Adjustment to an Ostomy: An Integrative Literature Review.

This integrative literature review summarizes recent literature relating to patient adjustment to stoma. The search strategy included 5 databases (CINAHL Plus, PsychINFO, Web of Science, Scopus, and MEDLINE); 65 articles meeting criteria were retrieved. Eleven were removed as duplicates, and a further 29 were removed when read in full, yielding 25 elements. Three were randomized controlled trials; 2 were prospective descriptive studies; 15 were cross-sectional descriptive studies; and 5 were qualitative studies. The quality of studies was evaluated using the Mixed Methods Appraisal Tool (MMAT). The calculated mean quality score was 97%, and no studies were excluded on quality grounds. Limited evidence suggests that adjustment occurs over time and provides some insight concerning how rehabilitation leads to resumption of an altered normality. Some evidence suggests that long-term adjustment is associated with demographic and pre- and postoperative factors. A knowledge gap was identified regarding the role of support groups, which in other fields has been shown to positively benefit psychological well-being. This review revealed a paucity of interventional studies seeking to test ways to address adjustment-related problems. Longitudinal studies are recommended as ostomy care nurses work to facilitate adjustment in the person with a stoma over time.

Evidence based nursing and midwifery practice in a regional Australian healthcare setting: Behaviours, skills and barriers.

AIM: To establish self-reported skill levels, behaviours and barriers in relation to evidence-based practice (EBP) among a representative sample of regional Australian nurses and midwives in senior roles. BACKGROUND: It has been widely established that nurses and midwives continue to face challenges in relation to putting evidence into practice on the clinical floor. Prior to conducting an EBP capacity building activity in a regional Australian Local Health District, a survey assessing needs and skill and barrier areas was conducted. METHODS: A quantitative descriptive survey which utilised the 'Developing Evidence Based Practice Questionnaire' (DEBPQ) was conducted in early 2012 among senior nurses and midwives of a regional New South Wales Local Health District (LHD). The survey results were contrasted with reported DEBPQ results from a sample of UK metropolitan nurses and a sample of Australian general practice nurses (GPNs). RESULTS: One hundred and sixty nine nurses completed the survey (response rate 42%). Survey respondents' reliance on accepted evidentiary knowledge sources was found to be low. Research literature-related knowledge sources were ranked outside of the top 10 sources, compared with numerous personalised and subjective sources, which ranked within the top 10. Access to and understanding of research material was a primary barrier to reviewing evidence in the study sample. Time-related barriers to changing practice on the basis of evidence figured prominently in the study sample and the UK and Australian GPN samples. The study sample rated their EBP skill levels significantly higher than both their UK counterparts and the Australian GPN sample (P < 0.0001). CONCLUSION: Capacity building interventions are needed among senior nurses and midwives in Australian regional LHDs, as the most prominent knowledge sources reported are non-evidentiary in nature and barriers to finding and reviewing evidence, along with barriers to making practice change, remain significant.

Factors influencing how senior nurses and midwives acquire and integrate coaching skills into routine practice: a grounded theory study.

AIM: To introduce a theory which describes the process of and explicates the factors moderating, the acquisition and integration of leadership coaching skills into the routine practice of senior nurses and midwives. BACKGROUND: Organizations invest significant resources in leadership coaching programs to ensure that coaching is embedded as a core function of the manager's role. However, even after training, many managers remain unable to undertake this role successfully. The process by which health professionals translate 'manager as coach' training into successful practice outcomes, has remained largely unexplored. DESIGN: A grounded theory study design. METHODS: Data, collected between February 2012-May 2013, included in-depth interviews with 20 senior nurses and midwives who had attended a leadership coaching program and analysis of nine reflective practice journals. Multiple researchers coded and analysed the data using constant comparative techniques. RESULTS: The outcomes of coaching training ranged from inappropriate use of the coaching skills through to transformed managerial practice. These outcomes were influenced by the dynamic interaction of three central domains of the emergent theoretical model: pre-existing individual perceptions, program elements and contemporaneous experiences. Interactions occurred within the domains and between them, impacting on activators such as courage, motivation, commitment and confidence. CONCLUSION: The study offers new insights into how senior nurses and midwives acquire and integrate coaching skills into their routine practice. The process is described as multifactorial and dynamic and has implications for the training design, delivery and organizational support of future leadership coaching programs.

Models of care choices in today's nursing workplace: where does team nursing sit?

This paper provides an overview of the developmental history of models of care (MOC) in nursing since Florence Nightingale introduced nurse training programs in a drive to make nursing a discipline-based career option. The four principal choices of models of nursing care delivery (primary nursing, individual patient allocation, team nursing and functional nursing) are outlined and discussed, and recent MOC literature reviewed. The paper suggests that, given the ways work is being rapidly reconfigured in healthcare services and the pressures on the nursing workforce projected into the future, team nursing seems to offer the best solutions.

Syncope vs. Seizure: Ictal Bradycardia and Ictal Asystole.

Background: Ictal arrhythmia is a rare condition that causes arrhythmic manifestations induced by epileptic seizures, including asystole or bradycardia. Ictal asystole (IA) is a very rare condition found in patients undergoing video-encephalography (EEG) monitoring. It is often related to temporal lobe epilepsy and can cause syncope, which can lead to injury or even death. Case Presentation. Two patients with epilepsy showed symptoms of syncope. Both patients underwent 4-day ambulatory EEG tests and were diagnosed with IA. Following the tests, the patients were implanted with a permanent pacemaker, and one of them underwent a temporal lobectomy. As a result of these procedures, the patients experienced a reduction in episodes of symptomatic syncope. Conclusion: Patients with ictal asystole and symptomatic ictal bradycardia are at increased risk of falls due to seizures. Although there are no specific guidelines for managing this condition, antiseizure medications, epilepsy surgery, and cardiac pacemaker implantation have been effective treatments.

How the expert nursing role was used to facilitate the co-design of a patient interview study.

BACKGROUND: Co-design is a research method that seeks to engage service users in research. The approach fosters inclusivity and shared power by having researchers and research participants work together for some or all of a study. AIM: To describe the experience of co-designing a patient interview study from the perspective of an expert stoma nurse, using a case-study approach and reflexive methods. DISCUSSION: Valuing expert patients' experiences when conducting research about them enabled patients to be trained as participant researchers to co-design and undertake a patient interview study. The co-design process enabled the researcher to develop a greater recognition of the fact that experience of looking after people with stomas does not equate to expertise in knowing what it is like to have a stoma. This enriched her research experience and increased the authenticity of the study. CONCLUSION: Co-designing a study with service users creates challenges for nurse researchers. They must pay attention to relational changes, time, planning and organisation to ensure that they conduct their research rigorously and ethically, and safeguard the co-researchers and other participants from potential risks. IMPLICATIONS FOR PRACTICE: Co-designing research is critical for developing effective, patient-centred bodies of evidence. Nurse researchers can play a critical role but must be prepared to shift from directive to participatory methods to identify appropriate, patient-focused improvements.

The long-term outcomes of patients with negative prolonged ambulatory electroencephalography tests: A cross-sectional follow-up study.

Background: Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis. Methods: This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia. Results: In total, 47 of 105 eligible (45%) participants were enrolled. Overall, 21 (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related. Conclusions: Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.

Ambulatory electroencephalography (AEEG) recording is an essential aid for detecting interictal discharges and providing a clinical diagnosis. This study aimed to describe long-term outcomes among a cohort of patients who yielded negative results on AEEG at the time of assessment and identify factors associated with contemporary quality of life (QOL) and ultimate epilepsy diagnosis. This cross-sectional telephone follow-up study was conducted in June-November 2021 at the Neurology Department in a metropolitan hospital in Sydney, Australia. In total, 47 of 105 eligible (45%) participants were enrolled. Overall, 21 (45%) participants had been diagnosed with epilepsy at a 12-year follow-up. Taking anti-seizure medication, having experienced a seizure event, and having marriage and education-related characteristics were associated with an epilepsy diagnosis. QOL was found to be associated with age, employment status and history of experience of a seizure event. QOL and an epilepsy diagnosis were not shown to be statistically related. Nearly half of the participants had received an epilepsy diagnosis at long-term follow-up, despite having tested negative on AEEG at the time of assessment. Prolonged AEEG testing is an important tool to aid the diagnostic process. However, clinical examination, including accurate history taking, is vital in establishing an epilepsy diagnosis.

Randomized controlled trial of laxative use in postcolostomy surgery patients.

PURPOSE: We compared a standardized postoperative laxative protocol to laxatives provided on an ad hoc basis by the surgical team. SUBJECTS AND SETTING: Forty-five patients who underwent colostomy surgery participated in the study. The research setting was 2 acute care facilities in south-eastern Sydney, New South Wales, Australia. METHODS: A randomized controlled trial was conducted. The intervention group (n 5 19) received a standardized laxative protocol postsurgery. Two types of laxatives were selected for first-line treatment: sterculia and frangula bark (Normacol Plus), a bulking agent and stimulant; and liquid paraffin (Agarol), a stool softener. An iso-osmotic polyethylene glycol macrogel (Movicol) was chosen as second-line treatment. The comparison group (n = 26) received laxative intervention(s) as preferred by the surgical team. Constipation, measured as fecal loading on plain abdominal film, stomal therapy nurse activity, patient comfort, and length of hospital stay were compared between intervention and control groups. RESULTS: The presence of fecal loading favored the intervention group (1 episode in the treatment group vs 7 episodes in the comparison group; χ5 = 3.8; P = .05). This finding suggests that the laxative protocol given to the treatment group was more likely to prevent fecal loading/constipation when compared to the ad hoc laxative group. Stomal therapy nurse activity in terms of the number of empty bag changes was significantly higher in the comparison group (F 5 4.8; P 5 .03). CONCLUSION: The findings of this study support the benefits of a standardized laxative protocol for prevention of constipation. Data collection was discontinued after 3 years due to a contamination effect developing, because our surgeons observed the utility of the laxative protocol and incorporated it into their routine practice. Further experimental research is needed to explore the best constipation prevention approaches for postcolostomy surgery patients.

A Prospective Randomized Controlled Trial: Alternative Approach to EEG Application to Reduce Electrode-induced Skin Injury among Ambulatory EEG Patients.

Ambulatory electroencephalography (AEEG) is a technique of continuous EEG recording of patients in their natural setting, outside the controlled environment of the hospital. Electrode-induced skin injury is a common complication of prolonged EEG monitoring. This randomized study aimed to investigate the performance of two methods of electrode application in reducing electrode-induced skin injury among patients undergoing 4-day AEEG monitoring. A randomized interventional study was conducted from November 2020 to May 2021 in the Neurosciences Ambulatory Care Unit at a metropolitan hospital in Sydney, Australia. We enrolled patients into two groups: i) Group 1 (standard protocol group) received Ten20 Conductive PasteTM with Tensive® adhesive gel as the primary approach to electrode application and ii) Group 2 (intervention group) received Ten20 Conductive PasteTM with Tensive® adhesive gel and hydrogel electrodes on hairless locations as the primary approach to electrode application. A total of 79 patients participated in this study. The group that received the addition of hydrogel electrodes (Group 2) performed better than the standard protocol group on electrode site inflammation for the frontal region, particularly FP1, FP2, F8, and the ground electrode sites. EEG quality and self-reports of patient comfort and mood did not differ significantly between the two groups. The addition of hydrogel electrodes using a Ten20 Conductive PasteTM with a Tensive® adhesive gel protocol results in reduced inflammation at frontal lobe and ground electrode sites.

Implementation of a New Clinical Testing Tool to Assess Patients During Ictal and Postictal Periods.

ABSTRACT: BACKGROUND: A seizure is a sudden, uncontrolled electrical disturbance of the cortical neurons in the brain, which can cause changes in behavior, movements, feelings, and consciousness. Clinical signs and symptoms before, during, and after a seizure can help to determine the seizure onset. The use of standardized clinical testing tools has been reported as being valuable, although also challenging, by some institutions. This study investigated the effectiveness of implementing a new clinical testing tool designed with an emphasis on simplicity for use during and after seizures. METHODS: A pre-and-post evaluation study was conducted from January 2020 to November 2020 in the epilepsy monitoring unit/neurology unit at a hospital in Sydney, Australia. The primary outcome of interest was the incidence of clinical testing during seizures. The secondary outcome of interest was nurse knowledge about clinical testing during a seizure. This knowledge was measured via testing before and after clinical education sessions. The third outcome of interest was nurse confidence regarding the use of the clinical testing tool. The confidence level was measured via posteducation session follow-up surveying. RESULTS: Forty-seven nursing staff (10 neurophysiology nurse technologists and 37 neurology unit nurses) participated in the education program. Forty-four seizures were evaluated. Clinical testing during ictal and postictal periods was performed by nursing staff 82% of the time during 2020, compared with 67% during the 2018 to 2019 preeducation comparison period. This difference was not statistically significant, but it was clinically relevant (P = .07). In addition, the time from seizure alarm to clinical testing improved significantly from a median of 30.5 seconds in 2018 to 2019 to 14 seconds in 2020 (P < .001). CONCLUSION: The tool is easy and convenient for nursing staff to perform clinical examinations accurately during ictal and postictal periods.

Adopting an American framework to optimize nursing admission documentation in an Australian health organization.

Objective: Apply and modify the American Essential Clinical Dataset (ECD) approach to optimize the data elements of an electronic nursing admission assessment form in a metropolitan Australian local health district. Materials and Methods: We used the American ECD approach but made modifications. Our approach included (1) a review of data, (2) a review of current admission practice via consultations with nurses, (3) a review of evidence and policies, (4) workshops with nursing and informatics teams in partnership with the electronic medical record (eMR) vendor, and (5) team debrief sessions to consolidate findings and decide what data elements should be kept, moved, or removed from the admission form. Results: Of 165 data elements in the form, 32% (n = 53) had 0% usage, while 25% (n = 43) had 100% usage. Nurses' perceptions of the form's purpose varied. Eight policy documents specifically prescribed data to be noted at admission. Workshops revealed risks of moving or removing data elements, but also uncovered ways of streamlining the form. Consolidation of findings from all phases resulted in a recommendation to reduce 91% of data elements. Discussion: Application of a modified ECD approach allowed the team to identify opportunities for significantly reducing and reorganizing data elements in the eMR to enhance the utility, quality, visibility, and value of nursing admission data. Conclusion: We found the modified ECD approach effective for identifying data elements and work processes that were unnecessary and duplicated. Our findings and methodology can inform improvements in nursing clinical practice, information management, and governance in a digital health age.

Completion of electronic nursing documentation of inpatient admission assessment: Insights from Australian metropolitan hospitals.

INTRODUCTION: Electronic nursing documentation is an essential aspect of inpatient care and multidisciplinary communication. Analysing data in electronic medical record (eMR) systems can assist in understanding clinical workflows, improving care quality, and promoting efficiency in the healthcare system. This study aims to assess timeliness of completion of an electronic nursing admission assessment form and identify patient and facility factors associated with form completion in three metropolitan hospitals. MATERIALS AND METHODS: Records of 37,512 adult inpatient admissions (November 2018-November 2019) were extracted from the hospitals' eMR system. A dichotomous variable descriptive of completion of the nursing assessment form (Yes/No) was created. Timeliness of form completion was calculated as the interval between date and time of admission and form completion. Univariate and multivariate multilevel logistic regression were used to identify factors associated with form completion. RESULTS: An admission assessment form was completed for 78.4% (n = 29,421) of inpatient admissions. Of those, 78% (n = 22,953) were completed within the first 24 h of admission, 13.3% (n = 3,910) between 24 and 72 h from admission, and 8.7% (n = 2,558) beyond 72 h from admission. Patient length of hospital stay, admission time, and admitting unit's nursing hours per patient day were associated with form completion. Patient gender, age, and admitting unit type were not associated with form completion. DISCUSSION: Form completion rate was high, though more emphasis needs to be placed on the importance of timely completion to allow for adequate patient care planning. Staff education, qualitative understanding of delayed form completion, and streamlined guidelines on nursing admission and eMR use are recommended.

Using a clinical judgement model to understand the impact of validated pain assessment tools for burn clinicians and adult patients in the ICU: A multi-methods study.

BACKGROUND: Intensive care (ICU) patients' burn pain is difficult to assess, communicate and address, risking chronic pain syndromes and psychological morbidity. AIMS: To understand how the introduction of validated pain tools (Critical Care Pain Observation Tool [CPOT], Numerical Rating Scale [NRS], Pain Assessment in Advanced Dementia [PAINAD]) affected clinical judgement processes, analgesia/sedation administration and the experience of burn-injured patients. METHODS: Consecutive chart review compared type and amount of analgesia/sedation administered, ventilation time and length of ICU/hospital stay between consecutive burn patients pre- and 6-months post-intervention (n=70). Analysis of 36 qualitative interviews with ICU clinicians (n=12) and burn-injured adults (n=12) pre- and post-intervention was guided by Tanner's (2006) Clinical Judgement Model. RESULTS: Overall, there was a significant increase in morphine (P=0.04) and propofol (P=0.04) use and a trend towards increased paracetamol (P=0.06) use post-intervention. There was a trend towards greater Midazolam use for TBSA<20% (P=0.06), and significantly increased propofol use for TBSA≥20% (P=0.03). Ventilation time and ICU/hospital length of stay were unchanged. Qualitative analysis revealed complex clinical judgement dependent on the context of the patient's situation, unit culture, background beliefs of clinicians and in knowing the patient. Whilst the CPOT and NRS enhanced analytic reasoning and pain advocacy, the PAINAD appeared redundant. CONCLUSIONS: Effective pain assessment, management and advocacy are assisted by evidence-based assessment practices.

Medication safety improvements during care transitions in an Australian intensive care unit following implementation of an electronic medication management system.

BACKGROUND: For patients requiring admission to the Intensive Care Unit (ICU), transfers of care (TOC) during admission to and discharge from the ICU are particularly high-risk periods for medication errors. In the Australian setting, commonly general wards and the ICU do not share an integrated Electronic Medical ecord (EMR) and specifically an Electronic Medication Management System (EMMS) as part of the EMR. PURPOSE: To evaluate the effect of a hospital wide integrated EMMS on medication error rates during ICU admission and at TOC. METHOD: A 6-month historical control study was performed before and after implementation of the EMMS in the ICU of a tertiary hospital. Prescribing errors detected by pharmacists in the study period were divided into phase 1, (pre-EMMS, 6months), phase 2 (3 months post implementation after shakedown stage) and phase 3 (next 3 months of post implementation). They were categorized as prescribing error types under system or clinical intervention. Chi square statistics and interrupted time series analysis were used to determine if there was significant change in the proportion of patients who had an error at TOC during each phase. Logistics regression was used to determine the relationship between the dependent (error type) and the independent variable (study phase) for errors that occurred during TOC. RESULTS: Errors occurred during TOC in 42 %, 64 % and 19 % of patients in phase 1, 2 and 3 respectively. There was a significant decline in the proportion of patients with an error between phase 1 and 3 (p < 0.01). During a patient's ICU admission, at least one medication error occurred in 28.3 %, 62.6 % and 25.1 % in phase 1, 2 and 3 respectively. Besides procedural errors, the likelihood of an error occurring was greatest in phase 1, compared to phase 2 and 3 across system-related error categories. CONCLUSION: Medication errors during TOC reduced following implementation of the integrated ICU EMMS. EMMS safety features facilitated reduced system related prescribing errors as well as the severity of errors made.

Starting a care improvement journey: focusing on the essentials of bedside nursing care in an Australian teaching hospital.

AIMS AND OBJECTIVES: To evaluate and improve patient assessment practices, care practices, recognition of patient deterioration and communication in the acute ward environment. BACKGROUND: A growing recognition of patient safety-related concerns in acute hospitals, a nursing shortage and a reduction in availability of skill and experience levels at the bedside led a group of clinicians to explore the issues that impacted on patient care at a ward level within their organisation. DESIGN: Multimethod practice development study. This paper reports phase one of concept development. METHOD: A practice review was conducted using clinical audit processes that examined practice and documentation in relation to patient assessment parameters and care planning, specifically identifying whether changes in clinical parameters were identified and acted on. RESULTS: Results highlighted a clear discrepancy between the care that was identified on the nursing care plan and the care the patient was receiving. Actions as a result of the disappointing audit results included changes to education programmes, strategies to improve critical discussion regarding clinical practices and the development of assessable domains of nursing care that were relevant and realistic to ward-based nurses. CONCLUSION: The results enabled the identification of eight domains of care and associated care outcomes that target strategies for care improvement. Emancipatory practice development methodology will be used to further progress this work and ensure successful implementation into clinical units. RELEVANCE TO CLINICAL PRACTICE: This paper examines the critical discussions, audit processes and actions that took place, leading to the development of care outcomes for nurses.

Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment.

Agreement was reached with 12 acute medical and surgical wards/units at Sydney's Prince of Wales Hospital to participate in a trial of team nursing (TN). Six units employed action research principles to undertake a change to a team nursing model and six remained with the pre-existing individual patient allocation (IPA) model. Task-based teaming was widely discarded by the team nursing units in favour of allocating patients within the team and introducing more supportive and communicative processes aimed at fostering responsibility sharing. Localised team-based models of care arose in the change wards and were outlined, implemented and refined using social action research principles. A 12-month prospective experimental comparison of job satisfaction and staff retention between the TN and IPA groups indicated statistically significant job satisfaction benefits and practically important staff retention benefits associated with moving away from an IPA model of nursing care delivery towards a team-based model of care delivery. Perhaps not surprisingly, job satisfaction gains were most marked among new graduate nurses, who reported real benefits from a teaming inspired shift in model of care in the acute inpatient environment.

Reducing EEG (Electroencephalogram) Electrode-induced Skin Injury among Ambulatory EEG Monitored Patients: A Non-randomized Interventional Study of Two Commonly Used Cream-based Products for Electrode Application.

Ambulatory electroencephalography (AEEG) seeks to capture inter-ictal epileptiform activity or paroxysmal events when patients are not in the clinic. Skin inflammation is a common complication of prolonged EEG monitoring. This non-randomized study aimed to investigate the performance of two commonly used cream-based methods of electrode application in reducing electrode-induced skin injury among patients undergoing AEEG monitoring. A non-randomized interventional study was conducted from July to December 2019 in the Neurosciences Ambulatory Care Unit at Royal Prince Alfred Hospital, Australia. Patients were enrolled into two groups: i) Group T, which received Ten20® Conductive Paste with Tensive® Conductive Adhesive Gel as the primary approach to electrode application; ii). Group E, which received EC2⁺® Conductive Cream as the primary approach to electrode application. Patients in Group T were enrolled in the 1st and 3rd week of the month, and patients in Group E were enrolled in the 2nd and 4th week for each month of the study. A total of 152 patients participated in this study. Two sub-groups were established: those who were monitored for two days (Group T; n = 36, Group E; n = 30) and those who were monitored for four days (Group T; n = 43, Group E; n = 43). Significant (p < 0.05) differences indicating greater inflammation in the Group E were noted for both Day 2 and Day 4 participants. Skin injury/inflammation was significantly less using the standard method (Group T: Ten20® with Tensive® gel) when compared to EC2⁺® (Group E) as the conductive material at the electrode site.

Engaging consumers in health research: a narrative review.

Objective Consumer and community engagement (CCE) in research is increasingly valued in a contemporary healthcare environment that seeks to genuinely partner with consumers and the wider community. Although there is widespread agreement at research governance levels as to the benefits of CCE in research, there is little available research-based guidance as to how best to proceed with CCE organisationally and how to manage and overcome barriers. The aim of this narrative review was to draw together the available research, review findings and relevant governance-related material and to discuss these in light of a case series among research-engaged consumers in order to chart a practical way forward. Methods A narrative literature review about CCE in research was conducted. Following this, a case series among seven consumers who had been engaged as partners in health research was conducted. Finally, the lived experience of these consumers was explored against the findings of the narrative review. Results In all, 121 papers were identified and reviewed, 37 of which were used to inform the content of this paper. The most important benefits of CCE to both consumers and healthcare researchers were related to improvements in trust between consumer and researchers, and the increased relevance and ethics of research agendas ultimately pursued. Barriers to CCE were found to be pragmatic, attitudinal and organisational. Enabling factors that capitalise on the benefits and help address the barriers to meaningful CCE are outlined and discussed in light of a case series conducted among research-engaged consumers in Australia and internationally. Conclusion Best practice standards, organisational commitments and resources are needed to improve the status quo in Australia and to provide health research end-users with research outcomes that better align with their priorities and needs. What is known about the topic? Consumer and community engagement (CCE) in research is increasing in prevalence and is likely to be beneficial to both consumers and healthcare providers and researchers. What does this paper add? Following review of the available research findings and governance statements about CCE, enabling strategies are presented in light of a case series among Sydney-based research-engaged consumers. What are the implications for practitioners? Barriers to consumer and community engagement can be overcome if well understood and tackled organisationally. The potential benefits of shifting to a fully consumer- or community-engaged healthcare research environment are multifactorial and represent a paradigm shift in favour of evidence-based patient and family-centred care.

Prevalence and predictors of metabolic syndrome among patients attending an outpatient clozapine clinic in Australia.

OBJECTIVE: This study aimed to determine the prevalence and predictors of metabolic syndrome in an outpatient clozapine clinic in Australia. METHODS: Metabolic syndrome is a cluster of some of the most dangerous cardiovascular risk factors, and its high prevalence in people with mental illness has been demonstrated. Patients attending a clozapine clinic were screened for the following: age, gender, ethnicity, waist circumference, blood pressure, high-density lipoprotein level, low-density lipoprotein level, blood sugar levels, total cholesterol level, triglycerides level, weight, body mass index, insulin resistance level, length of time on clozapine, clozapine dose, smoking status, family history of diabetes and cardiovascular disease, and personal history of polycystic ovarian syndrome. All the variables that were found to be significantly associated with metabolic syndrome were entered into a multivariate logistic regression analysis. RESULTS: Seventy-three patients were screened for metabolic syndrome using the International Diabetes Federation's (2007) definition. Forty-five (61.6%) patients met the criteria for the syndrome. Increased blood sugar level, high diastolic blood pressure, older age, increased waist circumference, raised triglycerides level, and higher body mass index emerged as significant predictors of metabolic syndrome in the sample. CONCLUSIONS: This study adds further support for the systematic screening for metabolic syndrome in patients receiving clozapine. The need for intervention programs which screen for and address the modifiable risk factors of metabolic syndrome is discussed.