Osteoporotic fracture is a significant public health burden associated with increased mortality risk and substantial healthcare costs. Accurate and early identification of high-risk in iduals and mitigation of their risks is a core part of the treatment and prevention of fractures. We aimed to introduce a digital tool called ’BONEcheck’ for personalized bone health assessment. The development of BONEcheck primarily utilized data from the prospective population-based Dubbo Osteoporosis Epidemiology Study and the Danish Nationwide Registry. BONEcheck has 3 modules: input data, risk estimates, and risk context. Input variables include age, gender, prior fracture, fall incidence, bone mineral density (BMD), comorbidities, and genetic variants associated with BMD. By utilizing published methodologies, BONEcheck generates output related to the likelihood of fracture and its associated outcomes. The vocabulary utilized to convey risk estimation and management is tailored to in iduals with a reading proficiency at level 8 or above. The tool is designed for men and women aged 50 years and older who either have or have not sustained a fracture. Based on the input variables, BONEcheck estimates the probability of any fragility and hip fracture within 5 years, skeletal age, subsequent fracture, genetic risk score, and recommended interval for repeating BMD. The probability of fracture is shown in both numeric and human icon array formats. The risk is also presented in the context of treatment and management options based on Australian guidelines. Skeletal age was estimated as the sum of chronological age and years of life lost due to a fracture or exposure to risk factors that elevate mortality risk. In its entirety, BONEcheck is a system of algorithms translated into a single platform for personalized osteoporosis and fracture risk assessment. BONEcheck is a new system of algorithms that aims to offer not only fracture risk probability but also contextualize the efficacy of anti-fracture measures concerning the survival benefits. The tool can enable doctors and patients to engage in well-informed discussions and make decisions based on the patient’s risk profile. Public access to BONEcheck is available via bonecheck.org and in Apple Store (iOS) and Google Play (Android).
Relationship Between Body Mass Index and Fracture Risk Is Mediated by Bone Mineral Density
Publisher: Wiley
Date: 20-10-2014
DOI: 10.1002/JBMR.2288
Abstract: The relationship between body mass index (BMI) and fracture risk is controversial. We sought to investigate the effect of collinearity between BMI and bone mineral density (BMD) on fracture risk, and to estimate the direct and indirect effect of BMI on fracture with BMD being the mediator. The study involved 2199 women and 1351 men aged 60 years or older. BMI was derived from baseline weight and height. Femoral neck BMD was measured by dual-energy X-ray absorptiometry (DXA GE-LUNAR, Madison, WI, USA). The incidence of fragility fracture was ascertained by X-ray reports from 1991 through 2012. Causal mediation analysis was used to assess the mediated effect of BMD on the BMI-fracture relationship. Overall, 774 women (35% of total women) and 258 men (19%) had sustained a fracture. Approximately 21% of women and 20% of men were considered obese (BMI ≥ 30). In univariate analysis, greater BMI was associated with reduced fracture risk in women (hazard ratio [HR] 0.92 95% confidence interval [CI], 0.85 to 0.99) and in men (HR 0.77 95% CI, 0.67 to 0.88). After adjusting for femoral neck BMD, higher BMI was associated with greater risk of fracture in women (HR 1.21 95% CI, 1.11 to 1.31) but not in men (HR 0.96 95% CI, 0.83 to 1.11). Collinearity had minimal impact on the BMD-adjusted results (variance inflation factor [VIF] = 1.2 for men and women). However, in mediation analysis, it was found that the majority of BMI effect on fracture risk was mediated by femoral neck BMD. The overall mediated effect estimates were -0.048 (95% CI, -0.059 to -0.036 p < 0.001) in women and -0.030 (95% CI, -0.042 to -0.018 p < 0.001) in men. These analyses suggest that there is no significant direct effect of BMI on fracture, and that the observed association between BMI and fracture risk is mediated by femoral neck BMD in both men and women.
Misdiagnosis of osteoporosis based on a single bone mineral density measurement
Publisher: Elsevier BV
Date: 05-2009
Cerebrovascular autoregulation monitoring and patient‐centred outcomes after cardiac surgery: a systematic review
Publisher: Wiley
Date: 24-03-2018
DOI: 10.1111/AAS.13115
Abstract: Impaired cerebrovascular autoregulation (CVAR) is observed in up to 20% of cardiac surgical patients. This systematic review aims to evaluate the association between impaired CVAR, measured by current monitoring techniques, and patient-centred outcomes in adults following cardiac surgery. MEDLINE, EMBASE, PubMed, MEDLINE In-Process and Cochrane Library were systematically searched through 8 December 2017. Studies were included if they assessed associations between CVAR and patient-centred outcomes in the adult cardiac surgical population. The primary outcome of this systematic review was mortality. Secondary outcomes were stroke, delirium and acute kidney injury. Risk of bias was systematically assessed, and the GRADE methodology was used to evaluate the quality of evidence across outcomes. Eleven observational studies and no randomised controlled trials met the inclusion criteria. Due to methodological heterogeneity, meta-analysis was not possible. There was a high risk of bias within in idual studies and low quality of evidence across outcomes. Of the included studies, one assessed mortality, five assessed stroke, four assessed delirium, and three assessed acute kidney injury. No reliable conclusions can be drawn from the one study assessing mortality. Interpretation of studies investigating CVAR and stroke, delirium and acute kidney injury was complicated by the lack of standardisation of monitoring techniques as well as varying definitions of impaired CVAR. There is a paucity of high quality evidence for CVAR monitoring and its associations with outcome measures in post-cardiac surgical patients, highlighting the need for future studies.
An introduction to Bayes’ theorem and examples of its application to a diagnostic test and a clinical trial
Publisher: RCN Publishing Ltd.
Date: 10-03-2022
Establishing baseline absolute risk of subsequent fracture among adults presenting to hospital with a minimal-trauma-fracture
Publisher: Springer Science and Business Media LLC
Date: 28-02-2020
DOI: 10.1186/S12891-020-3161-4
Abstract: One in three women and one in five men are expected to experience a minimal-trauma-fracture after the age of 50-years, which increases the risk of subsequent fracture. Importantly, timely diagnosis and optimal treatment in the form of a fracture liaison service (FLS), has been shown to reduce this risk of a subsequent fracture. However, baseline risk of subsequent fracture among this group of FLS patients has not been well described. Therefore, this study aims to estimate absolute risk of subsequent fracture, among women and men aged 50-years or more, presenting to hospital with a minimal-trauma-fracture. Women and men aged 50-years or more with a minimal-trauma-fracture, presenting to hospitals across the South Western Sydney Local Health District between January 2003 and December 2017 were followed to identify subsequent fracture presentations to hospital. Absolute risk of subsequent fracture was estimated, by taking into account the competing risk of death. Between January 2003 and December 2017–15,088 patients presented to the emergency departments of the five hospitals in the SWSLHD (11,149, women [74%]), with minimal-trauma-fractures. Subsequent fractures identified during the follow-up period (median = 4.5 years [IQR, 1.6–8.2]), occurred in 2024 (13%) patients. Death during the initial hospital stay, or during a subsequent hospital visit was recorded among 1646 patients (11%). Women were observed to have 7.1% risk of subsequent fracture after 1-year, following an initial fracture and, the risk of subsequent fracture after 1-year was 6.2% for men. After 5-years the rate among women was 13.7, and 11.3% for men, respectively. Cumulative risk of subsequent fracture when initial fractures were classified as being at proximal or distal sites are also presented. This study has estimated the baseline risk of subsequent fracture among women and men presenting to hospital with minimal trauma fractures. Importantly, this information can be used to communicate risk to patients deciding to attend an osteoporosis refracture prevention clinic, and highlight the need for screening, and initial of treatment when indicated, once a minimal-trauma-fracture has occurred.
Characteristics and outcomes of patients admitted to ICU following activation of the medical emergency team: Impact of introducing a two-tier response system
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 04-2015
Timing of Repeat BMD Measurements: Development of an Absolute Risk‐Based Prognostic Model
Publisher: Wiley
Date: 11-2009
DOI: 10.1359/JBMR.090514
Abstract: This study attempted to address the following questions: for an in idual who is at present nonosteoporotic, given their current age and BMD level, what is the in idual's risk of fracture and when is the ideal time to repeat a BMD measurement? Nonosteoporotic women (n = 1008) and men (n = 750) over the age of 60 in 1989 from the Dubbo Osteoporosis Epidemiology Study were monitored until one of the following outcomes occurred: (1) BMD reached "osteoporosis" level (i.e., T-scores < or = -2.5) or (2) an incident fragility fracture. During the follow-up period (average, 7 yr), 346 women (34%) and 160 men (21%) developed osteoporosis or sustained a low-trauma fracture. The risk of osteoporosis or fracture increased with advancing age (women: RR/10 yr, 1.3 95% CI, 1.1-1.6 men: RR/10 yr, 2.3 95% CI, 1.7-2.9) and lower BMD levels (women: RR per -0.12 g/cm(2), 3.2 95% CI, 2.6-4.1 RR per -0.12 g/cm(2), 2.6 95% CI, 2.0-3.3). Using the predicted risk (of osteoporosis or fracture) of 10% as a cut-off level for repeating BMD measurement, the estimated time to reach the cut-off level varied from 1.5 (for an 80-yr-old woman with a T-score of -2.2) to 10.6 yr (for a 60-yr-old man with a T-score of 0). These results suggest that, based on an in idual's current age and BMD T-score, it is possible to estimate the optimal time to repeat BMD testing for the in idual. The prognostic model and approach presented in this study may help improve the in idualization and management of osteoporosis.
Perception of cardiovascular risk following a percutaneous coronary intervention: A cross sectional study
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.IJNURSTU.2011.01.012
Abstract: An in idual's perception of the risk of, and their susceptibility to, future cardiovascular events is crucial in engaging in effective secondary prevention. To investigate the perception of a cardiovascular event by examining the level of agreement between in iduals with CHD views of their actual and perceived risk. This study examined the in idual's perception of the risk of a subsequent cardiac event among 220 patients hospitalised for a percutaneous coronary intervention (PCI) at a metropolitan, tertiary referral hospital in Sydney, Australia. Baseline clinical and demographic characteristics were collected, and actual risk (Personal Risk Score) calculated based on the presence or absence of nine cardiovascular risk factors: diabetes, hypertension, high cholesterol, cigarette smoking, previous history of CHD, family history of CHD, depression, overweight or obesity, and physical inactivity. Perception of risk was determined using an investigator-developed 4-item, 11-point Likert scale instrument (Perceived Heart Risk Questionnaire--PHRQ) which measured two dimensions of health threat: perceived seriousness, and perceived susceptibility. The correlation between the Personal Risk Score and the PHRQ was assessed using the Pearson product-moment correlation coefficient. The calculated mean Personal Risk Score was 4.63±1.71 and the PHRQ was 25.5±7.04. The correlation between the Personal Risk Score (actual risk) and the PHRQ (perceived risk) was r=0.26 (p<0.01). The weak relationship between actual and perceived risk is of concern, particularly in a population at higher risk for future cardiovascular events. Implementing strategies to personalise risk should be explored to improve the accuracy of risk perception, and facilitate tailoring of behaviour change strategies.
Cross-cultural validation of the Cardiac Depression Scale in Iran
Publisher: Wiley
Date: 11-2010
P2717Type-II MI and chronic myocardial injury rates, invasive management and 4 year mortality among consecutive patients undergoing high sensitivity troponin T testing in the emergency department
Publisher: Oxford University Press (OUP)
Date: 10-2019
DOI: 10.1093/EURHEARTJ/EHZ748.1034
Abstract: In emergency departments (EDs), assessment of patients with suspected acute coronary syndromes (ACS) represents a major workload and high sensitivity troponin (HsTn) T and I levels are frequently measured. A minority of patients have final diagnosis of myocardial infarction (MI). Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014, we determined the relative frequencies of 3 patient groups: type-I MI, type-II MI including chronic myocardial injury (CMI), and assessed the use of invasive and pharmacological therapies and 4-year outcomes. Adjudication of MI was according to the 4th universal definition of MI as follows: 1) type-I MI 2) type-II MI (including acute myocardial injury), and 3) CMI. Of 995 patients (36%) median age 76 years [IQR 65–83]), with at least 2 HsTnT measurements and one ng/l, 727 (73%) had chronic myocardial injury, 171 (17%) had type-II MI and 97 (9.7%) had type-I MI. Patients with type-I MI (mean age 63 years) were younger than those with type-II MI or chronic myocardial injury by 12 and 14 years respectively. The main triggering factors for type-II MI/acute injury included: sepsis (21.1%), acute heart failure (18.3%), tachyarrhythmia (16.9%), anaemia (8.6%) and a combination of factors (16%). In-hospital angiography (62% had PCI) rates were 95% for patients with type-I MI, 24% (7% PCI) for those with type-II MI and 3.4% for CMI. Mortality at 4 years was 55% for type-II MI, 44% for CMI and 18% for type-1 MI (P .001 Figure), though after Cox modelling adjusting for age, gender, renal function and COPD, compared to type 1 MI, type-II MI (hazard ratio 1.61 [95% CIs 0.90–2.86] p=0.106) and CMI (hazard ratio 1.01 [95% CIs 0.59–1.74] p=0.963) were not independently associated with increased late mortality, largely because patients with type 1 MI were a decade younger. Among unselected patients undergoing HsTnT testing in EDs, type-II MI including acute myocardial injury was more common than type-I MI. Chronic myocardial injury, which occurred in 3 of 4 patients. While patients with type-II MI acute myocardial injury had higher late mortality rates than type-I MI, though after multivariable analyses mortality rates were not different.
Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.
Publisher: Research Square Platform LLC
Date: 08-10-2020
DOI: 10.21203/RS.3.RS-52423/V5
Abstract: Background: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay were explored. Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio ( adj RR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72 – 3.75, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium. And, importantly to discuss these issues in an open and empathetic way with the patient and their families.
Subglottic secretion drainage for preventing ventilator associated pneumonia: A meta-analysis
Publisher: Elsevier BV
Date: 11-2013
DOI: 10.1016/J.AUCC.2013.03.003
Abstract: Ventilator associated pneumonia (VAP) in the intensive care unit (ICU) has been shown to be associated with significant morbidity and mortality.(1-3) It has been reported to affect between 9 and 27% of intubated patients receiving mechanical ventilation.(4-6) OBJECTIVE: A meta-analysis was undertaken to combine information from published studies of the effect of subglottic drainage of secretions on the incidence of ventilated associated pneumonia in adult ICU patients. Studies were identified by searching MEDLINE (1966 to January 2011), EMBASE (1980-2011), and CINAHL (1982 to January 2011). Randomized trials of subglottic drainage of secretions compared to usual care in adult mechanically ventilated ICU patients were included in the meta-analysis. Subglottic drainage of secretions was estimated to reduced the risk of VAP by 48% (fixed-effect relative risk (RR)=0.52, 95% confidence interval (CI), 0.42-0.65). When comparing subglottic drainage and control groups, the summary relative risk for ICU mortality was 1.05 (95% CI, 0.86-1.28) and for hospital mortality was 0.96 (95% CI, 0.81-1.12). Overall subglottic drainage effect on days of mechanical ventilation was -1.04 days (95% CI, -2.79-0.71). This meta-analysis of published randomized control trials shows that almost one-half of cases of VAP may be prevented with the use of specialized endotracheal tubes designed to drain subglottic secretions. Time on mechanical ventilation may be reduced and time to development of VAP may be increased, but no reduction in ICU or hospital mortality has been observed in published trials.
Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.
Publisher: Research Square Platform LLC
Date: 18-09-2020
DOI: 10.21203/RS.3.RS-52423/V3
Abstract: Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1 st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio ( adj RR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72 – 3.75, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: This study among adults, aged 50-years or more, admitted to intensive care has been able to show that clinical frailty on admission increases the risk of delirium by approximately 60%, and both increase the risk of hospital mortality. One in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.
Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study.
Publisher: Research Square Platform LLC
Date: 23-09-2020
DOI: 10.21203/RS.3.RS-52423/V4
Abstract: Background: As the population ages clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. Methods: This study is part of a Delirium in Intensive Care (Deli) study that is being conducted across the SWSLHD between May 1 st 2019 and the end of April 2020. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50-years or more, acute episodes of delirium, and the outcomes of intensive care and hospital stay will be described. Results: During the 6-month baseline period 997 patients, aged 50-years or more, were included in this study. The average age was 71-years (IQR, 63-79), 55% were male (n = 537). Among these patients 39.2% (95% CI 36.1 – 42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% (n=127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted Rate Ratio ( adj RR) = 1.71, 95% Confidence Interval (CI) 1.20 – 2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1-7 days, p = 0.009), and higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72 – 3.75, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality, versus 10% among non-frail patients who also experienced delirium in the ICU. Conclusion: We have been able to show that among older frail admissions to intensive care, not just delirium, but hospital mortality is high. Importantly, we have found that approximately one in three frail patients who experienced an acute episode of delirium during their stay in the intensive care did not survive to hospital discharge. These results suggest the importance of recognising clinical frailty in the intensive care setting, not just to improve the prediction of outcomes from critical illness, but to identify patients at the greatest risk of adverse events such as delirium, and institute measures to reduce risk, and, importantly to discuss these issues in an open and empathetic way with the patient and their families.
Nurse-led central venous catheter insertion—Procedural characteristics and outcomes of three intensive care based catheter placement services
Publisher: Elsevier BV
Date: 02-2012
DOI: 10.1016/J.IJNURSTU.2011.08.011
Abstract: Nurse-led central venous catheter placement is an emerging clinical role internationally. Procedural characteristics and clinical outcomes is an important consideration in appraisal of such advanced nursing roles. To review characteristics and outcomes of three nurse-led central venous catheter insertion services based in intensive care units in New South Wales, Australia. Using data from the Central Line Associated Bacteraemia project in New South Wales intensive care units. Descriptive statistical techniques were used to ascertain comparison rates and proportions. De-identified outcome data of patients who had a central venous catheter inserted as part of their therapy by one of the four advanced practice nurses working in three separate hospitals in New South Wales. Between March 2007 and June 2009, 760 vascular access devices were placed by the three nurse-led central venous catheter placement services. Hospital A inserted 520 catheters Hospital C with 164 and Hospital B with 76. Over the study period, insertion outcomes were favourable with only 1 pneumothorax (1%), 1 arterial puncture (1%) and 1 CLAB (1%) being recorded across the three groups. The CLAB rate was lower in comparison to the aggregated CLAB data set [1.3 per 1000 catheters (95% CI=0.03-7.3) vs. 7.2 per 1000 catheters (95% CI=5.9-8.7)]. This study has demonstrated safe patient outcomes with nurse led CVC insertion as compared with published data. Nurses who are formally trained and credentialed to insert CVCs can improve organisational efficiencies. This study adds to emerging data that developing clinical roles that focus on skills, procedural volume and competency can be a viable option in health care facilities.
Type-II myocardial infarction and chronic myocardial injury rates, invasive management, and 4-year mortality among consecutive patients undergoing high-sensitivity troponin T testing in the emergency department
Publisher: Oxford University Press (OUP)
Date: 20-05-2020
Abstract: As assessment of patients with suspected acute coronary syndromes (ACS) in emergency departments (EDs) represents a major workload because high-sensitivity troponin (HsTn) T and I levels are frequently measured, and a minority of patients have final diagnosis of myocardial infarction (MI). We determined the relative frequencies of three patients groups: Type-I MI, Type-II MI (including acute myocardial injury). Among 2738 consecutive patients with suspected ACS presenting to ED at Liverpool Hospital, Australia, between March and June 2014. We studied the use of invasive and pharmacological therapies, and 4-year outcomes. Adjudication of MI was according to the 4th universal definition as follows: (i) Type-I MI (ii) Type-II MI (including acute myocardial injury), and (iii) chronic myocardial injury. Of 995 patients (36%) [median age 76 years (interquartile range 65-83)] with ≥2 HsTnT measurements and one >14 ng/L, 727 (73%) had chronic myocardial injury, 171 (17%) had Type-II MI, and 97 (9.7%) had Type-I MI respective late mortality rates to 48 months were 33%, 43%, and 14% (P < 0.001). In-hospital angiography rates were 95% for patients with Type-I MI, [62% had percutaneous coronary intervention (PCI)] 24% (7% PCI) for those with Type-II MI, and 3.4% for chronic myocardial injury. On Cox modelling for mortality relative to Type 1 MI, adjusted hazard ratios were 1.94 [95% confidence intervals (CIs) 1.06-3.57] P = 0.032 for Type 2 MI, and for chronic myocardial injury 1.14 (95% CIs 0.64-2.02) P = 0.66. Among unselected patients undergoing HsTnT testing in EDs, Type-II MI including acute myocardial injury was more common than Type-I MI. Chronic myocardial injury, which occurred in three of four patients. Whereas patients with Type-II MI had higher late mortality than those with Type-I MI, after multivariable analyses mortality rates were marginally different.
Characteristics and outcomes of patients receiving Hospital at Home Services in the South West of Sydney
Publisher: Springer Science and Business Media LLC
Date: 26-11-2020
DOI: 10.1186/S12913-020-05941-9
Abstract: Hospital at home (HaH) provides acute or subacute care in a patient’s home, that normally would require a hospital stay. HaH has consistently been shown to improve patient outcomes and reduce health care costs. The characteristics and outcomes of patients receiving HaH care across the South Western Sydney Local Health District (SWSLHD) has not been well described. This project aimed to describe the characteristics and outcomes of HaH services across the SWSLHD. The characteristics of patients referred to HaH between January 2017 and December 2019, the indications for HaH, and representation rates to hospital emergency department (ED) will be presented. Between January 2017 and December 2019 there was 7118 referrals to the local health district’s (LHD) HaH services, among 6083 patients (3094 females, 51%), median age 56 years (Interquartile range (IQR), 40–69). The majority of indications for HaH were for intravenous venous (IV) medications (78%, n = 5552), followed by post-operative drain management (11%, n = 789), rehab in the home (RiTH) (5%, n = 334), bridging anticoagulant therapy (4%, n = 261), and intraperitoneal medications (1%, n = 100). The requirement for presentation to an ED for care, while receiving HaH only occurred on 172 (2%) of occasions. The average length of HaH treatment was 7-days (IQR 4–16). Rates of presentation to ED for HaH patients have decreased since 2017, 3.4% (95% CI 2.7–4.2%), 2018 2.1% (95% CI 1.5–2.8%), and 2019 1.8% (95% CI 1.3–2.4%), p -value for trend 0.001. Hospital at Home is well established, erse, and safe clinical service to shorten, or avoid hospitalisation, for many patients. Importantly, avoidance of hospitalisation can avoid many risks that are associated with being cared for in the hospital setting.
Delirium in the intensive care unit and its importance in the post-operative context: A review
Publisher: Frontiers Media SA
Date: 30-03-2023
DOI: 10.3389/FMED.2023.1071854
Abstract: The burden of delirium in the intensive care setting is a global priority. Delirium affects up to 80% of patients in intensive care units an episode of delirium is often distressing to patients and their families, and delirium in patients within, or outside of, the intensive care unit (ICU) setting is associated with poor outcomes. In the short term, such poor outcomes include longer stay in intensive care, longer hospital stay, increased risk of other hospital-acquired complications, and increased risk of hospital mortality. Longer term sequelae include cognitive impairment and functional dependency. While medical category of admission may be a risk factor for poor outcomes in critical care populations, outcomes for surgical ICU admissions are also poor, with dependency at hospital discharge exceeding 30% and increased risk of in-hospital mortality, particularly in vulnerable groups, with high-risk procedures, and resource-scarce settings. A practical approach to delirium prevention and management in the ICU setting is likely to require a multi-faceted approach. Given the good evidence for the prevention of delirium among older post-operative outside of the intensive care setting, simple non-pharmacological interventions should be effective among older adults post-operatively who are cared for in the intensive care setting. In response to this, the future ICU environment will have a range of organizational and distinct environmental characteristics that are directly targeted at preventing delirium.
Prevalence of SARS‐CoV‐2 antibodies among nurses: A systematic review and meta‐analysis
Publisher: Wiley
Date: 27-09-2021
DOI: 10.1111/JOCN.16009
Abstract: This systematic review and meta‐analysis reports the seroprevalence of SARS‐CoV‐2 antibodies among nurses. With a growing body of literature reporting the positive serology for SARS‐CoV‐2 antibodies among healthcare workers, it remains unclear whether staff at the point of direct patient care are more prone to developing and transmitting the virus. Given nurses make up the majority of the global health workforce, outbreaks among these workers could severely undermine a health system’s capability to manage the pandemic. We aimed to summarise and report the seroprevalence of SARS‐CoV‐2 antibodies among nurses globally. Systematic review and meta‐analyses. This systematic review was developed, undertaken and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We searched the electronic medical literature databases: MEDLINE CINAHL and EMBASE for studies reporting the seroprevalence of SARS‐CoV‐2 antibodies among nursing staff. Studies that reported nursing specific data were included in this review. Study quality was evaluated using the Joanna Briggs Institute checklist for studies reporting prevalence data. Studies were stratified according to the World Health Organisation region classifications, and results were presented using forest plots and summary prevalence and variance was estimated using a random effects model. Our electronic search identified 1687 potential studies, of which 1148 were screened for eligibility after duplicates were removed, and 51 of the studies were included in our meta‐analysis. The overall seroprevalence of SARS‐CoV‐2 antibodies among nurses was estimated to be 8.1% (95% CI 6.9%–9.4%) among the 60,571 participants included in the studies. Seropositivity was highest in the African region (48.2%, 95% CI 39.2%–57.3%), followed by the European region (10.3%, 95% CI 8.0%–12.5%), the Region of the Americas (8.4%, 95% CI 6.0%–10.7%), the South‐East Asia region (3.0%, 95% CI 0.00%–6.5%) and the Western Pacific region (0.5%, 95% CI 0.0%–1.0%). Pooled estimates were unable to be calculated in the Eastern Mediterranean region due to insufficient studies. The seroprevalence of SARS‐CoV‐2 antibodies among nurses is comparable to other healthcare workers, and possibly similar to the general population. Early adoption and adherence to personal protective equipment and social distancing measures could explain these similarities, meaning the majority of staff contracted the virus through community transmission and not in a healthcare setting. Fear and uncertainty have been features of this pandemic, including among nurses. This meta‐analysis should provide some comfort to nurses that risks are similar to community exposure when adequate PPE is available and there is an adherence to infection control measures.
The burden of peripheral intravenous catheters in older hospital inpatients: A national cross‐sectional study part of the ONE MILLION GLOBAL PERIPHERAL INTRAVENOUS CATHETERS COLLABORATION
Publisher: Wiley
Date: 05-04-2022
DOI: 10.1111/AJAG.13068
Abstract: To investigate the burden of peripheral intravenous catheters (PIVCs) in older hospitalised patients. A cross‐sectional prospective observational study (2014/2015) to describe the characteristics, indications and outcomes of PIVCs among patients aged ≥65 from 65 Australian hospitals. Amongst 2179 in idual PIVCs (in 2041 patients, mean age 77.6 years, 45% female, 58% in NSW), 43% were inserted by doctors and 74% used that day, meaning 25% were ‘idle’. Overall, 18% (393/2179) exhibited signs of PIVC‐related complications. Most commonly exhibited PIVC‐related complications were tenderness (4.1%) and local redness (1.8%). Nearly one in three (29.1%) dressings was soiled, loosened or had come off, and only 36.8% had the time and date documented on the dressing. Both infusing IV medications (aOR 1.74, 95% CI 1.28–2.38, p 0.001) and inserting the PIVC in a non‐upper limb vein (aOR 3.40 compared to forearm [reference site], 95% CI 1.62–7.17, p 0.001) were independently associated with PIVC failure. Phlebitis was exhibited in 7% (154) of the patients. Only infusing intravenous medications increased the likelihood of developing symptoms of phlebitis (aOR 1.61, 95% CI 1.01–2.57, p = 0.05). Increasing age was inversely associated with symptoms of phlebitis. Among the 1575 patients (79%) who rated their PIVC experience using the Likert scale 0–10 (where 10 = ‘best possible’), the median score was 8 (IQR 6–10). Age in highest quartile ( years) was independently associated with lower likelihood of a high score (aOR 0.71, 95% CI 0.54–0.94, p = 0.02). Given 1 in 5 PIVCs were identified with having complications, further research should focus on optimising PIVC use in older patients.
Readmission to intensive care: A meta-analysis of severity of illness on admission and risk of readmission
Publisher: Elsevier BV
Date: 02-2009
Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: a trial sequential meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 12-2018
P3480High sensitivity Troponin T and late survival of patients at least 80 years with suspected ACS
Publisher: Oxford University Press (OUP)
Date: 08-2018
Frailty in Heart Failure: It's Time to Intervene
Publisher: Elsevier BV
Date: 04-2023
Excess mortality attributable to hip-fracture: A relative survival analysis
Publisher: Elsevier BV
Date: 09-2013
DOI: 10.1016/J.BONE.2013.05.006
Abstract: In iduals with hip fracture are at substantially increased risk of mortality. The aim of this study was to estimate the excess mortality attributable to hip fracture in elderly men and women. The Dubbo Osteoporosis Epidemiology Study was designed as a prospective epidemiologic investigation, in which more than 2000 men and women aged 60+ as of 1989 had been followed for 21 years. During the follow-up period, the incidence of atraumatic hip fractures was ascertained by X-ray reports, and mortality was ascertained by the New South Wales Birth, Death and Marriage Registry. Relative survival ratios were estimated by taking into account the age-and-sex specific expected survival in the general Australian population from 1989 to 2010. During the follow-up period 151 women and 55 men sustained a hip fracture. Death occurred in 86 (57%) women and 36 (66%) men. In women, the cumulative relative survival post hip-fracture at 1, 5 and 10 years was 0.83 (95% confidence interval (CI) 0.76-0.89), 0.59 (95% CI 0.48-0.68), and 0.31 (95% CI 0.20-0.43), respectively in men, the corresponding estimates of relative survival were: 0.63 (95% CI 0.48-0.75), 0.48 (95% CI 0.32-0.63), and 0.36 (95% CI 0.18-0.56). On average post hip-fracture women died 4 years earlier (median: 4.1, inter-quartile range (IQR) 1.7-7.8) and men died 5 years earlier (median = 4.8, IQR 2.4-7.0) than expected. For every six women and for every three men with hip fracture one extra death occurred above that expected in the background population. Hip fracture is associated with reduced life expectancy, with men having a greater reduction than women, even after accounting for time-related changes in background mortality in the population. These data underscore that hip fracture is an independent clinical risk factor for mortality.
The Effectiveness of Chlorhexidine Bathing and Hospital Acquired Infections Among Adult Intensive Care Patients: A Trial Sequential Meta-analysis
Publisher: Elsevier BV
Date: 2019
The experience of nurses whose role requires allocating patients to outlier and over census beds during access-block: a review of the literature
Publisher: Research Square Platform LLC
Date: 12-05-2020
DOI: 10.21203/RS.3.RS-21798/V1
Abstract: Background Strategies intended to streamline ED patient admission and discharge have been introduced to alleviate access block. To meet policy, local hospitals design demand management processes which are intended to meet the changing needs of the facility by directing the patient journeys throughout the hospital. Given the crucial role patient flow managers and after-hours nurse managers play in managing patient flow there is a need to explore the experience of these nurse managers while managing access block. Objectives To gain a better understanding of the nurse managers experience of allocating patients to outlier or over-census beds. Methods A systematic literature search was undertaken and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. The search was for research papers which described the nurse manager’s experiences utilising outlier or surge beds at times of access block. The review included all relevant literature, and papers were not excluded based on study design or methodology. Results The electronic search identified 2,057 papers. The inclusion/exclusion criteria removed 2,010 papers, leaving 47 papers for further abstracts, or full text screening. Finally, five papers were identified for possible inclusion in the review. Two co-authors independently assessed the five, final papers for inclusion, yet, none contained the nurse managers experience of allocation patients to outlier beds. Conclusion The outlier and over-census protocols are two strategies employed in response to periods of peak demand. The application of these strategies is the responsibility of the nurse manager. Up until now, evidence remains unreported on the experience of nurse managers responsible for managing resources at times of access block. In an attempt to address this gap we have planned to address this as an area of future research.
Frailty in the prediction of delirium in the intensive care unit: A secondary analysis of the Deli study.
Publisher: Wiley
Date: 30-10-2023
DOI: 10.1111/AAS.14343
Facilitators and barriers of appropriate and timely initiation of intravenous fluids in patients with sepsis in emergency departments: a consensus development Delphi study.
Publisher: Springer Science and Business Media LLC
Date: 27-10-2023
Relationship between self-rated functional status and psychosocial stress in patients suffering from rheumatoid arthritis
Publisher: S. Karger AG
Date: 1997
DOI: 10.1159/000289143
Abstract: To assess relationship between psychosocial factors and self-rated functioning in rheumatoid arthritis (RA). In 66 RA patients (mean age +/- SD = 50.8 +/- 12.6 years, women 49 (74%), illness duration mean +/- SD = 13.4 +/- 10.5 years) aspects of developmental psychosocial stress thought to influence human behavior were assessed in an in depth interview using structured biographical history. Furthermore evaluation included Trait anxiety, global functional status according to the ACR criteria, radiological staging of illness and patients' self-ratings of functioning obtained by the Health Assessment Questionnaire (HAQ). Bivariate correlations were performed using psychosocial and somatic factors and self-rated functional status. Scores of developmental psychosocial stress significantly correlated with interviewers scoring of nurture (r = -0.722, p < 0.001) indicating good internal consistency of interview data. Significant correlations were found between patients' scoring of functional status (HAQ) and (i) ACR criteria (r = 0.490, p < 0.0001) and (ii) score of Trait anxiety (r = 0.367, p < 0.003). There was no significant correlation between developmental psychosocial stress and HAQ score. Developmental psychosocial stress does not significantly contribute as to how RA patients perceive their functional ability. In a proportion of RA patients self-rated functional status may depend on the patients disposition (e.g. neuroticism) probably promoting impaired illness behavior (e.g. regressive tendencies) which should be considered in assessing treatment procedures.
Unplanned admission to intensive care after emergency hospitalisation: Risk factors and development of a nomogram for individualising risk
Publisher: Elsevier BV
Date: 02-2009
DOI: 10.1016/J.RESUSCITATION.2008.10.030
Abstract: Unplanned admission to an intensive care unit (ICU) is associated with high mortality, having the highest incidence among patients who are emergency admissions to the hospital. This study was designed to identify factors associated with unplanned ICU admission in emergency admissions to hospital and develop an absolute risk tool to in idualise the risk of an event during a hospital stay. Emergency department (ED) and in-patient hospital data from a large teaching hospital of consecutive admissions from 1 January 1997 to 31 December 2007 aged over 14 years was included in this study. Patient data extracted from 126826 emergency presentations admitted as in-patients consisted of demographic and clinical variables. During an 11-year period 1582 incident unplanned ICU admissions occurred. Predictors of unplanned ICU admission included older age, being male, having a higher acuity triage category and a history of co-morbid conditions. Emergency department diagnostic groups associated with higher incidence of unplanned ICU admission included: sepsis, acute renal failure, lymphatic-hematopoietic tissue neoplasms, pneumonia, chronic-airways disease and bowel obstruction. The final model used to develop the nomogram had an ROC curve AUC of 0.7. This study identified factors associated with unplanned ICU admission and developed a nomogram to in idualise risk prior to a patient being transferred from the ED. This nomogram provides clinicians the opportunity prior to transfer from the ED, to either (1) review the appropriateness of the ward level of planned transfer or (2) flag patients for follow-up on the general ward to assess for deterioration.
Chlorhexidine bathing and health care-associated infections among adult intensive care patients: a systematic review and meta-analysis
Publisher: Springer Science and Business Media LLC
Date: 23-11-2016
Mortality at 5 Years Among Very Elderly Patients Undergoing High Sensitivity Troponin T Testing for Suspected Acute Coronary Syndromes
Publisher: Elsevier BV
Date: 11-2020
Correction for Polymorphs, Salts and Cocrystals: What’s in a Name?
Publisher: American Chemical Society (ACS)
Date: 26-06-2012
DOI: 10.1021/CG300704B
Congruence between the Indian Diabetes Risk Score and Australian Type 2 Diabetes Risk Assessment tool screening in Asian-Indians
Publisher: RCN Publishing Ltd.
Date: 11-2013
DOI: 10.7748/NR2013.11.21.2.36.E215
Abstract: To evaluate the performance of the simplified Indian Diabetes Risk Score (IDRS) and the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) instruments in predicting diabetes in Indian-Australians. Screening for diabetes in the general community is common and numerous scoring systems are being used to predict the risk of diabetes. For this cross-sectional study, data were obtained from people attending the Australia India Friendship Fair. Data relating to risk factors for diabetes were obtained using a questionnaire and a random blood glucose level. The IDRS and AUSDRISK scores were calculated. Student's t-test, Pearson chi-square, and receiver-operating characteristic curves were used to compare the performance of the predictive scores. Data were analysed for 136 participants: 28 per cent of in iduals considered to be low-risk and 35 per cent considered to be moderate-risk according to AUSDRISK were classified as moderate-risk and high-risk respectively by IDRS. The two models were not congruent in predicting diabetes risk among Asian-Indians. The results of this study have significant implications for education relating to diabetes screening.
Controlling the Uptake and Regulating the Release of Nitric Oxide in Microporous Solids
Publisher: American Chemical Society (ACS)
Date: 11-12-2017
Abstract: Representative compounds from three classes of microporous solids, namely, metal-organic frameworks (MOFs), hybrid ultra-microporous materials (HUMs), and porous-organic polymers (POPs), were investigated for their nitric oxide gas uptake and release behavior. Low-pressure sorption studies indicated strong chemisorption of NO on the free amine groups decorating the MOF UiO-66-NH
P6428Late mortality rates of patients with type 2 MI compared to type 1 MI and stable high sensitivity troponin T elevations
Publisher: Oxford University Press (OUP)
Date: 08-2018
The concept of frailty in intensive care
Publisher: Elsevier BV
Date: 03-2019
DOI: 10.1016/J.AUCC.2017.11.005
Abstract: Our population is ageing, and this is also reflected in the ageing of the hospital and intensive care population. Along with ageing, there is also an increase in age-related chronic health conditions or comorbidities, which in turn affects the patient's functional state. There is an increasing need to describe a patient's clinical condition in terms of their functional capacity, such as frailty. Frailty is an age-related syndrome which reduces physiological and cognitive reserves. As a result, frailty increases people's vulnerability to insults such as infection and trauma. The concept of frailty also indicates prognosis and levels of health from a patient's perspective rather than simply from the acute reason for admission to the intensive care unit. Understanding the concept of frailty may facilitate our awareness of long-term outcomes after intensive care and being a trigger for considering its prognostic implications and the need to honestly and empathetically begin discussions with patients and their carers and how the patient's own goals of care could be established around this information.
Construction of a Series of Porous (3,9)-c Coordination Networks Using Dicarboxylate and Tris-pyridyl Ligands and Their Gas Storage Properties
Publisher: American Chemical Society (ACS)
Date: 10-05-2017
The use of Midline Catheters in the Adult Acute Care Setting – Clinical Implications and Recommendations for Practice
Publisher: Association for Vascular Access
Date: 03-2011
DOI: 10.2309/JAVA.16-1-5
Abstract: Aim and objectives: The aim of this paper was to review published manuscripts on the use of midline catheters, the implications of study findings and recommendations for clinical practice in the acute care setting. Design: Modified integrative literature review Methods: Using key MeSH terms, we searched the electronic databases: CINAHL, Medline, and Embase. The Cochrane and Joanna Briggs databases, Google Search Engine and the reference lists of published materials were also searched. Studies were included if they were in the English language and reported the use of midline catheters in adult acute care populations. Manuscripts that described midlines made of aquavene were excluded Results: Two hundred and thirty two (232) papers were identified using the search strategy. From these identified papers, thirty (30) were included in the final review. Thematic analysis identified three major themes. These included: (i) advantages of using midline catheters (ii) disadvantages of using midline catheters (iii) insertion and management issues. Conclusion: Midline catheters have both positive and negative implications for clinical practice. They can be used for extended periods of intravenous therapy without requiring repeated cannulations but are not without risk. Midline catheters have been associated with mechanical and chemical phlebitis along with intravascular thrombosis. As such they are not suitable across the entire adult acute population. Midline catheters reduce the number of repeated cannulations which reduces patient discomfort, increases patient satisfaction and also contributes to organisational efficiency.
Discordance of longitudinal changes in bone density between densitometers
Publisher: Elsevier BV
Date: 10-2007
DOI: 10.1016/J.BONE.2007.07.002
Abstract: This study examined the concordance in BMD measurement and longitudinal change in BMD between the GE Lunar Prodigy and GE Lunar DPX. Even though a high concordance between the densitometers was observed on a single measurement occasion, a significant discordance in longitudinal changes in BMD was observed. Measurement of bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) technology plays an important role in the diagnosis and management of osteoporosis. The present study examined the concordance in BMD measurement and longitudinal change in BMD between GE Lunar Prodigy and DPX. BMD at the lumbar spine and femoral neck was measured in 135 in iduals (47 men and 88 women, mean age 73+/-9 years) using both GE Lunar DPX and Prodigy densitometers at baseline. In this group, 56 in iduals (22 men and 34 women) had repeated BMD measurements using the DPX and Prodigy during a subsequent follow-up visit (average duration: 2.2 years). For a single BMD measurement, the coefficient of concordance between the Prodigy and DPX was greater than 0.98 at the lumbar spine and 0.96 at the femoral neck, with the slope of linear regression being approximately 1.0. During the period of follow-up, the lumbar spine BMD decreased by -0.5% (S.D. 1.8%) when measured by DPX, which was significantly different (p=0.002) from the change measured by Prodigy (mean change=0, S.D. 2.0%). However, there was no significant difference (p=0.95) in the rate of change in femoral neck BMD measured by DPX (mean=-1.6%, S.D.=2.9) and Prodigy (mean=-1%, S.D.=1.8%). The correlation in rates of BMD change between Prodigy and DPX was 0.63 at the lumbar spine and 0.52 at the femoral neck. Simulation analysis showed that the theoretical maximum correlation in rates of BMD change between Prodigy and DPX was 0.71. Despite both densitometers being highly concordant in a single BMD measurement, discordance in the assessment of BMD changes between the Prodigy and DPX densitometers was observed. These findings have implications regarding the assessment of response to therapy in a multi-centre setting when different densitometers are used.
Reliability of intra-abdominal pressure measurements using the modified Kron technique
Publisher: Informa UK Limited
Date: 07-10-2014
Prediction of disability-free survival in healthy older people
Publisher: Springer Science and Business Media LLC
Date: 14-04-2022
DOI: 10.1007/S11357-022-00547-X
Abstract: Prolonging survival in good health is a fundamental societal goal. However, the leading determinants of disability-free survival in healthy older people have not been well established. Data from ASPREE, a bi-national placebo-controlled trial of aspirin with 4.7 years median follow-up, was analysed. At enrolment, participants were healthy and without prior cardiovascular events, dementia or persistent physical disability. Disability-free survival outcome was defined as absence of dementia, persistent disability or death. Selection of potential predictors from amongst 25 biomedical, psychosocial and lifestyle variables including recognized geriatric risk factors, utilizing a machine-learning approach. Separate models were developed for men and women. The selected predictors were evaluated in a multivariable Cox proportional hazards model and validated internally by bootstrapping. We included 19,114 Australian and US participants aged ≥65 years (median 74 years, IQR 71.6–77.7). Common predictors of a worse prognosis in both sexes included higher age, lower Modified Mini-Mental State Examination score, lower gait speed, lower grip strength and abnormal (low or elevated) body mass index. Additional risk factors for men included current smoking, and abnormal eGFR. In women, diabetes and depression were additional predictors. The biased-corrected areas under the receiver operating characteristic curves for the final prognostic models at 5 years were 0.72 for men and 0.75 for women. Final models showed good calibration between the observed and predicted risks. We developed a prediction model in which age, cognitive function and gait speed were the strongest predictors of disability-free survival in healthy older people. Trial registration Clinicaltrials.gov (NCT01038583)
Effect of Steroids on Coronavirus Disease 2019 (COVID-19) Mortality Risk: A Bayesian Interpretation
Publisher: Oxford University Press (OUP)
Date: 29-11-2021
DOI: 10.1093/CID/CIAA1783
Predicting Absolute Risk for Unplanned Cardiovascular Readmissions in Adults With Chronic Heart Failure
Publisher: Elsevier BV
Date: 08-2015
PO159 Mortality at 4 Years In Patients With Type 2 MI Compared to Type 1 MI and Stable High Sensitivity Troponin T Elevations
Publisher: Ubiquity Press, Ltd.
Date: 12-2018
Severity of illness and risk of readmission to intensive care: A meta-analysis
Publisher: Elsevier BV
Date: 05-2009
Polymorphs, Salts, and Cocrystals: What’s in a Name?
Publisher: American Chemical Society (ACS)
Date: 19-04-2012
DOI: 10.1021/CG3002948
Facilitators and barriers of appropriate and timely initial fluid administration in sepsis: A qualitative study
Publisher: Elsevier BV
Date: 07-2023
Elements of Risk Prediction Models to Predict Readmission to Hospital in Older Patients with Chronic Heart Failure
Publisher: Elsevier BV
Date: 2010
Readmission to intensive care: development of a nomogram for individualising risk
Publisher: Elsevier BV
Date: 06-2010
The Prevent Alcohol and Risk-Related Trauma in Youth (P.A.R.T.Y) program: An interactive injury prevention initiative in South-Western Sydney
Publisher: Elsevier BV
Date: 09-2022
DOI: 10.1016/J.INJURY.2022.07.023
Abstract: The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y) program is an interactive injury prevention intervention, specifically designed for "at risk" youths aged 15 to 19 years. Emerging evidence has highlighted its positive impact on altering student attitudes towards risk-taking behaviour across several Australian and international settings. This study aims to describe the risk-taking behaviours of youths in South-Western and Greater Western Sydney, and assess the effectiveness of the Liverpool P.A.R.T.Y program to alter attitudes towards risk-taking. From 2015 to 2020, schools and youth organisations across South-Western and Greater Western Sydney were invited to participate in the Liverpool Hospital P.A.R.T.Y program. Youths aged 15 to 19 years were selected to attend by their respective teachers based on eligibility criteria. Knowledge and attitudes towards risk-taking behaviours were measured using surveys across three time points (pre-program, immediately post-program, 3-to-6 months post-program). A total of 2544 participants from 50 schools and youth organisations attended the Liverpool Hospital P.A.R.T.Y program. There were 130 participants who did not record a response to a single question across all three time points and were omitted from analysis. Of the remaining 2414 participants, 49% were male, and 41% had access to a provisional driver's license or learner's permit. There were significant changes in knowledge and attitudes to risk-taking behaviours from pre-to immediately-post-program. A separate analysis across all three time points was conducted in response to a poor 3-to-6-month follow-up rate (25%). There was decay in improvements across all six questions, with the largest change seen in perceived likelihood of injury when engaging in physically risk-taking activities (52.2% to 36.9%, OR 0.44, 95% CI 0.33 - 0.60, p < 0.001). This study demonstrated significant changes in participant attitudes towards risk-taking behaviours and their consequences, immediately after participating in the Liverpool Hospital P.A.R.T.Y program. However, the poor response rates at later follow-up highlight the need for ongoing engagement of the South-Western and Greater Western Sydney youths, to ensure these improvements are sustained.
Frailty, delirium and hospital mortality of older adults admitted to intensive care: the Delirium (Deli) in ICU study
Publisher: Springer Science and Business Media LLC
Date: 15-10-2020
DOI: 10.1186/S13054-020-03318-2
Abstract: Clinical frailty among older adults admitted to intensive care has been proposed as an important determinant of patient outcomes. Among this group of patients, an acute episode of delirium is also common, but its relationship to frailty and increased risk of mortality has not been extensively explored. Therefore, the aim of this study was to explore the relationship between clinical frailty, delirium and hospital mortality of older adults admitted to intensive care. This study is part of a Delirium in Intensive Care (Deli) Study. During the initial 6-month baseline period, clinical frailty status on admission to intensive care, among adults aged 50 years or more acute episodes of delirium and the outcomes of intensive care and hospital stay were explored. During the 6-month baseline period, 997 patients, aged 50 years or more, were included in this study. The average age was 71 years (IQR, 63–79) 55% were male ( n = 537). Among these patients, 39.2% (95% CI 36.1–42.3%, n = 396) had a Clinical Frailty Score (CFS) of 5 or more, and 13.0% ( n = 127) had at least one acute episode of delirium. Frail patients were at greater risk of an episode of delirium (17% versus 10%, adjusted rate ratio ( adj RR) = 1.71, 95% confidence interval (CI) 1.20–2.43, p = 0.003), had a longer hospital stay (2.6 days, 95% CI 1–7 days, p = 0.009) and had a higher risk of hospital mortality (19% versus 7%, adj RR = 2.54, 95% CI 1.72–3.75, p 0.001), when compared to non-frail patients. Patients who were frail and experienced an acute episode of delirium in the intensive care had a 35% rate of hospital mortality versus 10% among non-frail patients who also experienced delirium in the ICU. Frailty and delirium significantly increase the risk of hospital mortality. Therefore, it is important to identify patients who are frail and institute measures to reduce the risk of adverse events in the ICU such as delirium and, importantly, to discuss these issues in an open and empathetic way with the patient and their families.
The Extended Dwell Peripheral Intravenous Catheter Is an Alternative Method of NICU Intravenous Access (vol 18, pg 295, 2018)
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 12-2018
Epidemiological transition to mortality and refracture following an initial fracture
Publisher: eLife Sciences Publications, Ltd
Date: 09-02-2021
DOI: 10.7554/ELIFE.61142
Abstract: This study sought to redefine the concept of fracture risk that includes refracture and mortality, and to transform the risk into "skeletal age". We analysed data obtained from 3521 women and men aged 60 years and older, whose fracture incidence, mortality, and bone mineral density (BMD) have been monitored since 1989. During the 20-year follow-up period, among 632 women and 184 men with a first incident fracture, the risk of sustaining a second fracture was higher in women (36%) than in men (22%), but mortality risk was higher in men (41%) than in women (25%). The increased risk of mortality was not only present with an initial fracture, but was accelerated with refractures. Key predictors of post-fracture mortality were male gender (hazard ratio [HR] 2.4 95% CI, 1.79–3.21), advancing age (HR 1.67 1.53–1.83), and lower femoral neck BMD (HR 1.16 1.01–1.33). A 70-year-old man with a fracture is predicted to have a skeletal age of 75. These results were incorporated into a prediction model to aid patient-doctor discussion about fracture vulnerability and treatment decisions.
Identifying factors associated with intravenous fluid administration in patients with sepsis presenting to the emergency department: a retrospective cohort study
Publisher: Springer Science and Business Media LLC
Date: 03-06-2022
DOI: 10.1186/S12873-022-00650-4
Abstract: Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis, to identify factors associated with receiving intravenous fluids while in the ED and, secondly to identify determinants associated with the actual time to fluid administration. We conducted a retrospective multicentre cohort study of adult ED presentations between October 2018 and May 2019 in four metropolitan hospitals in Western Sydney, Australia. Patients meeting pre-specified criteria for sepsis and septic shock and treated with antibiotics within the first 24 h of presentation were included. Multivariable models were used to identify factors associated with fluid administration in sepsis. Four thousand one hundred forty-six patients met the inclusion criteria, among these 2,300 (55.5%) patients with sepsis received intravenous fluids in ED. The median time to fluid administration from the time of diagnosis of sepsis was 1.6 h (Interquartile Range (IQR) 0.5 to 3.8), and the median volume of fluids administered was 1,100 mL (IQR 750 to 2058). Factors associated with patients receiving fluids were younger age (Odds Ratio (OR) 1.05, 95% Confidence Interval (CI (1.03 to 1.07), p 0.001) lower systolic blood pressure (OR 1.11, 95% CI (1.08 to 1.13), p 0.001) presenting to smaller hospital (OR 1.48, 95% CI (1.25 to 1.75, p 0.001) and a Clinical Rapid Response alert activated (OR 1.64, 95% CI (1.28 to 2.11), p 0.001). Patients with Triage Category 1 received fluids 101.22 min earlier (95% CI (59.3 to131.2), p 0.001) and those with Category 2 received fluids 43.58 min earlier (95% CI (9.6 to 63.1), p 0.001) compared to patients with Triage Category 3–5. Other factors associated with receiving fluids earlier included septic shock (-49.37 min (95% CI (-86.4 to -12.4), p 0.001)) each mmol/L increase in serum lactate levels (-9.0 min, 95% CI (-15.7 to -2.3), p 0.001) and presenting to smaller hospitals (-74.61 min, 95% CI (-94.0 to -55.3), p 0.001). Younger age, greater severity of sepsis, and presenting to a smaller hospital increased the probability of receiving fluids and receiving it earlier. Recognition of these factors may assist in effective implementation of sepsis management guidelines which should translate into better patient outcomes. Future studies are needed to identify other associated factors that we have not explored.
Safewards: Changes in conflict, containment, and violence prevention climate during implementation
Publisher: Wiley
Date: 20-07-2020
DOI: 10.1111/INM.12762
Establishing a nurse-led central venous catheter insertion service
Publisher: Association for Vascular Access
Date: 03-2010
DOI: 10.2309/JAVA.15-1-5
Abstract: Background: Health care systems promote care models that deliver both safety and quality. Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes. Objectives: The aim of this paper is to discuss the process of establishing a nurse-led central venous catheter (CVC) insertion service in a university affiliated hospital using a process evaluation method. Method: Archival information, including reports, communications and minutes of departmental meetings were reviewed. Key stakeholders involved in establishing this nurse-led service at the time were interviewed. Results: A nurse-led CVC insertion service was first established in 1996 and has increased in service provision over 13 years. Initially there was scepticism from some medical practitioners about the feasibility of a nurse performing a traditional medical procedure. The service currently provides central venous access across the hospital including critical care areas. The service places up to 500 catheters per annum. Conclusions: Establishing a nurse-led CVC insertion service has increased organizational efficiencies and provided an infrastructure for support of best practice. The support of senior management and medical practitioners was crucial to the successful implementation of this model of care.
International prevalence of the use of peripheral intravenous catheters
Publisher: Wiley
Date: 03-06-2015
DOI: 10.1002/JHM.2389
Abstract: Over a billion peripheral intravenous catheters (PIVCs) are inserted each year in hospitalized patients worldwide. However, international data on prevalence and management of these devices are lacking. The study assessed the prevalence of PIVCs and their management practices across different regions of the world. This global audit involved 14 hospitals across 13 countries, with 479 patients screened for the presence of a PIVC. We found 59% of patients had at least 1 PIVC in place, and 16% had other types of vascular devices. We also found that overall, 25% of patients had no vascular device in place. The majority of PIVCs were inserted by nursing staff or a specialist team. The prevalence of idle PIVCs in place with no fluid or medication orders was 16%, and 12% of PIVCs had at least 1 symptom of phlebitis.
World Delirium Awareness Day 2019, delirium and risk of falls in the hospital setting
Publisher: Research Square Platform LLC
Date: 22-08-2019
Abstract: Background Delirium is an acute change in cognition, common among older hospitalized patients, however, patients of all ages are at risk of delirium during a hospital stay. The International Federation of Delirium Societies promotes, each year, a World Delirium Awareness Day, to raise the awareness of, not just recognizing delirium in the hospital setting, but ensuring interventions are in place to prevent the development of delirium. Hospitalized patients with delirium have increased risk of adverse events such as falls, pressure injury, malnutrition, increased length of stay, increased health care costs, and mortality. This clinical audit aimed to estimate the risk of a subsequent fall, following an acute episode of in-hospital delirium, across a broad cross-sectional of clinical settings. Methods Seventeen adult acute inpatient wards across a health district, undertook an audit of the number of admitted patients who had had at least one episode of delirium since being admitted to hospital. Using the hospital-based incident management reporting system, the rates of subsequent falls was compared between delirium and non-delirium patients. Results Fifty of the 473 patients (11.4%) were identified by the nursing staff to have had at least one episode of delirium since admission. The proportion of fallers among the delirium and non-delirium patients were 10% and 2%, respectively (p = 0.004). The rate of falls per 1000 patient days was 6.45 (95% confidence interval (CI) 2.1 to 15.1) among delirium patients, compared to 2.12 (95% CI 1.0 to 4.0) among patients without delirium. The risk of falling among delirium patients was 4.25 higher compared to non-delirium patients (adjusted hazard ratio (HR) = 4.25, 95% CI 1.26 to 14.39). Conclusion This clinical audit has been able to show that an acute episode of delirium increases the risk of an in-hospital fall fourfold. Importantly, these results have highlighted the need for a hospital wide approach, to not just in identifying delirium, but the need to have interventions in place to reduce the risk of delirium. In other words, delirium prevention should be ‘core business’ of all nursing care, across the acute hospital setting.
Misclassification and measurement error – planning a study and interpreting results
Publisher: RCN Publishing Ltd.
Date: 11-03-2021
The changing nature of the population of intensive-care patients
Publisher: Sciedu Press
Date: 07-02-2018
DOI: 10.5430/JHA.V7N2P1
Abstract: Background: The increase in the number of Australia’s frail, very elderly ( 80 years of age) population will have an impact on admissions to intensive care. As the number of very elderly patients increase, it will be important to have information about what the impact of increasing age will have on aspects such as: the impact of age and chronic health conditions on intensive care treatment, and the impact on prognosis in the short and longer-term as well as how we should be involving the very elderly in determining their own goals of care.Objective: To evaluate the long-term trend in the rates of the very elderly ( 80 years of age) admitted to intensive care, as well as describe their chronic health conditions, length of stay, and mortality rates.Methods: This study was a retrospective review that used a database from a 40-bed, multidisciplinary, adult intensive care unit (ICU), located in South-Western Sydney, Australia. The setting is an 877-bed tertiary hospital that has medical and surgical specialties including a referral trauma unit, with approximately 80,000 admissions a year. Data were acquired over 15-years, from January 1st, 2000 to December 31st, 2015.Results: Data were available for 32,796 patients, and of these, 4,137 (12.5%) were aged ≥ 80 years. The percentage of the very elderly admitted to ICU progressively increased from 8.6% in 2000 to (14.5% in 2015, p .001). Overall, the median length of stay (LOS) in the ICU was 2-days (interquartile range: 1.2-4.1), and increased from 2.0 to 2.3 (p .001). Similarly, the median hospital LOS increased over time from 9 to 11 days (p .001). Intensive care and hospital death rates decreased over time from 19.9% to 9.8% (p .001), and 31.8% to 19.9% (p .001), respectively. The majority of the very elderly were admitted from the emergency department (ED) (38.1%), other sources of admission being from the operating theatres (OT) (33.5%), and the general ward (18.1%).Conclusions: The number and percentage of very elderly patients being managed in ICU is increasing, representing a different population from the one that much of our practice has been previously based. For ex le, we may need to review the way we estimate severity of illness on admission to the ICU with more weight given to the chronic health component of the very elderly. The acute indications for admission to ICU such as falls and infections are relatively straightforward to manage and usually have a good outcome. However, because age and the chronic health status of the very elderly are largely progressive and irreversible, we as health care professionals working in intensive care may have to consider longer-term post hospital outcomes as a basis for evaluating the effectiveness of the interventions in ICU.
Australia's health care reform agenda: Implications for the nurses' role in chronic heart failure management
Publisher: Elsevier BV
Date: 08-2011
DOI: 10.1016/J.AUCC.2010.08.003
Abstract: The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including "heart failure", "management", "Australia" and "nursing". In addition policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of in iduals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care.
Delirium in intensive care: A stepped-wedge cluster randomised controlled trial for a nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the intensive car
Publisher: Elsevier BV
Date: 09-2020
Using administrative data to develop a nomogram for individualising risk of unplanned admission to intensive care
Publisher: Elsevier BV
Date: 11-2008
DOI: 10.1016/J.RESUSCITATION.2008.06.023
Abstract: Although unplanned admissions to the intensive care unit (ICU) are associated with poorer prognoses, there is no published prognostic tool available for predicting this risk in an in idual patient. We developed a nomogram for calculating the in idualised absolute risk of unplanned ICU admission during a hospital stay. Hospital administrative data from a large district hospital of consecutive admissions from 1 January 2000 to 31 December 2006 of aged over 14 years was used. Patient data was extracted from 94,482 hospital admissions consisted of demographic and clinical variables, including diagnostic categories, types of admission and time and day of admission. Multivariate logistic regression coefficients were used to develop a predictive nomogram of in idual risk to patients admitted to the study hospital of unplanned ICU admission. A total of 672 incident unplanned ICU admissions were identified over this period. Independent predictors of unplanned ICU admissions included being male, older age, emergency department (ED) admissions, after-hour admissions, weekend admissions and six principal diagnosis groups: fractured femur, acute pancreatitis, liver disease, chronic airway disease, pneumonia and heart failure. The area under the receiver operating characteristic curve was 0.81. The use of a nomogram to accurately identify at-risk patients using information that is readily available to clinicians has the potential to be a useful tool in reducing unplanned ICU admissions, which in turn may contribute to the reduction of adverse events of patients in the general wards.
Unplanned admission to the intensive care unit in the very elderly and risk of in-hospital mortality
Publisher: Elsevier BV
Date: 09-2010
A nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to intensive care: A stepped-wedge cluster randomised trial
Publisher: Elsevier BV
Date: 07-2023
DOI: 10.1016/J.AUCC.2022.08.005
Abstract: Delirium is an acute change in behaviour, characterised by a fluctuating course, inattention, and disorganised thinking. For critically ill adults in the intensive care, the incidence of delirium has been reported to be at least 30% and is associated with both short-term and long-term complications, longer hospital stay, increased risk of mortality, and long-term cognitive problems. The objective of this study was to determine the effectiveness of a nurse-led delirium-prevention protocol in reducing the incidence and duration of delirium among adults admitted to intensive care. A hybrid stepped-wedge cluster randomised controlled trial was conducted to assess the effectiveness of the implementation and dissemination of the nurse-led intervention to reduce the incidence and duration of delirium among adults admitted to the four adults intensive care units in the southwest of Sydney, Australia. Between May 2019 and February 2020, over a 10-month period, 2618 admissions, among 2566 patients, were included in the study. After an initial 3-month baseline period, each month there was a random crossover to the nurse-led intervention in one of the four intensive care units, and by the 7th month of the trial, all units were exposed to the intervention for at least 3 months. The incidence of acute delirium was observed to be 10.7% (95% confidence interval [CI] = 9.1-12.4%), compared to 14.1% (95% CI = 12.2-16.2%) during the preintervention (baseline) period (adjusted rate ratio [adjRR] = 0.78, 95% CI = 0.57-1.08, p = 0.134). The average delirium-free-days for these preintervention and postintervention periods were 4.1 days (95% CI = 3.9-4.3) and 4.4 days (95% CI = 4.2-4.5), respectively (adjusted difference = 0.24 days [95% CI = -0.12 to 0.60], p = 0.199). Following the introduction of a nurse-led, nonpharmacological intervention to reduce the burden of delirium, among adults admitted to intensive care, we observed no statistically significant decrease in the incidence of delirium or the duration of delirium.
Wrist deformity, bother and function following wrist fracture in the elderly
Publisher: Springer Science and Business Media LLC
Date: 20-03-2020
DOI: 10.1186/S13104-020-05013-5
Abstract: Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: (1) determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it (2) test if there were associations between deformity and treatment-type and between deformity and function (3) test for associations between bother and treatment-type and between bother and function (4) measure the test–retest reliability of the ‘bother’ question. Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR = 3.85, p = 0.006) but was not significantly associated with functional outcomes (p = 0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p = 0.006) and this association was clinically significant (MD = 35 points). The deformity and bother questions were found to have excellent test–retest reliability κ = 1.00 and κ = 0.92, respectively.
BONEcheck: A digital tool for personalized bone health assessment
Publisher: Elsevier BV
Date: 09-2023
Wrist deformity, bother and function following wrist fracture in the elderly
Publisher: Research Square Platform LLC
Date: 04-02-2020
Abstract: Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it 2. test if there were associations between deformity and treatment-type and between deformity and function 3. test for associations between bother and treatment-type and between bother and function 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability ᴋ=1.00 and ᴋ=0.92, respectively.
Type-II MI and Chronic Myocardial Injury Rates, Invasive Management and 4 Year Mortality Among Consecutive Patients Undergoing High Sensitivity Troponin T Testing in the Emergency Department
Publisher: Elsevier BV
Date: 2019
Wrist deformity, bother and function following wrist fracture in the elderly
Publisher: Research Square Platform LLC
Date: 16-03-2020
Abstract: Objective Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: 1. determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it 2. test if there were associations between deformity and treatment-type and between deformity and function 3. test for associations between bother and treatment-type and between bother and function 4. measure the test-retest reliability of the ‘bother’ question. Results Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR=3.85, p=0.006) but was not significantly associated with functional outcomes (p=0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p=0.006) and this association was clinically significant (MD=35 points). The deformity and bother questions were found to have excellent test-retest reliability ᴋ=1.00 and ᴋ=0.92, respectively.
A comparison of fluid instillation volumes to assess intra-abdominal pressure using Kron’s methods
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 07-2012
Self‐efficacy, resilience and healthy ageing among older people who have an acute hospital admission: A cross‐sectional study
Publisher: Wiley
Date: 21-08-2023
DOI: 10.1002/NOP2.1960
Abstract: To examine the associations between self‐efficacy, resilience and healthy ageing among older people who have an acute hospital admission. A cross‐sectional study. Survey and medical record data were collected from older people on discharge from hospital. The survey measured self‐efficacy with the 6‐item General Self‐Efficacy scale (GSE‐6), resilience with the Brief Resilience Scale (BRS), and healthy ageing with the Selfie Ageing Index (SAI). Medical record data included potential confounders: co‐morbidities, frailty items, previous falls and previous admission in the last 28 days. Multi‐linear regression and Spearman's rank correlation coefficient were used to examine the independent associations between self‐efficacy, resilience and healthy ageing. Responses were received from 143 older people (mean age 79). After adjusting for potential confounders, co‐morbidities ( ß = ‐0.08, p = 0.001) remained negatively associated with healthy ageing, while self‐efficacy ( ß = 0.03, p = 0.005) and resilience ( ß = 0.05, p 0.001) remained positively associated with healthy ageing ( R 2 = 0.243). Positive correlations were found between self‐efficacy ( ρ = 0.33, p 0.01), resilience ( ρ = 0.38, p 0.001) and healthy ageing. Positive correlations were also found between self‐efficacy and resilience ( ρ = 0.38, p 0.01). Those with lower self‐efficacy and resilience were more likely to report reduced activities of daily living, mobility, physical activity and mood. Findings indicate that while the number of co‐morbidities have negative consequences for healthy ageing among older people who are hospitalised, the promotion of self‐efficacy and resilience can potentially contribute to healthy ageing within the physical and psychological domains. Nurses can promote self‐efficacy, which can potentially increase resilience and help to improve self‐management of chronic conditions, functional ability in daily activities, mobility and physical activity and reduce both anxiety and depressive symptoms. Participant feedback throughout the data collection process assisted in the evaluation of study methods and data interpretation. This included processes such as assessing selected tools and clarifying the meanings of healthy ageing factors.
Interpreting the results of clinical trials, embracing uncertainty: A Bayesian approach
Publisher: Wiley
Date: 24-10-2020
DOI: 10.1111/AAS.13725
Abstract: Most clinical trials use null hypothesis significance testing with frequentist statistical inference to report P values and confidence intervals for effect estimates. This method leads to a dichotomisation of results as ‘significant’ or ‘non‐significant’. A more nuanced interpretation may often be considered and in particular when the majority of the confidence interval for the effect estimate suggests benefit or harm. In contrast to the frequentist dichotomised approach based on a P value, the application of Bayesian statistics allocates credibility to a continuous spectrum of possibilities and for this reason a Bayesian approach to inference is often warranted as it will incorporate uncertainty when updating our current belief with information from a new trial. The use of Bayesian statistics is introduced in this paper for a hypothetical sepsis trial with worked ex les in the R language for Statistical Computing environment and the open‐source statistical software JASP. It is hoped that this general introduction to Bayesian inference stimulates some interest and confidence among clinicians to consider applying these methods to the interpretation of new evidence for interventions relevant to anaesthesia and intensive care medicine.
Quantitative methods used in Australian health promotion research
Publisher: CSIRO Publishing
Date: 2006
DOI: 10.1071/HE06032
Abstract: This study examined the use of quantitative methods in Australian health promotion research in order to identify methodological trends and priorities for strengthening the evidence base for health promotion. Australian health promotion articles were identified by hand searching publications from 1992-2002 in six journals: Health Promotion Journal of Australia, Australian and New Zealand journal of Public Health, Health Promotion International, Health Education Research, Health Education and Behavior and the American Journal of Health Promotion. The study designs and statistical methods used in articles presenting quantitative research were recorded. 591 (57.7%) of the 1,025 articles used quantitative methods. Cross-sectional designs were used in the majority (54.3%) of studies with pre- and post-test (14.6%) and post-test only (9.5%) the next most common designs. Bivariate statistical methods were used in 45.9% of papers, multivariate methods in 27.1% and simple numbers and proportions in 25.4%. Few studies used higher-level statistical techniques. While most studies used quantitative methods, the majority were descriptive in nature. The study designs and statistical methods used provided limited scope for demonstrating intervention effects or understanding the determinants of change.
Training of Undergraduate Clinicians in Vascular Access: An Integrative Review
Publisher: Association for Vascular Access
Date: 09-2012
DOI: 10.1016/J.JAVA.2012.07.001
Abstract: Introduction: Peripheral venous cannulas are predominantly inserted by nurses and medical practitioners. Placement and related care of such devices are one of the most frequently performed tasks by these staff members. Clinicians in training should be given le opportunity to practice these skills before patient encounters begin. Aims: To identify the best available evidence on the training of undergraduate clinicians in peripheral venous access. Methods: We used an integrative literature review method that considered both experimental- and nonexperimental-design studies that addressed the issue of clinician peripheral venous access training of undergraduates. The electronic databases Medline, Embase, Ovid Nursing Database, British Nursing Index, Pre Medline, Mosby's Index, and CINAHL were searched using a predetermined search strategy. The Cochrane and Joanna Briggs databases were also searched along with the reference lists of published materials. Results: A total of 56 articles were retrieved using the defined search strategy. There were 11 experimental-design studies and 1 nonexperimental-design study selected for final review after independent assessment for methodologic quality. Retrieved articles found disparity between actual skill and student self-evaluation. Teaching methods varied with the use of traditional task trainers and high-fidelity simulation. No method was found to be superior. Conclusion: Skill acquisition in vascular access is an international issue and one that has been addressed in varying degrees. We identified heterogeneity in training methods that were tailored to institutional requirements and resources. Training in this skill is imperative to ensure competency before patient encounters.
Patient, provider and system factors influencing rehospitalisation in adults with heart failure: a literature review.
Publisher: Informa UK Limited
Date: 22-09-2012
Association between intravenous fluid resuscitation and outcome among patients with suspected infection and sepsis: A retrospective cohort study
Publisher: Wiley
Date: 12-11-2022
Abstract: To investigate the association between timing and volume of intravenous fluids administered to ED patients with suspected infection and all-cause in-hospital mortality. Retrospective cohort study of ED presentations at four metropolitan hospitals in Sydney, Australia, between October 2018 and May 2019. Patients over 16 years of age with suspected infection who received intravenous fluids within 24 h of presentation were included. During the study period, 7533 patients with suspected infection received intravenous fluids. Of these, 1996 (26.5%) and 231 (3.1%) had suspected sepsis and septic shock, respectively. Each 1000 mL increase in intravenous fluids administered was associated with a reduction in risk of in-hospital mortality (adjusted odds ratio [AOR] 0.87, 95% confidence interval [CI] 0.76-0.99). This association was stronger in patients with septic shock (AOR 0.66, 95% CI 0.49-0.89), and those admitted to intensive care unit (ICU) (AOR 0.74, 95% CI 0.56-0.96). Patients with suspected sepsis and septic shock who received a total volume of >3600 mL had lower in-hospital mortality (AOR 0.44, 95% CI 0.22-0.91 AOR 0.16, 95% CI 0.05-0.57) compared to those administered <3600 mL within the first 24 h of presenting to the ED. There was no association between the time of initiation of fluids and in-hospital mortality among survivors and non-survivors (2.3 vs 2.5 h, P = 0.50). We observed a reduction in risk of in-hospital mortality for each 1000 mL increase in intravenous fluids administered in patients with septic shock or admitted to ICU suggesting illness severity to be a likely effect modifier.
Measuring final-year nursing students' satisfaction with the viva assessment
Publisher: Elsevier BV
Date: 2016
DOI: 10.1016/J.NEPR.2015.09.003
Abstract: This paper reports a study conducted to develop and test the psychometric properties of a brief 5-item Satisfaction with the Oral Viva Assessment Scale. The viva has been increasingly used to gauge students' learning, beyond the traditional written assessments. This assessment approach may pose additional challenges to various student groups. Using a prospective, correlational design, this study surveyed 275 final year nursing students about their satisfaction with the viva as an assessment approach. The survey was administered to those who attended a revision session in an undergraduate high dependency unit. Descriptive and inferential statistical analyses, as well as exploratory and confirmatory factor analyses of the scale were computed. Exploratory factor analysis yielded a one-component structure that explained 51% of the total variance, which was supported by confirmatory factor analysis (standardised factor loadings: 0.54-0.73). Internal consistency as computed by a Cronbach's alpha was 0.8. The results also revealed that those who obtained higher grades in their viva performance (OR: 2.78, 95% CI: 1.58-4.90) and English-speaking only students (OR: 1.87, 95% CI: 1.07-3.27) were more satisfied with the viva assessment. These findings support the validity and reliability of this scale, and can be used to assess students' satisfaction with the viva.
Management of intra-abdominal hypertension and abdominal compartment syndrome: a review
Publisher: Springer Science and Business Media LLC
Date: 05-02-2014
Abstract: Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL) Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function.
Do men and women have similar absolute risk of fracture?
Publisher: Elsevier BV
Date: 05-2009
Late Survival Among Patients ≥80 Years with Suspected ACS According to High Sensitivity Troponin T Levels
Publisher: Elsevier BV
Date: 2017
Late Mortality Rates of Patients with Type 2 MI Compared to Type 1 MI and Stable Troponin Elevation
Publisher: Elsevier BV
Date: 2017
Related Organisations
Related Funding Activities
TRANSLATION OF BEST PRACTICE OSTEOPOROSIS REFRACTURE PREVENTION: STOPPING FRAGILITY FRACTURES TO KEEP AUSTRALIANS OUT OF HOSPITAL
Start Date: 2019
End Date: 2022
Funder: Department of Health
View Funded ActivitySafer Medicines To Reduce Falls And Fractures For OsteoPorosis (#STOP)
Start Date: 2021
End Date: 2025
Funder: Department of Health
View Funded Activity