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BACKGROUND: The Stop Cancer PAIN Trial was a phase III pragmatic stepped wedge cluster randomised controlled trial which compared effectiveness of screening and guidelines with or without implementation strategies for improving pain in adults with cancer attending six Australian outpatient comprehensive cancer centres (n = 688). A system for pain screening was introduced before observation of a 'control' phase. Implementation strategies introduced in the 'intervention' phase included: (1) audit of adherence to guideline recommendations, with feedback to clinical teams; (2) health professional education via an email-administered 'spaced education' module; and (3) a patient education booklet and self-management resource. Selection of strategies was informed by the Capability, Opportunity and Motivation Behaviour (COM-B) Model (Michie et al., 2011) and evidence for each strategy's stand-alone effectiveness. A consultant physician at each centre supported the intervention as a 'clinical champion'. However, fidelity to the intervention was limited, and the Trial did not demonstrate effectiveness. This paper reports a sub-study of the Trial which aimed to identify factors inhibiting or enabling fidelity to inform future guideline implementation initiatives. METHODS: The qualitative sub-study enabled in-depth exploration of factors from the perspectives of personnel at each centre. Clinical champions, clinicians and clinic receptionists were invited to participate in semi-structured interviews. Analysis used a framework method and a largely deductive approach based on the COM-B Model. RESULTS: Twenty-four people participated, including 15 physicians, 8 nurses and 1 clinic receptionist. Coding against the COM-B Model identified 'capability' to be the most influential component, with 'opportunity' and 'motivation' playing largely subsidiary roles. Findings suggest that fidelity could have been improved by: considering the readiness for change of each clinical setting; better articulating the intervention's value proposition; defining clinician roles and responsibilities, addressing perceptions that pain care falls beyond oncology clinicians' scopes of practice; integrating the intervention within existing systems and processes; promoting patient-clinician partnerships; investing in clinical champions among senior nursing and junior medical personnel, supported by medical leaders; and planning for slow incremental change rather than rapid uptake. CONCLUSIONS: Future guideline implementation interventions may require a 'meta-implementation' approach based on complex systems theory to successfully integrate multiple strategies. TRIAL REGISTRATION: Registry: Australian New Zealand Clinical Trials Registry; number: ACTRN 12615000064505; data: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspxid=367236&isReview=true .
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Dor do Câncer , Fidelidade a Diretrizes , Pesquisa Qualitativa , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Austrália , Institutos de Câncer/normas , Dor do Câncer/terapia , Manejo da Dor/métodos , Manejo da Dor/normas , Guias de Prática Clínica como Assunto , Melhoria de QualidadeRESUMO
OBJECTIVE: Management of sport-related and recreation-related concussions (SRCs) in children and adolescents is challenging as brain maturation affects prognosis. However, impact seizure was removed as a prognosis modifying factor in children and adolescents with SRCs in the 2017 consensus statement on concussion in sport, based mostly on adult literature. Therefore, this study evaluates the association of impact seizure on the recovery in children and adolescents with SRCs. DESIGN: Retrospective matched case-control study. SETTING: Tertiary pediatric sports medicine service, from January 1, 2015, to June 30, 2022. PATIENTS: A cohort of 452 patients, aged 7 to 18 years, with new episode of SRC was seen. From this cohort, 396 patients were included in the analysis, including 22 with impact seizures. Controls were generated using the propensity score matching approach. Patients with moderate or severe traumatic brain injury or incomplete treatment were excluded. INDEPENDENT VARIABLE: Impact seizure during SRC. MAIN OUTCOME MEASURES: Primary outcome was recovery duration in number of days. RESULTS: The median recovery duration was longer in the cases (73 days, interquartile range [IQR] = 38-143 days) as compared with controls (49.5 days, IQR = 30.5-93.5 days). There was no difference in patients with prolonged recovery (ie >28 days) between both groups (OR 1.6, 95% CI, 0.4-6.6, P = 0.505). CONCLUSIONS: Impact seizures prolonged the recovery duration in children and adolescents with SRCs and have a potential concussion modifying prognostic role. These findings could help provide evidence-based management principles for children and adolescents with SRCs in subsequent concussion consensus statements.
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BACKGROUND: The purpose of this study was to compare open insertion to ultrasound guided percutaneous insertion of central access catheters performed in a tertiary pediatric hospital in terms of its safety and complication rates. METHODS: This was an ethics approved prospective randomized trial of children under 16 y of age. Procedure was performed by surgeons with varying experience with percutaneous and open insertion. Primary outcome studied was complications-immediate and late. Secondary outcomes were time taken to complete procedure, conversion rates, duration of line use. RESULTS: A total of 108 patients were analyzed. Sixty-four were male. Right internal jugular vein was accessed in 97. Eighty-one lines were double lumen, 23 implantable access devices, and the rest were single lumen catheters. More than one needle puncture was needed in 22% of the cases but there were no conversions in the ultrasound group. Twelve patients needed more than one insertion to achieve optimal position of the tip. Eleven patients had immediate and late complications. Percutaneous lines lasted 45 d longer though this was not statistically significant. Operating time was 20.6% shorter with percutaneous access. Post-removal measurement of vein size by ultrasound demonstrated significant decrease in size in the open group. CONCLUSIONS: Ultrasound guided percutaneous insertion was safe. The study also demonstrated a decrease in operating times, preservation of vein size, and no increase in complication rates in the US group when performed by operators of varying expertise.
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Cateterismo Venoso Central/métodos , Complicações Pós-Operatórias/prevenção & controle , Ultrassonografia de Intervenção , Adolescente , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/instrumentação , Cateteres Venosos Centrais , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Erros Médicos/estatística & dados numéricos , Duração da Cirurgia , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Prospectivos , Reoperação/estatística & dados numéricos , Método Simples-CegoRESUMO
OBJECTIVE: To determine whether graded exercise testing can predict recovery trajectory of concussion in children and adolescents. DESIGN: Prospective study. SETTING: Children's Hospital, Westmead, Australia. PARTICIPANTS: One hundred thirty-nine children aged 12 to 16 years at 5 to 7 days after an acute concussive injury. INTERVENTION: Graded exercise testing on a treadmill at the subacute phase to assess symptom provocation and determine clinical recovery indicating readiness to commence a return to activity (RTA) protocol. Exercise time to symptom exacerbation and clinical recovery were measured. MAIN OUTCOME MEASURES: Standard concussion assessment and clinical testing (neurocognitive, vestibular/ocular, and balance) were conducted to determine major clinical drivers/indicators. RESULTS: Participants (mean age 12.4 ± 2.8 years, 73% male) had a confirmed sport-related concussion. The main clinical drivers identified on exercise testing were headache, balance, and vestibular dysfunction. Participants fell into 1 of 2 groups, exercise-tolerant (54%) and exercise-intolerant (46%). Exercise-tolerant patients showed mild clinical indicators, no symptom exacerbation during 10.3 ± 3.3 minutes of exercise, were safely transitioned to a RTA protocol, and recovered within 10 days. Exercise-intolerant patients had high clinical indicators, significant symptom exacerbation at 4.2 ± 1.6 minutes of exercise, and prolonged recovery of 45.6 days. No adverse effects from exercise were reported in either group. Combined use of provocative exercise and clinical testing was 93% predictive of outcome. CONCLUSIONS: Exercise testing during the subacute phase after a concussion can predict longer recovery. Exercise testing can identify a unique window where patients can be safely transitioned to activity, enabling clinicians to better inform patients and families, allocate resources and streamline care.
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Traumatismos em Atletas/diagnóstico , Concussão Encefálica/diagnóstico , Teste de Esforço , Tolerância ao Exercício , Adolescente , Austrália , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos , Volta ao EsporteRESUMO
BACKGROUND: Care home residents are frequently transferred to hospital, rather than provided with appropriate and timely specialist care in the care home. AIM: To determine whether a model of care providing specialist palliative care in care homes, called Specialist Palliative Care Needs Rounds, could reduce length of stay in hospital. DESIGN: Stepped-wedge randomised control trial. The primary outcome was length of stay in acute care (over 24-h duration), with secondary outcomes being the number and cost of hospitalisations. Care homes were randomly assigned to cross over from control to intervention using a random number generator; masking was not possible due to the nature of the intervention. Analyses were by intention to treat. The trial was registered with ANZCTR: ACTRN12617000080325. Data were collected between 1 February 2017 and 30 June 2018. SETTING/PARTICIPANTS: 1700 residents in 12 Australian care homes for older people. RESULTS: Specialist Palliative Care Needs Rounds led to reduced length of stay in hospital (unadjusted difference: 0.5 days; adjusted difference: 0.22 days with 95% confidence interval: -0.44, -0.01 and p = 0.038). The intervention also provided a clinically significant reduction in the number of hospitalisations by 23%, from 5.6 to 4.3 per facility-month. A conservative estimate of annual net cost-saving from reduced admissions was A$1,759,011 (US$1.3 m; UK£0.98 m). CONCLUSION: The model of care significantly reduces hospitalisations through provision of outreach by specialist palliative care clinicians. The data offer substantial evidence for Specialist Palliative Care Needs Rounds to reduce hospitalisations in older people approaching end of life, living in care homes.
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Instituição de Longa Permanência para Idosos , Tempo de Internação/estatística & dados numéricos , Cuidados Paliativos , Idoso , Idoso de 80 Anos ou mais , Austrália , Hospitais , Humanos , Casas de SaúdeRESUMO
OBJECTIVES: To compare physical and mental health status between cancer carers versus non-carers in a population-based sample and explore sociodemographic and caring characteristics associated with poor carer health status. METHODS: The South Australian Health Omnibus is a population-based cross-sectional survey. Carer status was self-defined by participants as having cared for someone with cancer in the last 5 years. Health status was considered poor if it was 0.5 standard deviation lower than Australian norms on the Medical Outcomes Study 12-Item Short-Form (SF-12) physical and mental component summary scores (PCS and MCS). Regression analyses compared mean PCS/MCS between carers versus non-carers, controlling for sociodemographic variables, and explored associations between poor health status and caring and support among carers. RESULTS: The weighted sample included 2962 people, of whom 374 (12.6%) were cancer carers and 1993 (67.3%) non-carers. Carers had significantly worse PCS/MCS, controlling for sociodemographic variables, but did not differ significantly regarding proportions with poor health status. Carer characteristics associated with poor PCS and MCS included socio-economic indicators and involvement in medication management. Assisting with household tasks was protective. CONCLUSIONS: This population-based study followed those previous ones in finding cancer carers to have poorer mean health status than non-carers. However, differences were less pronounced than previously reported, likely because of the sample being drawn from a general rather than cancer service population and including past as well as current carers, as well as all cancer types and stages. Future longitudinal research is needed to identify factors that predict recovery post caring.
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Cuidadores/psicologia , Nível de Saúde , Neoplasias/enfermagem , Neoplasias/psicologia , Qualidade de Vida/psicologia , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Apoio Social , Fatores Socioeconômicos , Austrália do Sul , Inquéritos e QuestionáriosRESUMO
PURPOSE: Corticosteroids are commonly used in palliative care settings, but are associated with several side effects. Although adverse events (AEs) are highly distressing for patients, few data are available from prospective studies to look at incidence or predictors of such harms. The aim of this study is to identify AE reporting among studies of patients with advanced cancer receiving corticosteroids for any reason. METHODS: A systematic review was conducted using the following data sources: PubMed, Medline, SCOPUS, Cochrane reviews, and CINAHL. Randomized controlled trials (RCTs) with patients with advanced cancer assessing the effect of corticosteroids were included. Consecutive cohort observational studies of corticosteroid toxicities in cancer patients were also included. RESULTS: Twenty-seven RCTs and 12 consecutive cohort observational studies were identified. The most frequently reported primary outcome of RCTs was nausea and vomiting (8/27). Dexamethasone was prescribed in almost half of RCTs (13/27). In consecutive cohort studies, the primary outcomes were a wide variety of symptoms. Dexamethasone was also the most common glucocorticoid used (7/12). In terms of quality of AE reporting, two RCTs and one consecutive cohort study used a validated AE assessment tool in their studies. CONCLUSIONS: Side effects of corticosteroids in advanced cancer patients were poorly reported with few data using validated tools. Researchers should be aware of the guideline of AE reporting to provide the best evidence of risk-benefit balance. Developing specific consensus guidelines about AE reporting in studies of glucocorticoids in studies of people with advanced cancer would be useful.
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Corticosteroides/efeitos adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/etiologia , Neoplasias/tratamento farmacológico , Corticosteroides/uso terapêutico , Adulto , Estudos de Coortes , Humanos , Neoplasias/complicações , Estudos ProspectivosRESUMO
BACKGROUND: Driving cessation is associated with poor health-related outcomes. People with chronic diseases are often prescribed long-term opioid agonists that have the potential to impair driving. Studies evaluating the impact of opioids on driving-related psychomotor skills report contradictory results likely due to heterogeneous designs, assessment tools and study populations. A better understanding of the effects of regular therapeutic opioid agonists on driving can help to inform the balance between individual's independence and community safety. AIM: To identify the literature assessing the impact of regular therapeutic opioid agonists on driving-related psychomotor skills for people with chronic pain or chronic breathlessness. DESIGN: Systematic review reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis statement; PROSPERO Registration CRD42017055909. DATA SOURCES: Six electronic databases and grey literature were systematically searched up to January, 2017. Inclusion criteria were as follows: (1) empirical studies reporting data on driving simulation, on-the-road driving tasks or driving outcomes; (2) people with chronic pain or chronic breathlessness; and (3) taking regular therapeutic opioid agonists. Critical appraisal used the National Institutes of Health's quality assessment tools. RESULTS: From 3809 records screened, three studies matched the inclusion criteria. All reported data on people with chronic non-malignant pain. No significant impact of regular therapeutic opioid agonists on people's driving-related psychomotor skills was reported. One study reported more intense pain significantly worsened driving performance. CONCLUSION: This systematic review does not identify impaired simulated driving performance when people take regular therapeutic opioid agonists for symptom control, although more prospective studies are needed.
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Analgésicos Opioides/efeitos adversos , Condução de Veículo , Desempenho Psicomotor/efeitos dos fármacos , Humanos , Análise e Desempenho de TarefasRESUMO
BACKGROUND: Pain is a common and distressing symptom in people with cancer, but is under-recognised and under-treated. Australian guidelines for 'Cancer Pain Management in Adults' are available on the Cancer Council Australia Cancer Guideline Wiki. This study aims to evaluate the effectiveness and cost-effectiveness of a suite of guideline implementation strategies for improving pain outcomes in adults with cancer in oncology and palliative care outpatient settings. METHODS: The study will use a stepped-wedge cluster randomised controlled design, with oncology and palliative care outpatient services as the clusters. Patients will be eligible if they are adults with cancer and pain presenting to participating services during the study period. During an initial control arm, services will routinely screen patients for average and worst pain over the past 24 h using a 0-10 numerical rating scale (NRS) and have unfettered access to online guidelines. During the intervention arm, staff at each service will be encouraged to use: 1) a patient education booklet and self-management resource; 2) an online spaced learning cancer pain education module for clinicians from different disciplines; and 3) audit and feedback of service performance on key indices of cancer pain screening, assessment and management. Service-based clinical change champions will lead implementation of these strategies. The trial's primary outcome will be the probability that patients initially screened as having moderate-severe (≥5/10 NRS) worst pain experience a clinically important improvement one week later, defined as ≥ 30% reduction. Secondary outcomes will include patient empowerment and quality of life, carer experience, and cost-effectiveness. For the main analysis, linear mixed models will be used, accounting for clustering and the longitudinal design. Eighty-two patients per service at six services (N = 492) will provide > 90% power. A qualitative sub-study and analyses of structural and process factors will explore opportunities for further refinement and tailoring of the intervention. DISCUSSION: This pragmatic trial will inform implementation of guidelines across a range of oncology and palliative care outpatient service contexts. If found effective, the implementation strategies will be made freely available on the Wiki alongside the guidelines. TRIAL REGISTRATION: Registered 23/01/2015 on the Australian New Zealand Clinical Trials Registry ( ACTRN12615000064505 ).
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Dor do Câncer/prevenção & controle , Adulto , Assistência Ambulatorial/economia , Austrália , Dor do Câncer/economia , Ensaios Clínicos Fase III como Assunto , Análise por Conglomerados , Análise Custo-Benefício , Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/métodos , Feminino , Humanos , Masculino , Estudos Multicêntricos como Assunto , Neoplasias/economia , Neoplasias/prevenção & controle , Pacientes Ambulatoriais , Manejo da Dor/economia , Manejo da Dor/métodos , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como AssuntoRESUMO
BACKGROUND: Pain is highly prevalent in all health care settings, and frequently poorly managed. Effective pain management is predicated on a continuous cycle of screening, assessing, intervening and evaluating. Identifying gaps in nurses' self-perceived pain assessment competencies is an essential first step in the design of tailored interventions to embed effective pain assessment into routine clinical practice, and improve patient reported pain outcomes. Yet, few validated instruments focus on the competencies required for undertaking a comprehensive pain assessment, with most focusing on clinician's pain management competencies. AIM: To examine the validity of the 'Self-Perceived Pain Assessment Knowledge and Confidence' (Self-PAC) Scale. DESIGN: Preliminary instrument validation. SETTING: Two Australian cancer and palliative care services. PARTICIPANTS/SUBJECTS: 186 cancer and palliative care nurses. METHODS: The Self-PAC Scale was administered to participants online. Factor Analyses, including Exploratory and Confirmatory, were applied to examine the structural validity, Cronbach's alpha was calculated for internal consistency. Criterion validity was investigated by comparing responses from experienced and non-experienced nurses. RESULTS: Two components resulted with a single factor structure for pain assessment confidence and a two-factor structure for the knowledge of pain assessment. The factor loading for the subscales ranged from 0.653 to 0.969, with large proportions of the variances explained by the factors. Cronbach's alpha of the subscales ranged from 0.87-0.92 and significant difference in responses were found between experienced and non-experienced nurses. CONCLUSION: Preliminary validation of the Self-PAC Scale suggests that it is a helpful instrument for assessing cancer and palliative care nurse' pain assessment competencies.
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Competência Clínica , Neoplasias/enfermagem , Medição da Dor , Dor Intratável/enfermagem , Adulto , Feminino , Humanos , Masculino , Manejo da Dor/enfermagem , Cuidados Paliativos , Reprodutibilidade dos Testes , AutoimagemRESUMO
AIM: Advance care planning (ACP) in nephrology is widely advocated but not always implemented. The aims of this study were to describe current ACP practice and identify barriers/facilitators and perceived need for health professional education and chronic kidney disease (CKD)-specific approaches. METHODS: An anonymous cross-sectional survey was administered online. Nephrology health professionals in Australia and New Zealand were recruited via professional societies, email lists and nephrology conferences. Multiple regression explored the influence of respondents' attributes on extent of involvement in ACP and willingness to engage in future. RESULTS: A total of 375 respondents included nephrologists (23%), nurses (65%), social workers (4%) and others (8%) with 54% indicated that ACP at their workplace was performed ad hoc and 61% poorly. Perceived barriers included patient/family discomfort (84%), difficulty engaging families (83%), lack of clinician expertise (83%) and time (82%), health professional discomfort (72%), cultural/language barriers (65%), lack of private space (61%) and lack of formal policy/procedures (60%). Respondents overwhelmingly endorsed the need for more dialysis-specific ACP programs (96%) and education (95%). Whilst 85% thought ACP would be optimally performed by specially trained staff, comments emphasized that all clinicians should have a working proficiency. Respondents who were more willing to engage in future ACP tended to be non-physicians (odds ratio (OR) 4.96, 95% confidence intervals (CI) 1.74-14.07) and reported a greater need for CKD-specific ACP materials (OR 10.88, 95% CI 2.38-49.79). CONCLUSION: Advance care planning in nephrology needs support through education and CKD-specific resources. Endorsement by nephrologists is important. A multidisciplinary approach with a gradient of ACP expertise is also recommended.
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Planejamento Antecipado de Cuidados/tendências , Nefrologia/tendências , Padrões de Prática Médica/tendências , Insuficiência Renal Crônica/terapia , Adulto , Atitude do Pessoal de Saúde , Atitude Frente a Morte , Austrália , Estudos Transversais , Educação Médica Continuada , Feminino , Pesquisas sobre Atenção à Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Capacitação em Serviço , Modelos Lineares , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Nefrologia/educação , Razão de Chances , Educação de Pacientes como Assunto/tendências , Relações Médico-Paciente , Relações Profissional-Família , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/mortalidadeRESUMO
Unrelieved cancer pain has an adverse impact on quality of life. While routine screening and assessment forms the basis of effective cancer pain management, it is often poorly done, thus contributing to the burden of unrelieved cancer pain. The aim of this study was to test the impact of an online, complex, evidence-based educational intervention on cancer nurses' pain assessment capabilities and adherence to cancer pain screening and assessment guidelines. Specialist inpatient cancer nurses in five Australian acute care settings participated in an intervention combining an online spaced learning cancer pain assessment module with audit and feedback of pain assessment practices. Participants' self-perceived pain assessment competencies were measured at three time points. Prospective, consecutive chart audits were undertaken to appraise nurses' adherence with pain screening and assessment guidelines. The differences in documented pre-post pain assessment practices were benchmarked and fed back to all sites post intervention. Data were analyzed using inferential statistics. Participants who completed the intervention (n = 44) increased their pain assessment knowledge, assessment tool knowledge, and confidence undertaking a pain assessment (p < .001). The positive changes in nurses' pain assessment capabilities translated into a significant increasing linear trend in the proportion of documented pain assessments in patients' charts at the three time points (χ2 trend = 18.28, df = 1, p < .001). There is evidence that learning content delivered using a spaced learning format, augmented with pain assessment audit and feedback data, improves inpatient cancer nurses' self-perceived pain screening and assessment capabilities and strengthens cancer pain guideline adherence.
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Dor do Câncer/enfermagem , Capacitação em Serviço , Neoplasias/enfermagem , Manejo da Dor/enfermagem , Dor/enfermagem , Terapia Assistida por Computador/métodos , Dor do Câncer/prevenção & controle , Competência Clínica , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Avaliação em Enfermagem/métodos , Pesquisa em Avaliação de Enfermagem , Projetos PilotoRESUMO
Excessive use of the Internet is considered a problematic behaviour by clinicians and researchers. Cognitive behaviour therapy (CBT) has been advocated for a long time as a treatment approach and has been extended to include family therapy in the recent years. As eTherapy (eHealth) has become an important component in the treatment of many mental health problems, it is prudent to explore the current status of the eHealth approach as an intervention option for this problem. This systematic review aims to examine the current development of online intervention programmes for this particular condition. The PRISMA guidelines for systematic reviews and meta-analysis were employed to conduct the search for literature following a systematic and structured approach. Of the 182 articles screened, three satisfied the selection criteria. Information was extracted and analysed systematically for each study and tabulated. All these studies were pilot studies with small sample sizes. Two of these articles aimed to explore the therapeutic efficacy of newly developed online intervention programmes for Internet addiction (IA) and online gaming addiction. The third article described the design and development of an App for smartphone addiction. The results obtained from this review have provided insight into the on-going development of eHealth interventions as well as the health informatics approaches in offering a possible and practical solution to tackle this growing problem.
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Comportamento Aditivo/terapia , Internet , Aplicativos Móveis , Entrevista Motivacional/métodos , Psicoterapia/métodos , Telemedicina/métodos , Terapia Cognitivo-Comportamental/métodos , Humanos , Informática Médica , Terapia de Exposição à Realidade Virtual/métodosRESUMO
BACKGROUND: Internationally, delirium prevalence in palliative care is reported to range between 26-88%, yet little is known about the occurrence of delirium in Australian palliative care inpatient populations. AIMS: To: 1) ascertain 24-hour delirium point-prevalence in an Australian palliative care inpatient population; 2) test the feasibility and acceptability of the delirium measurement methodology. METHODS: This was a prospective cross-sectional study. Delirium was measured in patients of two palliative care units using the Nursing Delirium Screening Scale, Memorial Delirium Assessment Scale and DSM-5 diagnostic criteria. Descriptive statistics were used to report patient demographics, palliative care phase, function, delirium measure completion, and proportion of patients with a positive screen and diagnosis. RESULTS: Patients (n=47) had a mean age of 74 years (SD+10) and mostly malignant diagnoses (96%). All patients were screened for delirium, but few were capable of completing the Memorial Delirium Assessment Scale (n=2). One-third of patients (34%) screened positive for delirium and 19% were diagnosed as delirious according to the DSM-5. CONCLUSION: The Nursing Delirium Screening Scale and physician application of DSM-5 proved feasible and acceptable, while the Memorial Delirium Assessment Scale did not. Patients' advanced age and proportions screening positive for delirium and diagnosed as delirious attest to the need to rapidly recognise, assess and respond to patients experiencing this distressing disorder while being cared for in palliative care inpatient settings.
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Delírio/diagnóstico , Delírio/epidemiologia , Pacientes Internados/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Austrália/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos ProspectivosRESUMO
AIM: To examine longitudinal changes in the profile of Australian nurse practitioners surveyed in both 2007 and 2009 ('resurveyed respondents') and to determine differences between nurse practitioners who completed the census only in 2009 ('new respondents') and resurveyed respondents. BACKGROUND: The nurse practitioner role is integral to the development and sustainability of advanced practice roles in healthcare systems. However, its success depends upon support from policy makers, health services and nursing. A census of Australian nurse practitioners previously was conducted in 2007 to obtain national data on the role and scope of practice of nurse practitioners in Australia. DESIGN: A quantitative self-administered survey. METHODS: Questionnaires were sent to all authorised Australian nurse practitioners in 2009. RESULTS/FINDINGS: A total of 408 surveys were administered with 293 questionnaires completed (response rate 76.3%). Of these, 49% of participants also had completed the 2007 survey. There were no differences in the limitations and enablers identified in 2007 compared to 2009, indicating that perceived barriers had not been addressed over time, nor had there been substantial improvements. New respondents were more likely to have worked as a nurse practitioner in the previous week (p < 0.004). There was a significant increase in the number of nurse practitioners waiting on approval for some or all clinical protocols (p = 0.024). CONCLUSIONS: Conditions enabling work to full scope of practice continue to be perceived as suboptimal by Australian nurse practitioners. Supportive strategies are needed to enable the role to be effectively utilised.
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Profissionais de Enfermagem/estatística & dados numéricos , Profissionais de Enfermagem/tendências , Papel do Profissional de Enfermagem , Adulto , Austrália , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Fatores de TempoAssuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus , Dengue , Pandemias , Administração dos Cuidados ao Paciente/métodos , Pneumonia Viral , Atenção Primária à Saúde , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/fisiopatologia , Infecções por Coronavirus/terapia , Dengue/epidemiologia , Dengue/fisiopatologia , Dengue/terapia , Diagnóstico Diferencial , Surtos de Doenças/prevenção & controle , Transmissão de Doença Infecciosa/prevenção & controle , Doenças Endêmicas , Humanos , Controle de Infecções/métodos , Gravidade do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/fisiopatologia , Pneumonia Viral/terapia , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , SARS-CoV-2 , Singapura/epidemiologia , Avaliação de Sintomas/métodosRESUMO
BACKGROUND: Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. METHODS: A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). RESULTS: Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. CONCLUSION: This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.
RESUMO
Internet gaming addiction was included in the latest version of the DSM-V as a possible disorder recently, while debate is still on-going as to whether the condition called "Internet Addiction" (IA) could be fully recognised as an established disorder. The major contention is how well IA could fulfil the validation criteria as a psychiatric disorder as in other well-established behavioural addictions. In addition to various proposed validation criteria, evidence of risk and protective factors as well as development of outcomes from longitudinal and prospective studies are suggested as important. A systematic review of available longitudinal and prospective studies was conducted to gather epidemiological evidence on risk and protective factors of IA and the health effect of IA on adolescents. Nine articles were identified after an extensive search of the literature in accordance to the PRISMA guidelines. Of these, eight provided data on risk or protective factors of IA and one focused solely on the effects of IA on mental health. Information was extracted and analysed systematically from each study and tabulated. Many exposure variables were studied and could be broadly classified into three main categories: psychopathologies of the participants, family and parenting factors, and others such as Internet usage, motivation, and academic performance. Some were found to be potential risk or protective factors of IA. It was also found that exposure to IA had a detrimental effect on the mental health of young people. These results were discussed in light of their implications to the fulfilment of the validation criteria.
Assuntos
Comportamento do Adolescente/psicologia , Comportamento Aditivo/epidemiologia , Internet/estatística & dados numéricos , Adolescente , Humanos , Fatores de RiscoRESUMO
The effect of problematic use of the Internet on mental health, particularly depression among young people, has been established but without a probable model for the underlying mechanism. In this study, a model is presented to describe possible pathways for the linkage between Internet gaming addiction and depression possibly mediated by sleep problems. A systematic review was conducted to gather epidemiological evidence to support or refute the link between addictive Internet gaming, problematic Internet use, and sleep problems including insomnia and poor sleep quality. Seven studies were identified through a systematic literature search, of these three related to addictive Internet gaming and four on problematic Internet uses and sleep problems. Information was extracted and analysed systematically from each of the studies and tabulated as a summary. Results of the review suggest that additive gaming, particularly massively multiplayer online role-playing games MMORPG, might be associated with poorer quality of sleep. Results further indicated that problematic Internet use was associated with sleep problems including subjective insomnia and poor sleep quality.