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ItemA 3-year follow-up study of inpatients with lower limb ulcers: evidence of an obesity paradox?(Dove Press, 2012-08-09) Miller, Michelle Deanne; Delaney, Christopher; Penna, Deanna; Liang, Lilian; Thomas, Jolene Marie; Puckridge, Phillip; Spark, James IObjectives: To determine whether body composition is related to long-term outcomes amongst vascular inpatients with lower limb ulcers. Design: Prospective study with 3 years follow-up. Materials and methods: Body mass index (BMI), fat, and fat-free mass were measured and associations with readmission to hospital (number, cause, length of stay) and all-cause mortality were explored. Results: Thirty patients (22 men, 8 women) participated in the study. Ten patients (33%) had a BMI ≥ 30 kg/m2. 18/20 (90%) patients with a BMI < 30 kg/m2 and 9/10 (90%) patients with a BMI ≥ 30 kg/m2 were admitted to hospital in the 3 years of follow-up. Patients with a BMI < 30 kg/m2 were admitted more frequently, earlier and for longer compared to those with BMI ≥ 30 kg/m2 but these did not reach statistical significance. The 3 year mortality rate for patients with BMI ≥ 30 kg/m2 was 20% (n = 2/10) compared to 70% (n = 14/20) with a BMI <30 kg/m2, P = 0.019. Conclusion: This preliminary study suggests that higher BMI may have a protective effect against mortality in vascular patients with lower limb ulcers. These findings contradict the universal acceptance that obesity leads to poor health outcomes. Further work is required to confirm these findings and explore some of the potential mechanisms for this effect. ItemAbsconding: A review of the literature 1996-2008(John Wiley & Sons, 2008) Muir-Cochrane, Eimear Caitlin; Mosel, Krista AAbsconding is a significant problem with potential for harm to patients or the general public. The consequences of absconding include physical harm, prolonged treatment time, and substantial economic costs. The aim of this systematic literature review is to synthesize quality literature about absconding from psychiatric facilities, identify gaps in knowledge, and make recommendations for practice. An electronic search yielded 39 journal articles that met the review criteria. Findings demonstrate that a single definition of absconding remains elusive, making the prevalence of absconding difficult to establish. Absconding events are multifactorial, with environmental, psychosocial, and organic aspects. Negative consequences exist including violence, aggression, and self-neglect and harm to self and others. Papers are clustered around the following themes: harm and risk, absconder profiles, absconding rates, and perceptions of nurses and patients. Nursing interventions designed to decrease absconding have been implemented with success, but only in a few studies and in Australia, none have been reported in the literature to date. Further research is required to identify appropriate nursing-based interventions that may prove useful in reducing the risk of absconding. Itemac.care, Antenatal Dads and First Year Families, Communities for Children Murraylands: Final Report(Flinders University, 2016) Parry, Yvonne; Abbott, ShellyIntroduction: The evaluation of the programs provided by the Communities for Children initiative (CfC) is presented here. This report is divided into five sections. The first section presents the background information on the CfC initiative including an outline of the demographic and epidemiological outcomes for children in the area of focus for this evaluation. Additionally, the introduction outlines some of the theoretical basis for the models of care and the therapeutic models of care that are common in all the programs provided. Subsequent sections provide the therapeutic models of care specific to the particular program provided by the organisation or service. The report also provides a conclusion for each program and a final conclusion for the evaluation research project as a whole. Itemac.care, Beyond Kayaking, Communities for Children Murraylands Final Report: The use of Communities for Children programs to improve family outcomes in Murraylands region of South Australia(Flinders University, 2016) Parry, Yvonne; Abbott, ShellyThe evaluation of the programs provided by the Communities for Children initiative (CfC) is presented here. This report is divided into five sections. The first section presents the background information on the CfC initiative including an outline of the demographic and epidemiological outcomes for children in the area of focus for this evaluation. Additionally, the introduction outlines some of the theoretical basis for the models of care and the therapeutic models of care that are common in all the programs provided. Subsequent sections provide the therapeutic models of care specific to the particular program provided by the organisation or service. The report also provides a conclusion for each program and a final conclusion for the evaluation research project as a whole. Itemac.care, Murraylands, Aspire Children’s Development and Wellbeing Program, Communities for Children: Final Report(Flinders University, 2017) Parry, Yvonne; Abbott, ShellyIntroduction: The evaluation of one of the programs provided by the Communities for Children initiative (CfC) is presented here. This ac.care Murraylands commissioned report is divided into five sections. The first section presents the background information on the CfC Initiative including an outline of the demographic and epidemiological outcomes for children in the Murraylands Rural Region. Additionally, the introduction outlines some of the theoretical basis for the models of care and the therapeutic models of care that are common in all the programs provided. Subsequent sections provide the therapeutic models of care specific to the program provided by the organisation or service. The report also provides a conclusion for each program type; i.e. the program provided to parents and children, and the program provided to staff/workers in the Murraylands Rural Region, and the conclusion for the evaluation research project. ItemACCCN Workforce Standards for Intensive Care Nursing: Systematic and evidence review, development, and appraisal(Elsevier, 2017-08-28) Chamberlain, Diane Joy; Pollock, Wendy; Fulbrook, PaulBackground: The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses’ ability to maintain the safety of those in their care. In Australia, the Australian College of Critical Care Nurses (ACCCN) has previously published a position statement on intensive care staffing. There was a need for a stronger more evidence based document to support the intensive nursing workforce. Objectives: To undertake a systematic and evidence review of the evidence related to intensive care nurse staffing and quality of care, and determine evidence-based professional standards for the intensive care nursing workforce in Australia. Methods: The National Health and Medical Research Council standard for clinical practice guidelines methodology was employed. The English language literature, for the years 2000-2015 was searched. Draft standards were developed and then peer- and consumer-reviewed. Results: A total of 553 articles was retrieved from the initial searches. Following evaluation, 231 articles met the inclusion criteria and were assessed for quality using established criteria. This evidence was used as the basis for the development of ten workforce standards, and to establish the overall level of evidence in support of each standard. All draft standards and their subsections were supported multiprofessionally (median score >6) and by consumers (85e100% agreement). Following minor revisions, independent appraisal using the AGREE II tool indicated that the standards were developed with a high degree of rigour. Conclusion: The ACCCN intensive care nursing nurse workforce standards are the first to be developed using a robust, evidence-based process. The standards represent the optimal nurse workforce to achieve the best patient outcomes and to maintain a sustainable intensive care nursing workforce for Australia. ItemAcceptability of participatory social network analysis for problem-solving in Australian Aboriginal health service partnerships(BioMed Central Ltd., 2012-06-10) Fuller, Jeffrey; Hermeston, Wendy; Passey, Megan; Fallon, Tony; Muyambi, KudaWhile participatory social network analysis can help health service partnerships to solve problems, little is known about its acceptability in cross-cultural settings. We conducted two case studies of chronic illness service partnerships in 2007 and 2008 to determine whether participatory research incorporating social network analysis is acceptable for problem-solving in Australian Aboriginal health service delivery. Methods: Local research groups comprising 13–19 partnership staff, policy officers and community members were established at each of two sites to guide the research and to reflect and act on the findings. Network and work practice surveys were conducted with 42 staff, and the results were fed back to the research groups. At the end of the project, 19 informants at the two sites were interviewed, and the researchers conducted critical reflection. The effectiveness and acceptability of the participatory social network method were determined quantitatively and qualitatively. Results: Participants in both local research groups considered that the network survey had accurately described the links between workers related to the exchange of clinical and cultural information, team care relationships, involvement in service management and planning and involvement in policy development. This revealed the function of the teams and the roles of workers in each partnership. Aboriginal workers had a high number of direct links in the exchange of cultural information, illustrating their role as the cultural resource, whereas they had fewer direct links with other network members on clinical information exchange and team care. The problem of their current and future roles was discussed inside and outside the local research groups. According to the interview informants the participatory network analysis had opened the way for problem-solving by “putting issues on the table”. While there were confronting and ethically challenging aspects, these informants considered that with flexibility of data collection to account for the preferences of Aboriginal members, then the method was appropriate in cross-cultural contexts for the difficult discussions that are needed to improve partnerships. Conclusion: Critical reflection showed that the preconditions for difficult discussions are, first, that partners have the capacity to engage in such discussions, second, that partners assess whether the effort required for these discussions is balanced by the benefits they gain from the partnership, and, third, that “boundary spanning” staff can facilitate commitment to partnership goals. ItemAccessing donor conception information in Australia: a call for retrospective access(Thomson Reuters, 2012) Adams, Damian Hedley; Lorbach, Caroline ItemAddition of botulinum toxin type A to casting may improve wrist extension in people with chronic stroke and spasticity: A pilot double-blind randomized trial(Endorium Journals, 2017-03-15) Scott, Hayley; Lannin, Natasha A; English, Coralie; Ada, Louise; Levy, Tamina; Hart, Rhiannon; Crotty, MariaAims: Does the addition of botulinum toxin type A increase the effect of casting for improving wrist extension after stroke in people with upper limb spasticity? Methods: Randomized trial with concealed allocation, assessor blinding and intention-to-treat analysis which was part of a larger trial included 18 adults with upper limb spasticity two years after stroke (89%) or stroke-like conditions (11%). The experimental group (n=7) received botulinum toxin type A injections to upper limb muscles for spasticity management followed by two weeks of wrist casting into maximum extension. The control group (n=11) received two weeks of casting only. Range of motion (goniometry) measured at baseline and after two weeks of casting. Results: Passive wrist extension for the experimental group improved over two weeks from 22 degrees (SD 16) to 54 degrees (SD 16), while the control group improved from 21 degrees (SD 29) to 43 degrees (SD 26). The experimental group increased passive wrist extension 13 degrees (95% CI 4 to 31) more than the control group which was not statistically significant. Conclusion: Joint range of motion improved over a two-week period for both groups. Botulinum toxin type A injection followed-by casting produced a mean, clinically greater range of motion than casting alone, therefore, a fully-powered trial is warranted. ItemAdditional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data(Elsevier, 2016) English, Coralie; Shields, Nora; Brusco, Natasha Kareem; Taylor, Nicholas F; Watts, Jennifer J; Peiris, Casey L; Bernhardt, Julie; Crotty, Maria; Esterman, Adrian Jeffrey; Segal, Leonie; Hillier, SusanQuestions: Among people receiving inpatient rehabilitation after stroke, does additional weekend physiotherapy and/or occupational therapy reduce the length of rehabilitation hospital stay compared to those who receive a weekday-only service, and does this change after controlling for individual factors? Does additional weekend therapy improve the ability to walk and perform activities of daily living, measured at discharge? Does additional weekend therapy improve health-related quality of life, measured 6 months after discharge from rehabilitation? Which individual, clinical and hospital characteristics are associated with shorter length of rehabilitation hospital stay? Design: This study pooled individual data from two randomised, controlled trials (n = 350) using an individual patient data meta-analysis and multivariate regression. Participants: People with stroke admitted to inpatient rehabilitation facilities. Intervention: Additional weekend therapy (physiotherapy and/or occupational therapy) compared to usual care (5 days/week therapy). Outcome measures: Length of rehabilitation hospital stay, independence in activities of daily living measured with the Functional Independence Measure, walking speed and health-related quality of life. Results: Participants who received weekend therapy had a shorter length of rehabilitation hospital stay. In the un-adjusted analysis, this was not statistically significant (MD –5.7 days, 95% CI –13.0 to 1.5). Controlling for hospital site, age, walking speed and Functional Independence Measure score on admission, receiving weekend therapy was significantly associated with a shorter length of rehabilitation hospital stay (b = 7.5, 95% CI 1.7 to 13.4, p = 0.001). There were no significant between-group differences in Functional Independence Measure scores (MD 1.9 points, 95% CI –2.8 to 6.6), walking speed (MD 0.06 m/second, 95% CI –0.15 to 0.04) or health-related quality of life (SMD –0.04, 95% CI –0.26 to 0.19) at discharge. Discussion: Modest evidence indicates that additional weekend therapy might reduce rehabilitation hospital length of stay. Clinical Trial Registration: ACTRN12610000096055, ACTRN12609000973213. [English C, Shields N, Brusco NK, Taylor NF, Watts JJ, Peiris C, et al. (2016) Additional weekend therapy may reduce length of rehabilitation stay after stroke: a meta-analysis of individual patient data. Journal of Physiotherapy 62: 124–129] ItemAddressing men's health policy concerns in Australia: what can be done?(BioMed Central - http://www.biomedcentral.com, 2007-10-10) Smith, JamesThere is a lack of consensus about what men's health constitutes in Australia. The absence of a widely accepted definition has been problematic for establishing state and national men's health policies. I consider that one impediment to the implementation of state and federal men's health policies has been a lack of willingness to approach men's health from a broad public health perspective. In particular, scant attention has been paid to exploring lay perspectives of how men define and understand health, and in turn, how these relate to significant policy problems such as men's health service use. I conclude by suggesting that a focus on men's lay perspectives of their health emerging from the United Kingdom and the Republic of Ireland provides a useful framework to guide men's health policy discussion in Australia. ItemAddressing nutrition and social connection through community gardening: A South Australian study(Wiley, 2019-02-11) Mehta, Kaye Phillips; Lopresti, Silvia; Thomas, JessicaBackground This research aimed to evaluate the benefits of the community gardening program called ‘‘Magic Harvest (MH)” with respect to its key elements: social interaction; gardening skills; and, healthier eating. The MH program supports community participants to grow food, share produce, prepare and preserve food. Methods Two focus groups were conducted with participants in MH programs in the south of Adelaide, South Australia. The MH programs were located in lower socio‐economic areas. Focus group interviews were recorded, transcribed verbatim, coded and analysed thematically. Results Thirteen participants took part in the focus groups and reported gains in community connectedness and shared learning, skills for growing food and healthy eating and making more sustainable food choices. Conclusion This study highlights the social and nutritional benefits that can be derived from a community gardening program in low‐income communities. Health practitioners and policymakers should consider community gardening as an effective health promotion strategy that can address physical and social determinants of health and nutrition for low‐income communities. ItemAddressing the English language needs of international nursing students(Association for Academic Language and Learning, 2011) Muller, AmandaThis paper addresses the English language needs of the international nursing student, and outlines the factors requiring the most immediate attention. A strategic direction that could be taken for the implementation of an English language intervention will be suggested. The paper will begin by reviewing the research on the language needs of international nursing students, followed by an investigation of the academic demands on the international cohort, especially considering the students’ lack of time for extra study. Drawing from the research, a focus on specialised vocabulary (in both spoken and written forms) is suggested as a preparatory strategy for students. This is because vocabulary learning is a core language activity that is key to the reception of knowledge, and essential to the preparation of the student for engagement in the classroom and the clinical placement setting. The paper provides further evidence that validates a focus on vocabulary, referring to how vocabulary breadth is a better predictor of academic success than IELTS (yet problematises any simple applications of this finding, both in terms of the important role of the IELTS test and the complicated processes underpinning vocabulary acquisition). Finally, some key recommendations are given at the end of the paper. ItemAddressing Uncomfortable Issues: Reflexivity as a Tool for Culturally Safe Practice in Aboriginal and Torres Strait Islander Health(Cambridge University Press, 2014-11-10) Wilson, AnnabelleIt is well recognised that research with Aboriginal communities needs to be ethical, meaningful and useful, in a way that is defined by communities themselves. This article provides an example of how reflexivity, from a number of positions and paradigms, can be used to undertake such research. I used a reflexive journal to document and critically assess the challenges and discomfort I experienced while undertaking research with Aboriginal communities, including uncertainty and feeling in the minority. Reflexivity allowed me to experience a number of key learnings, including: the importance of relationships; the importance of time, transparency and trust in relationships; reciprocity; the importance of listening; a partnership approach; and the impact of Aboriginal culture and past experience. The way in which I redefined my success as a researcher is also explored. In using reflexivity I reached new levels of understanding about myself, which enabled me to alter my practice and therefore change the experiences of those I was working with, ideally towards experiences that were perceived as culturally safe. Using reflexivity also enabled me to identify my position as a White researcher and centralise the needs and perspectives of Aboriginal people in my research. The purpose of this article is to present my own journey, as well as start a dialogue and provide a framework for how others might use reflexivity to become a culturally safe health professional or researcher and centralise the needs and perspectives of Aboriginal people in research and practice. ItemAdhering to the principles of physical restraint free environments in residential aged care: a literature review(2005) King, Lindy; Harding, Graham ItemAdults’ Perceptions of Their Tinnitus and a Tinnitus Information Service(Australian Academic Press, 2010) Adams, Jennie; Verrier, Emily; Walsh, Megan; Lind, ChristopherThe South Australian Government funds Tinnitus SA to provide advice and information to South Australians to assist in their understanding of tinni-tus and their decision making about tinnitus-related service provision. This qualitative study aimed to identify key motivations for adults seeking tinnitus advice, determine how those services are perceived, and provide insight into the help-seeking behaviour of those who experience tinni-tus. Participants in this study were recruited from Tinnitus SA’s attendance lists for their community information sessions held in 2008 and 2009. Of the 60 people contacted, 13 adults agreed to particpate in the semistructured interviews. Interviews, lasting approximately 45 minutes focused on interviewees’ perceptions of their tinnitus prior to attending the Tinnitus SA information session, their response to the information session itself, and their perceptions and actions following the information session. Grounded theory was used as the guiding method-ology for analysis of the transcribed interview data. The themes that emerged during analysis of the interviews fell into two broad descriptive categories: Empowerment through information and education; and If you can’t cure me I’ll cope. Together these categories led to the overarching theme of participants’ responses: ‘I don’t need help, but I’d like more information’. Further analy-sis revealed that the Tinnitus SA community sessions were the primary source of information for the majority of these participants and there was a high level of satisfaction with these sessions by contrast to other information sources. ItemAdvance Care Planning for Adults With CKD: A Systematic Integrative Review(Elsevier, 2014-05) Luckett, T; Sellars, M; Tieman, Jennifer; Pollock, CA; Silvester, W; Butow, Phyllis N; Detering, KM; Brennan, Frank; Clayton, Josephine MBackground Recent clinical practice guidelines have highlighted the importance of advance care planning (ACP) for improving end-of-life care for people with chronic kidney disease (CKD). Study Design We conducted a systematic integrative review of the literature to inform future ACP practice and research in CKD, searching electronic databases in April 2013. Synthesis used narrative methods. Setting & Population We focused on adults with a primary diagnosis of CKD in any setting. Selection Criteria for Studies We included studies of any design, quantitative or qualitative.. Interventions ACP was defined as any formal means taken to ensure health professionals and family members are aware of patients’ wishes for care in the event they become too unwell to speak for themselves. Outcomes Measures of all kinds were considered to be of interest. Results Fifty-five articles met criteria reporting on 51 discrete samples. All patient samples included people with Stage 5 CKD; two also included patients with Stage 4. Seven interventions were tested; all were narrowly focused and none was evaluated by comparing wishes for end-of-life care with care received. One intervention demonstrated effects on patient/family outcomes in the form of improved wellbeing and anxiety following sessions with a peer mentor. Insights from qualitative studies that have not been emphasised in interventions include the importance of instilling patient confidence that their advance directives will be enacted and discussing decisions about (dis)continuing dialysis separately from ‘aggressive’ life-sustaining treatments (e.g. ventilation). Limitations Whilst quantitative and qualitative findings were integrated according to best practice, methods for this are in their infancy. Conclusions Research on ACP in patients with CKD is limited, especially regarding intervention studies. Interventions in CKD should attend to barriers and facilitators at the levels of patient, caregiver, health professional and system. Intervention studies should measure impact on compliance with patient wishes for end-of-life care. Index words Chronic kidney disease, Renal failure, Advance care planning, Advance directives, Decision-making ItemAdvancing aged care: a systematic review of economic evaluations of workforce structures and care processes in a residential care setting(Springer Nature, 2016) Easton, Tiffany; Milte, Rachel; Crotty, Maria; Ratcliffe, JulieLong-term care for older people is provided in both residential and non-residential settings, with residential settings tending to cater for individuals with higher care needs. Evidence relating to the costs and effectiveness of different workforce structures and care processes is important to facilitate the future planning of residential aged care services to promote high quality care and to enhance the quality of life of individuals living in residential care. A systematic review conducted up to December 2015 identified 19 studies containing an economic component; seven included a complete economic evaluation and 12 contained a cost analysis only. Key findings include the potential to create cost savings from a societal perspective through enhanced staffing levels and quality improvement interventions within residential aged care facilities, while integrated care models, including the integration of health disciplines and the integration between residents and care staff, were shown to have limited cost-saving potential. Six of the 19 identified studies examined dementia-specific structures and processes, in which person-centred interventions demonstrated the potential to reduce agitation and improve residents’ quality of life. Importantly, this review highlights methodological limitations in the existing evidence and an urgent need for future research to identify appropriate and meaningful outcome measures that can be used at a service planning level. ItemAfter hours nurse staffing, work intensity and quality of care - missed care study: New South Wales public and private sectors. Final report to the New South Wales Nurses and Midwives' Association(Flinders University, 2015-07) Blackman, Ian Robert; Henderson, Julie Anne; Willis, Eileen Mary; Toffoli, Luisa PatriziaThe MISSCARE survey was developed by Beatrice Kalisch who defines missed care as “required patient care that is omitted (either in part or in whole) or delayed” and is a response, she claims, to “multiple demands and inadequate resources”. The MISSCARE survey has three components: demographic and workplace data; missed nursing care, which consists of a list of nursing tasks which had been identified; and reasons for missed care. Core nursing tasks routinely omitted in Kalisch’ studies are discharge planning and patient education, emotional support, hygiene and mouth care, documentation of fluid intake and output, ambulation, feeding and general nursing surveillance of the patient. Nurses and midwives consistently attributed instances of missed care to inadequate staffing levels, unexpected heavy workloads, too few resources, lack of supplies, shift rosters with an inappropriate mix of nursing skills, inadequate handovers, orientation to the ward and poor teamwork. ItemAfter hours nurse staffing, work intensity and quality of care - Missed Care Study: South Australia(Flinders University, 2013-04) Henderson, Julie Anne; Blackman, Ian Robert; Hamilton, Patti; Willis, Eileen Mary; Toffoli, Luisa Patrizia; Verrall, Claire; Abery, Elizabeth; Harvey, ClareDuring November, 2012, the Flinders University After Hours Nurse Staffing, Work Intensity and Quality of Care project team, in collaboration with the Australian Nursing and Midwifery Federation, SA Branch (ANMFSA), administered the MISSCARE survey to a sample of 354 nurse/midwife members of ANMFSA. The survey contained 13 demographic questions, 28 questions that explored working conditions, 96 questions concerning missed nursing care (defined as care that is omitted, postponed, or incomplete) and 17 questions concerning perceived reasons care is omitted in the settings in which the nurse/midwives practice. In addition, respondents were asked to add comments of their own concerning nursing care that is missed and why.