ORCID Profile
0000-0002-0828-9852
Current Organisations
Community and Oral Health at Brighton Health Campus
,
Royal Brisbane and Women's Hospital
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Publisher: BMJ
Date: 03-02-2015
Publisher: John Wiley & Sons, Ltd
Date: 06-07-2011
Publisher: Wiley
Date: 02-2016
Publisher: Cambridge University Press (CUP)
Date: 31-07-2019
DOI: 10.1017/ICE.2019.205
Abstract: To establish the reliability of the application of National Health and Safety Network (NHSN) central-line–associated bloodstream infection (CLABSI) criteria within established reporting systems internationally. Diagnostic-test accuracy systematic review. We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed. A systematic search identified 1,259 publications 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58–0.81) to 0.99 (95% CI, 0.99–1.00) and sensitivity ranged from 0.42 (95% CI, 0.15–0.72) to 0.88 (95% CI, 0.77–0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%–4.4%. The risk of bias was low to moderate in most included studies. Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time. Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989 June 7, 2015). www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989
Publisher: Microbiology Society
Date: 04-2017
DOI: 10.1099/JMM.0.000463
Abstract: Dressings containing chlorhexidine gluconate (CHG) are increasingly used in clinical environments for prevention of infection at central venous catheter insertion sites. Increased tolerance to this biocide in staphylococci is primarily associated with the presence of qacA/B and smr genes. We used a culture-independent method to assess the prevalence of these genes in 78 DNA specimens recovered from the skin of 43 patients at catheter insertion sites in the arm that were covered with CHG dressings. Of the 78 DNA specimens analysed, 52 (67 %) possessed qacA/B and 14 (18 %) possessed smr all s les positive for smr were also positive for qacA/B. These prevalence rates were not statistically greater than those observed in a subs le of specimens taken from non-CHG treated contralateral arms and non-CHG-dressing exposed arms. A statistically greater proportion of specimens with greater than 72 h exposure to CHG dressings were qac-positive (P=0.04), suggesting that the patients were contaminated with bacteria or DNA containing qacA/B during their hospital stay. The presence of qac genes was not positively associated with the presence of DNA specific for Staphylococcusepidermidis and Staphylococcusaureus in these specimens. Our results show that CHG genes are highly prevalent on hospital patients' skin, even in the absence of viable bacteria.
Publisher: Springer Science and Business Media LLC
Date: 25-11-2022
DOI: 10.1007/S00520-021-06654-3
Abstract: Oral mucositis is a common complication in patients undergoing hematopoietic stem cell transplantation. Accurate oral mucositis grading is essential for both clinical practice and oral mucositis research. This study aimed to evaluate the accuracy of daily oral mucositis grading by nurses in a tertiary hospital in Australia. A retrospective study was undertaken to review the daily patient oral assessment record, including diet, pain, erythema, ulceration and the oral mucositis grade based on World Health Organization (WHO) oral mucositis grading scale. The accuracy of the grade was determined by the observations recorded, and reasons for inaccuracy were documented. Any repetition of the same error in the same patient was noted. In total, 6841 oral assessments in 373 patients, conducted between 2017 and 2020, were reviewed. A total of 70% (N = 4781) were graded correctly. Of these, 64% (N = 3043) were grade 0. When the grade 0 scores were excluded, the accuracy of grading was reduced to 46% (N = 1738). Common reasons for incorrect grading included: unable to grade due to diet not specified, no ulceration and no pain was scored grade 1, no ulceration was scored as grade 2-4, oral intake was not taken into account, and pain without ulcer was scored 0. A total of 77% of the errors were repeated in the same patient on consecutive days. Our results suggest there is frequent inaccurate evaluation of oral mucositis and a need for nurse training to accurately assess oral mucositis.
Publisher: SAGE Publications
Date: 18-05-2019
Abstract: Central venous access devices (CVADs) are vital to enable treatment for children with cancer and other complex health conditions. However, complications effecting the CVAD wound are commonly reported. This study aimed to identify the incidence and prevalence of CVAD-associated skin complications current management, and characteristics associated with complication development, in pediatrics. A prospective observational study performed across medical, oncology, and hematology departments at a tertiary pediatric hospital in Australia, between April and July 2017. Children admitted with CVADs were assessed twice weekly for CVAD-associated skin complications and associated signs and symptoms. The data were analyzed using descriptive statistics (i.e., proportions, frequency) and time-to-event multivariable regression (i.e., hazard ratios [HRs]). Two hundred and seventy-one CVADs were reviewed over 43,787 catheter days, with over one eighth of participants (14% n = 37) having a CVAD-associated skin complication during their admission (0.95 per 1,000 catheter days, 95% confidence interval [CI 0.61, 1.17]), most commonly contact dermatitis (11% n = 29 0.72 per 1,000 catheter days 95% CI [0.50, 1.04]). Within biweekly checks the median point prevalence of complications varied between 0.4% and 11% and clinical management was wide-ranging. A primary diagnosis of oncology (HR 2.89, 95% CI [1.10, 7.62]) or medical/surgical (HR 2.55, 95% CI [1.04, 6.22]) conditions plain, nonbordered polyurethane dressings (HR 4.92, 95% CI [2.00, 12.13]) and poor dressing integrity (HR 2.64, 95% CI [1.18, 5.92]) were significantly associated with contact dermatitis. In conclusion, substantial numbers of pediatric patients experience CVAD-associated skin complications, and innovations are necessary to identify, prevent, and treat these health care–associated injuries.
Publisher: Cambridge Media
Date: 28-10-2020
DOI: 10.33235/VA.6.2.9-14
Publisher: Mary Ann Liebert Inc
Date: 12-2018
Abstract: Identifying people who are at risk of deteriorating and dying is essential to inform goals of care, appropriate treatment decisions, patient autonomy, and effective end-of-life care. Limited literature exists on predicting survival near the end of life for people with a hematological malignancy. To identify the key clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying. Eleven clinical indicators identified in a Delphi approach were tested via a retrospective case-control study. Each indicator was assessed for at each in-patient admission between living (n = 236) and deceased (n = 120) people with a hematological malignancy who were admitted to a large tertiary hospital between 1st July 2014 and 31st December 2015. Six clinical indicators were independently associated with mortality in the final three months of life: declining performance status (Odds Ratio [OR] 7.153, 95% Confidence Intervals [CI] 3.281-15.597, p = < 0.001) treatment limitations of the hematological malignancy (OR 7.855, 95% CI 3.528-17.489, p = < 0.001) relapse, refractory or persistent disease (OR 3.749, 95% CI 1.749-8.039, p = 0.001) presence of two or more comorbidities (OR 2.991, 95% CI 1.319-6.781, p = 0.009) invasive fungal infections (OR 4.887, 95% CI 1.197-19.949, p = 0.027) and persistent infections (OR 6.072, 95% CI 2.551-14.457, p = < 0.001). This study has identified six clinical indicators that signal a person with a hematological malignancy is at high risk of deteriorating and dying and may benefit from an assessment of palliative needs and proactive planning, along-side appropriate treatment.
Publisher: Wiley
Date: 08-01-2018
DOI: 10.1002/JPEN.1039
Abstract: Recommendations prescribe daily intravenous administration set (IVAS) replacement for parenteral nutrition (PN) comprising intravenous fat emulsions (IVFE) due to risk of micro-organism growth and resultant central-line associated bloodstream infections (CLABSIs), but system disconnection for this practice may allow contamination and CLABSIs. Laboratory experiments and model development were used to simulate PN administration after contamination from healthcare workers' hands. This study observed the growth of micro-organisms known to cause CLABSIs in a variety of PN and other IV fluids and developed a model to investigate the effect of delaying IVAS replacement on microbial growth for up to 7 days. Micro-organisms grew at different rates and were affected by solution type. In static experiments, growth was supported in IVFE and all-in-one PN, but suppressed in 50% glucose. Growth patterns were consistent over time for Staphylococcus epidermidis, Staphylococcus aureus, and Candida albicans in IVFE, all-in-one PN, and 0.9% sodium chloride in both static and dynamic experiments. C. albicans grew exponentially to clinically significant numbers in all-in-one PN and IVFE IVAS after 30 hours, but negligible growth of S. epidermidis or S. aureus occurred for 7 days. All-in-one PN and IVFE support the C. albicans growth after minimal initial contamination, with micro-organisms migrating from the fluid bag to the central venous access device. Improved aseptic nontouch technique during clinical practice is vital to prevent contamination. Daily IVAS replacement of for all-in-one PN and IVFE should continue until the safety of prolonging IVAS replacement is confirmed by randomized trials.
Publisher: Springer Science and Business Media LLC
Date: 26-08-2022
DOI: 10.1007/S00520-022-07328-4
Abstract: Oral mucositis is a common complication during haematopoietic stem cell transplantation (HSCT). This study aimed to assess the incidence of severe mucositis in patients undergoing different HSCT regimens. This single-centre retrospective study reviewed daily oral assessment for 467 consecutive patients who underwent different transplant regimens for matched unrelated or related allogeneic HSCT with post-transplant methotrexate, haploidentical or mismatched HSCT with post-transplant cyclophosphamide (PTCy), or autologous HSCT. Oral care and cryotherapy with melphalan were used. Patient demographic data, oral mucositis WHO grade, use of total parenteral nutrition (TPN) and patient-controlled analgesia (PCA) were collected. Grade 3–4 oral mucositis was common in myeloablative total body irradiation (TBI)-based regimens cyclophosphamide/ TBI (CyTBI) (71%) and fludarabine/ TBI (FluTBI) with PTCy (46%), as well as reduced-intensity fludarabine/melphalan (FluMel) (43%) and carmustine/etoposide/cytarabine/melphalan (BEAM) autologous HSCT (41%). In contrast, grade 3–4 oral mucositis was less common in reduced-intensity haploidentical regimen melphalan/fludarabine/TBI with PTCy (19%), all non-myeloablative regimens (0–9%) and high-dose melphalan autologous HSCT (26%). TPN and PCA use were correlated to oral mucositis severity. Severe oral mucositis was associated with myeloablative TBI, methotrexate and melphalan in combination with methotrexate and in BEAM. Use of PTCy was preferable over methotrexate to prevent oral mucositis.
Publisher: Ovid Technologies (Wolters Kluwer Health)
Date: 03-2018
DOI: 10.1097/NAN.0000000000000270
Abstract: Guidelines recommend using single-lumen central vascular access devices (CVADs) for the administration of parenteral nutrition (PN) or lipid-based solutions, or a dedicated lumen on a multilumen CVAD. Publications reviewed by the authors reported comparative rates of catheter-related bloodstream infection (CR-BSI) in patients with CVADs who received PN through a dedicated lumen compared with those who had PN administered through multilumen CVADs. Two studies included 650 patients with 1349 CVADs. CR-BSIs were equally distributed between the 2 groups. Both studies were poorly reported and had significant risk of bias. These results should be interpreted with caution.
Publisher: Wiley
Date: 27-06-2017
Abstract: Central venous access devices (CVADs) are used for parenteral nutrition (PN) delivery. We systematically reviewed research-based publications that reported comparative rates of catheter-related bloodstream infection (CRBSI) in patients with CVADs who received PN vs those who did not receive PN therapy. The literature search included the Cochrane Library, MEDLINE, CINAHL, and PubMed up to July 14, 2015, to identity studies that compared patients with a CVAD who did and did not have PN therapy. Eleven observational studies were identified, comprising 2854 participants with 6287 CVADs. Six studies produced significant results in favor of non-PN, 4 studies showed no evidence of a difference between PN and non-PN, and 1 study produced significant results in favor of PN when analyzed per patient with multiple CVADs. Incidence ranged from 0 to 6.6 CRBSIs per 1000 CVAD days in the PN patients and 0.39 to 3.6 CRBSIs per 1000 CVAD days in the non-PN patients. The Cochrane risk of bias assessment tool for nonrandomized studies of interventions was used. Eight studies were rated as moderate risk of bias, 2 as serious, and 1 as critical. The data presented in this systematic review are not sufficient to establish whether patients receiving PN are more at risk of developing CRBSI than those who do not. Future PN studies needs to adjust for baseline imbalances and improve quality and reporting.
Publisher: Mary Ann Liebert Inc
Date: 09-2022
Publisher: BMJ
Date: 10-2020
DOI: 10.1136/BMJOPEN-2020-038567
Abstract: Graft versus host disease (GVHD) is a major cause of morbidity and mortality following allogenic haematopoietic stem cell transplantation. It is an immunological reaction, involving many organs, leading to a wide range of clinical manifestations. Cutaneous manifestations are the most common sign of GVHD, as well as pain, vulnerability to infection and impaired quality of life. Despite the burdens that cutaneous GVHD presents for patients, their carers and the healthcare system, limited evidence is available to guide day to day supportive skin care and wound management. Our objective is to conduct a scoping review to map the evidence for skin and wound management and identify evidence-practice gaps for in iduals with acute or chronic cutaneous GVHD. Our review will follow the scoping review methodological framework developed by Arksey and O’Malley and further refined by the Joanna Briggs Institute Scoping Review Methods Manual. Databases to be searched include PubMed, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, Cumulative Index to Nursing and Allied Health Literature, Web of Science and MEDLINE from 1970 to February 2020. Database searches will be supplemented with searches from relevant reference lists and grey literature. Descriptive statistical analyses will be performed. This scoping review does not require ethical approval. Findings will be disseminated through a peer-reviewed publication and conference presentation.
Publisher: Springer Science and Business Media LLC
Date: 04-10-2017
Publisher: BMJ
Date: 06-2017
Publisher: CSIRO Publishing
Date: 08-12-2023
DOI: 10.1071/AH22142
Abstract: Objective This study aimed to investigate COVID-19 vaccine hesitancy, acceptance, and unmet informational needs in a cancer population during the first phase of the coronavirus disease 2019 (COVID-19) vaccination rollout in Australia. Methods A cross-sectional survey was conducted in a large tertiary hospital in Queensland, Australia, between 10 May and 31 July 2021. The survey assessed health beliefs, experiences of the COVID-19 pandemic, COVID-19 vaccine hesitancy and informational needs. Results COVID-19 was perceived to be a significant threat to both physical and mental health. While 57.9% (n = 110) of respondents believed the COVID-19 vaccines were safe and 64.2% (n = 122) believed they were effective, more than half (52.6% n = 100) agreed that they worried about vaccine side effects. Most respondents (84.2% n = 160) planned to receive the COVID-19 vaccine however, feelings of hesitancy remained. There was a statistically significant association between those aged under 60 years (P = 0.003), those with previous vaccine hesitancy (P = 0.000), those who felt they had not received adequate information (P = 0.000) and vaccine hesitancy. Requested information pertained to interactions with cancer treatments, those with a history of blood clotting and information for those undergoing bone marrow transplantation. Conclusions There is a need for tailored COVID-19 vaccine communication that is responsive to the concerns of people with cancer. This will be beneficial during current and future vaccination rollouts.
Publisher: CSIRO Publishing
Date: 04-09-2019
DOI: 10.1071/AH18102
Abstract: Objective The aim of this study was to quantify the utilisation of vascular access devices in Queensland public hospitals and their associated cost. Methods Devices were broadly classified into peripheral intravenous catheters, central venous catheters and arterial lines. The number of catheters used was obtained from a central procurement department at Queensland Health and validated using Medicare Benefits Schedule (MBS) claims and/or hospital data from the Australian Institute of Health and Welfare for the same period. Resources consumed included equipment and staff time required to insert and remove catheters. Equipment costs were valued using negotiated hospital prices, and staff time was valued at the fixed industrial award wages in Australia or relevant MBS fees. Device maintenance costs (e.g. dressings) and costs of treating complications were excluded. Results Approximately 2.75 million vascular access devices were used in public hospitals in Queensland in 2016, at a total cost of A$59.14 million. This comprised a total equipment cost of around A$10.17 million and a total labour cost of A$48.85 million Conclusion Vascular access is an important component of healthcare expenditure. The present study is the first to characterise and cost vascular access devices in Queensland. Further research is needed on the costs of maintaining device function and of treating complications associated with vascular access. What is known about the topic? The cost of vascular access in Australia has previously been estimated from modelling, using various assumptions, or based on device utilisation in other countries. What does this paper add? For the first time, device utilisation for vascular access in Queensland has been quantified and costed. Results were obtained from reliable sources and validated against other databases. What are the implications for practitioners? Practitioners and managers may now provide accurate estimates about the cost of catheter failure, a potentially preventable problem that affects up to 50% of all catheters placed. Attaching costs to such failure may also stimulate research into how to reduce the problem.
Publisher: Springer Science and Business Media LLC
Date: 14-09-2020
DOI: 10.1186/S13063-020-04699-Z
Abstract: To evaluate the feasibility of an efficacy trial comparing a hydrophobic polyurethane peripherally inserted central catheter (PICC) with a standard polyurethane PICC. This pilot randomised controlled trial (RCT) was conducted between May 2017 and February 2018. Adult participants ( n = 111) were assigned to hydrophobic polyurethane PICC with proximal valve (intervention) or a polyurethane PICC with external cl (standard care). Primary outcome was trial feasibility including PICC failure. Secondary outcomes were central line-associated bloodstream infection, local infection, occlusion, thrombosis, fracture and dislodgement, phlebitis, local or systemic allergic reaction, and PICC dwell time. All feasibility outcomes were achieved, apart from eligibility criteria. In total, 338 patients were screened, 138 were eligible (41%), and of these 111 were randomised (80%). Patients received the allocated PICC in 106 (95%) insertions. No patients withdrew from the study and there was no missing data. PICC failure was 24% (13/55) in the intervention group and 22% (12/55) in the standard care group ( p = 0.820). PICC failure per 1000 PICC days was 16.3 in the intervention group and 18.4 in the control group ( p = 0.755). The average dwell time was 12 days in the intervention and 8 days in the control group. This study demonstrates the feasibility of an efficacy trial of PICC materials in an adult population, once adjustments were made to include not only in-patients, but also patients being discharged to the Hospital in the Home service. Australia and New Zealand Clinical Trials Registry ACTRN12616001578493 . Prospectively registered on 16 November 2016. The trial protocol was published a priori (Kleidon et al., Vasc Access 3:15–21, 2017).
Publisher: CSIRO Publishing
Date: 13-07-2021
DOI: 10.1071/AH20346
Abstract: Objective Many cancer care services (CCS) provide pragmatic models of emergent care for their patients as part of ‘business as usual’ without understanding the scope of this work. We aimed to describe an Australian CCS-led model of emergent care and quantify and profile emergent care provided over a 6-month period to understand scope and demand. Methods This prospective cohort study was performed at a large tertiary hospital on the eastern coast of Australia in 2016. The study explored emergent care provided during business hour and after-hours, including telephone advice, unplanned care and unplanned admissions. Data were collected via electronic hospital records and clinical nurses regarding who accessed care, why care was accessed, what care was provided and how the episode of care ended. Results Between March and September 2016, 1412 episodes of unplanned care were provided in the CCS-led model of care, including 307 episodes of telephone advice (237 patients min max 1–4 episodes per patient 825 episodes of unplanned care (484 patients min max 1–9 episodes per patient) and 280 unplanned admissions (233 patients min max 1–6 episodes per patient). During the same time, an additional 459 unplanned admissions (361 patients) occurred via the emergency department (ED), of which 125 (27.2%) occurred during business hours which could have been managed by the CCS. Most people who received care experienced issues associated with disease or treatment and had received systemic anticancer therapy in the past 30 days. Conclusions The data demonstrate that a significant volume of emergent care was provided within the CCS over the study period, in addition to planned cancer treatment. Due to the ever-increasing demands on EDs and the significant need for emergent care for people with cancer, there is need for CCS-led models of care to provide specialist emergent care specifically for people who are receiving systemic anticancer therapy. Such models must be adequately resourced to meet the needs of patients, carers and healthcare professionals. What is known about the topic? There is increasing focus on innovative models of emergent care for people with cancer in the out-patient setting to relieve pressure on EDs and improve patient experiences. Limited literature has focused on such models in the Australian context. What does this paper add? This paper describes, quantifies and profiles care provided in a pragmatic CCS-led model of emergent care in a large tertiary hospital in Australia over 6 months. The data demonstrate significant demand for emergent care within business hours, as well as out of hours, predominantly for people undergoing systemic anticancer therapy. What are the implications for practitioners? The findings of this study highlight the need for CCS to develop pragmatic models of emergent care. Appropriate resources, infrastructure, policies and procedures are required to adequate meet the needs of patients and carers.
Publisher: Springer Science and Business Media LLC
Date: 07-08-2022
DOI: 10.1007/S00520-021-06461-W
Abstract: Patients who undergo haematopoietic stem cell transplantation (HSCT) often have multiple health issues following hospital discharge. In many centres, outpatient follow-up is solely conducted by specialist physicians. We aimed to implement and describe the outcomes of a nurse-allied health multidisciplinary clinic. The clinic consisted of six disciplines-nursing, pharmacy, dietetics, physiotherapy, occupational therapy and social work. All allogeneic and high risk autologous HSCT patients were reviewed at 2 weeks after discharge and on day 100 post HSCT, with additional reviews as needed. Occasions of service, interventions, readmission data and physician satisfaction survey were collected prior to and after implementation. Additionally, patient feedback and quality of life survey (FACT-BMT) were collected during the first 6 months. From July to December 2019, 57 patients were reviewed in the clinic (475 reviews, average 8.3 reviews per patient). Common interventions included the following: exercise programs by physiotherapist (n = 111), diet prescription (n = 103), counselling by social worker (n = 53), medication lists provision (n = 51), fatigue management (n = 43) and nurse education (n = 22). The clinic did not reduce patients' readmission rate however, positive feedback from patients and physicians were reported. FACT-BMT results demonstrated that there are unmet needs, particularly fatigue management, sexual education and support, body images, back to work support and quality of life improvement. From discharge to day 100, there was no significant improvement in quality of life. This clinic provides an innovative approach to patient-centred care in HSCT. It has been well received by patients who were supported by multidisciplinary interventions.
Publisher: Wiley
Date: 10-07-2023
DOI: 10.1002/JPEN.2530
Abstract: Distinguishing primary bloodstream infections (BSIs) related to central venous access devices (CVADs) from those that occur through other mechanisms, such as a damaged mucosal barrier, is difficult. Secondary analysis was conducted on data from patients with CVADs that were collected for a large, randomized trial. Patients were ided into two groups: those who received parenteral nutrition (PN)–containing intravenous lipid emulsion (ILE) and those who did not have PN‐containing ILE. This study investigated the influence of PN‐containing ILE (ILE PN) on primary BSIs in patients with a CVAD. Of the 807 patients, 180 (22%) received ILE PN. Most (627/807 73%) were recruited from the hematology and hematopoietic stem cell transplant unit, followed by surgical (90/807 11%), trauma and burns (61/807 8%), medical (44/807 5%), and oncology (23/807 3%). When primary BSI was differentiated as a central line‐associated BSI (CLABSI) or mucosal barrier injury laboratory‐confirmed BSI (MBI‐LCBI), the incidence of CLABSI was similar in the ILE PN and non–ILE PN groups (15/180 [8%] vs 57/627 [9%] P = 0.88) and the incidence of MBI‐LCBI was significantly different between groups (31/180 [17%] ILE PN vs 41/627 [7%] non–ILE PN P 0.01). Our data indicate that twice as many primary BSIs in ILE PN patients are due to MBIs than CVADs. It is important to consider the MBI‐LCBI classification, as some CLABSI prevention efforts aimed at CVADs for the ILE PN population may be better directed to gastrointestinal tract protection interventions.
Publisher: Elsevier BV
Date: 12-2015
DOI: 10.1016/J.EJON.2015.05.003
Abstract: The aim of this study was to determine whether a variation in practice from an aseptic non-touch technique (ANTT) to a sterile technique when changing needleless connectors on central venous access devices (CVAD) was associated with any change in catheter related bloodstream infection (CRBSI) rates in the bone marrow transplant (BMT) population. A two group comparative study without concurrent controls using a retrospective cohort was conducted in a large metropolitan hospital in Brisbane, Australia. haematological malignancy, Hickman catheter inserted, age ≥18. A tool was developed to extract historical data from medical records and pathology results. CRBSI. laboratory confirmed bloodstream infection, mucosal barrier injury laboratory confirmed bloodstream infection and skin contaminants. One hundred and fifty patients were assessed, 73/150 (49%) in the ANTT group. males 95/150 (63%), with 71/150 (47%) receiving an autologous BMT. No difference in CRBSI rates between groups was observed (ANTT n = 3 (4%) vs Sterile n = 1 (2.7%), p = 0.357 Fishers Exact Test). Infection by skin contaminants were identified in a similar number of cases across both groups (ANTT n = 9 (12.3%) vs Sterile n = 6 (7.8%)). No causal effect can be deduced from this small study nevertheless results imply that an ANTT was not associated with increased CRBSI. Poor hand hygiene and ANTT were perceived across both groups. Quality and consistent ANTT is a safe method for managing intravascular devices, however education and awareness of pathogen transfer from healthcare worker and patient to their device is required.
Publisher: Oncology Nursing Society (ONS)
Date: 26-06-2014
Publisher: Wiley
Date: 19-11-2018
DOI: 10.1111/JAN.13889
Abstract: To provide expert consensus on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. Identification of people who are at risk of deteriorating and dying is essential to facilitate patient autonomy, appropriate treatment decisions, and effective end-of-life care. A three-step modified Delphi approach. The study was conducted over 6 months (September 2015-March 2016) to gather opinion from an international panel of experts (N = 27) on the clinical indicators that signal a person with a haematological malignancy is at high risk of deteriorating and dying. The first round was informed by a systematic review of prognostic factors present in the final months of life for people with a haematological malignancy. Consensus was achieved if 70% of responses fell within two points on a seven-point Likert-type scale. Consensus was achieved on the following 11 clinical indicators: (a) advancing age (b) declining performances status (c) presence of co-morbidities (d) disease status (e) persistent infections (bacterial and viral) (f) fungal infections (g) severe graft versus host disease (h) requiring high care (i) signs of frailty (j) treatment limitations and (k) anorexia and/or weight loss. Consensus was also achieved on associated themes and statements for each indicator. The findings of this study indicate that subjective clinician-assessed indicators that are contextually relevant to the nature of haematological malignancies are markers of risk. This study has provided valuable preliminary findings on the topic and will inform future research.
Publisher: SAGE Publications
Date: 06-2023
DOI: 10.1177/11297298231171422
Abstract: Optimising first time success of peripheral intravenous catheter (PIVC) insertion and reducing intravenous (IV) complications in cancer patients undergoing contrast-enhanced computed tomography (CT) is vital to ensure vascular access preservation and diagnostic accuracy. The aim of this study was to test the feasibility of a randomised controlled trial (RCT) evaluating a novel perforated PIVC compared to a standard PIVC. A single centre, parallel-group, pilot RCT was conducted between March and May 2020. Adult participants diagnosed with cancer were randomised to a non-perforated PIVC (standard care) or a PIVC with a novel perforated design (intervention) for the administration of IV contrast. There were two primary outcomes: (1) feasibility of an adequately powered RCT with pre-established criteria and (2) all-cause PIVC failure. Secondary outcomes included: first insertion success, modes of PIVC failure, dwell time, contrast injection parameters (volume and injection rate), contrast enhancement, radiographer satisfaction and adverse events. Feasibility outcomes were met, except for eligibility (⩾90%) and recruitment (⩾90%). In total, 166 participants were screened, 128 (77%) were eligible and of these 101/128 (79%) were randomised 50 to standard care and 51 to intervention. First time insertion rate was 94% (47/50) in standard care and 90% (46/50) in intervention. The median dwell time was 37 minutes (interquartile range (IQR): 25–55) in standard care and 35 minutes (IQR: 25–60) in the intervention group. There was one PIVC failure, a contrast media extravasation, in the intervention group (1/51 2%). The desired contrast injection rate was not achieved in 4/101 (4%) of participants two from each group. Radiographers were satisfied with the contrast flow rate. This pilot RCT suggests perforated PIVCs provide expected flow rate, with no evidence of differences in contrast enhancement to non-perforated PIVCs. The feasibility of conducting a larger powered RCT was demonstrated.
Publisher: Elsevier BV
Date: 04-2021
Location: Australia
Location: United Kingdom of Great Britain and Northern Ireland
Location: United Kingdom of Great Britain and Northern Ireland
No related grants have been discovered for Nicole Gavin.