Analgesic and adjuvant properties of exercise with vaccinations in healthy young population.

Introduction: Exercise holds the potential to be beneficial if used during vaccination processes by 1)exercise-induced analgesia to reduce pain associated with vaccination, 2)immune-enhancing effects, improving antibody responses to the vaccine, and 3)reducing local and systemic adverse reactions to the vaccine. This study examines whether analgesic responses could be enhanced locally in the exercising limb to further benefit the use of exercise during influenza vaccination processes to minimize vaccine-related pain and improve antibody response to inactivated influenza vaccines.Methods: 57 participants (22.6 ± 3.2 years, 33 females) randomized into a control (n = 19) or one of two exercise groups: pre-vaccine arm (n = 19) or pre-vaccine leg (n = 19). Intervention groups performed exercise (15 minutes), prior to administration of the vaccine. Vaccine-related pain and pressure pain threshold (PPT) were measured at baseline and post-vaccination for all groups. Blood samples were taken on the day of vaccination and one month later to measure serum antibody titers to influenza.Results: No significant difference in vaccine-related pain or change in PPT was found with exercise, however, there was a trend in higher reports of vaccine-related pain in females compared to males(p = .06). Significantly higher fold increase (p = .02) of the B/Brisbane/60/2008 strain was found in the exercise group compared to the control group.Conclusion: The current study failed to observe an analgesic effect of exercise to improve vaccine-related pain in young adults. However, immune-enhancing effects in one of four strains suggest potential adjuvant effects of exercise. Importantly, the sex difference in pain sensitivity suggests the need for separate analysis, especially when examining pain perception.Australian New Zealand Clinical Trial Registry (ACTRN:12617000374369).

Models of prescribing, scope of practice, and medicines prescribed, a survey of nurse practitioners.

AIMS AND OBJECTIVES: The aim of this study was to explore current Australian Nurse Practitioners (NPs) models of prescribing used and medicines prescribed within their scopes of practice. DESIGN: Descriptive online electronic national survey. METHODS: An online survey of Australian NPs was conducted in 2017. A total of 252 NP participants reported on their current prescribing practices. RESULTS: Participants reported prescribing via three prescribing models with autonomous prescribing the most frequently used, followed by prescribing under supervision and prescribing under a structured arrangement. Participants reported prescribing 298 separate medications, representative of all major drug classifications from the Australian Medicines Handbook. CONCLUSIONS: NPs appear to engage in several modes of prescribing as relevant to their context of practice with most NPs prescribing using all models of prescribing at different times. Findings also highlight the diversity of and breath of the medicines that NP prescribes and highlight the need for NPs to have broad capability in relation to the quality use of medicines, irrespective of specialty or location of practice. IMPACT: Findings of this research add to the international literature on NP prescribing and through identification of models of prescribing and medicines prescribed inform future NP education and policy.

"Providing a complete episode of care": A survey of registered nurse and registered midwife prescribing behaviours and practices.

AIMS AND OBJECTIVES: To describe the prescribing behaviours and practices of registered nurse and midwife prescribers and to explore experiences of enablers and barriers to prescribing practices. BACKGROUND: The extension of prescriptive authority to nurses and midwives internationally has created new opportunities for them to expand their scope of practice and is of significant benefit to effective and efficient health service provision. DESIGN: Cross-sectional national survey of registered nurse and midwife prescribers. METHODS: Data were collected through an online survey between April-July 2018. A total of 84 nurse and midwife prescribers participated. The STROBE checklist was applied as the reporting guideline for this study. RESULTS: Respondents estimated that two-fifths of their consultations involved an episode of prescribing. Nurse and midwife prescribers engaged in similar prescribing behaviours spanning the range of activities from initiating new medications to ceasing medicines. The most frequently selected criterion for prescribing was clinical effectiveness. Prescribing was viewed as essential to respondents' clinical practice, allowing them to provide a complete episode of care and leading to a reduction in medication errors and reduced delays and waiting times for patients. Enablers of prescribing included knowledge, experience, education and access to continuous professional development, as well as support from colleagues and organisations. CONCLUSION: Little is known about the prescribing behaviours and practices of registered nurse and midwife prescribers. While prescribing authority enables nurse and midwife practitioners to deliver holistic care, there remain significant barriers and challenges including increased workloads, lack of continuous professional development, lack of support and overly restrictive rules and policies governing prescribing. RELEVANCE TO CLINICAL PRACTICE: Addressing the barriers identified in this study could enable more nurse and midwife prescribers to work to their full scope of practice, enabling populations to fully capitalise on the contributions of registered nurse and midwife prescribing services.

Improving vaccine-related pain, distress or fear in healthy children and adolescents-a systematic search of patient-focused interventions.

OBJECTIVE: The WHO recently highlighted the need for research into potential interventions that can be used to mitigate pain during mass vaccinations, in addition to interventions specific for adolescents. The current review examines the literature on potential interventions that can be used during mass vaccination settings in healthy individuals between the ages of 4 and 15 years old. METHODS: Criteria for inclusion were: 1)participants between the ages of 4-15 years, 2)interventions that were patient-focused, 3)vaccinations in healthy individuals, 4)outcome measures to include self-reported pain, fear or distress. RESULTS: Twenty-seven articles were identified with a total of 31 interventions. Eleven interventions used injection-site specific interventions, 17 used patient-led interventions and three used a combination of both site-specific and patient-led interventions. CONCLUSION: Interventions using coolant and vibration together, as well as a combination of site-specific and patient-led interventions, showed the most consistent effects in reducing self-reported pain, fear or distress.

Nurse practitioner prescribing in Australia: A comprehensive literature review.

BACKGROUND: In Australia, the nurse practitioner (NP) obtained prescriptive authority in some jurisdictions in 2001. One of the key aspects in which the scope of NPs differs from Registered Nurses (RNs) relates to the legal privilege to prescribe medications. Although NPs have had prescriptive authority in Australia since 2001, with access to the Commonwealth subsidy scheme (PBS) since 2010, little is known about NPs prescriptive patterns or outcomes of prescriptive practice. AIM: The aim of this scoping review was to examine the extent, range and nature of research conducted in relation to NP prescribing in the Australian health context as well as identify gaps in the existing literature. Whilst considerable research has been undertaken on medical prescribing, to date there is no published review of studies regarding NP prescribing in the Australian context. METHOD: A structured search of the literature was undertaken using permutations of the following key words 'nurse practitioner prescribing Australia', 'nurse practitioner and prescribing', 'advanced practice nurse and prescribing', 'nurse practitioner and Australia'. Databases where searched from January 2000 to January 2016. Databases searched include PsycInfo, Pubmed, CINAHL and Medline. FINDINGS: There are a number of distinguishing features of NP prescribing practices in the Australian context. Little is known about the prescribing behaviours of critical care NPs in both the international and Australian context. Key themes identified were: barriers to prescribing, attitudes to NP prescribing, frequency of prescribing, types of medications prescribed, prescribing practice behaviours and confidence in prescribing. CONCLUSION: The impact of legislative changes on Australian NPs clinical practice and service delivery is still evolving. This review should create impetus for further research to determine the outcomes of NP prescribing on both patient and health service outcomes in the Australian healthcare context including critical care settings.

Carbene-Catalyzed Dynamic Kinetic Resolution of Carboxylic Esters.

Carbene-catalyzed reaction of carboxylic esters has the potential to offer effective synthetic solutions that cannot be readily achieved by using the more conventional aldehyde-type substrates. Here we report the first carbene-catalyzed dynamic kinetic resolution of α,α-disubstituted carboxylic esters with up to 99:1 er and 99% yield. The present study clearly illustrates the unique power of carbene-catalyzed reactions of readily available and easy to handle carboxylic esters.

Directed orthometalation and the asymmetric total synthesis of N-deoxymilitarinone A and torrubiellone B.

A diverted total synthesis (DTS) approach to the total synthesis of pyridone alkaloids N-deoxymilitarinone A (8) and torrubiellone B (10) has been developed. The common intermediate 14 was first assembled by a dual directed orthometalation process using a methoxymethyl group as directed metalation group. Other crucial steps include the assembly of polyenes under aldol condensation for DTS using general and concise strategy and diastereoselective synthesis of the syn-dimethyl array by an Evans aldol reaction.

A four month prospective descriptive exploratory study of patients receiving antibiotics in one Emergency Department.

BACKGROUND: Any infection can potentially develop into sepsis. Many patients present to the Emergency Department (ED) with infection and go on to require antibiotics. However, the timeliness of antibiotics can make a difference to patient survival and reduce the risk of infection developing into sepsis and or septic shock. METHODS: Our study was a 4month prospective descriptive exploratory pilot study. RESULTS: Of all adult (n=18,807) presentations 3339 (18%) patients had a primary diagnosis related to infection. The study collected data on 104 (3%) patients who were administered antibiotics. One hundred (95%) patients who received antibiotics were admitted to hospital. Triage code did not influence time to antibiotic (p=.352). Eighty-five (81%) patients waited longer than 1h for their first antibiotic with the shortest administration time 19min (mean 233min, SD 247) and the maximum wait for antibiotics was 1481min. For sepsis or septic shock patients (n=8) the average time to antibiotics was 411min (SD=455min). CONCLUSION: The study provides a detailed analysis of ED patients receiving antibiotics. Further research is needed to identify strategies to improve the timely delivery of antibiotics for patients with infections.

Nursing praxis, compassionate caring and interpersonal relations: an observational study.

BACKGROUND: The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests, treat and manage a range of patient conditions. The CIN role is focused on the waiting room and to 'communicate the wait', initiate diagnostics or treatment and follow-up for waiting room patients. We aim to explore what emergency nurses' do in their extended practice role in observable everyday life in the emergency department (ED). The paper argues that compassionate caring is a core nursing skill that supports CIN interpersonal relations, despite the role's highly clinical nature. METHOD: Sixteen non-participant observations were undertaken in three EDs in New South Wales, Australia. Nurses were eligible for inclusion if they had two years of emergency experience and had worked in the CIN role for more than one year. All CIN's that were observed were highly experienced with a minimum three year ED experience. RESULTS: The CIN observations revealed how compassionate caring was utilised by CIN's to quickly build a therapeutic relationship with patients and colleagues, and helped to facilitate core communication and interpersonal skills. While the CIN role was viewed as extended practice, the role relied heavily on compassionate care to support interpersonal relationships and to actualise extended practice care. CONCLUSION: The study supports the contribution made by emergency nurses and demonstrates how compassionate caring is central to nursing praxis. This paper also demonstrates that the CIN role utilises a complex mix between advanced clinical skills and compassion that supports interpersonal and therapeutic relationships. Further research is needed to understand how compassionate care can be optimised within nursing praxis and the duty of care between nurses and patients, nurses and other health care professionals so that future healthcare goals can be realised.

Managing the wait: clinical initiative nurses' perceptions of an extended practice role.

INTRODUCTION: The Clinical Initiative Nurse (CIN) is a role that requires experienced emergency nurses to assess, initiate diagnostic tests and treat and manage a range of patient conditions. In 2010, the New South Wales Ministry of Health redefined the focus of the CIN role to be on waiting room patients. The new CIN role was now focused on the waiting room and to 'communicate the wait', initiate diagnostics and or treatment and follow-up for waiting room patients. While new models of care are often introduced the perceptions of those undertaking the roles are often absent from evaluation. We aimed to explore emergency nurses' perceptions of the extended practice role known as the Clinical Initiative Nurse. METHOD: This was a multicentre study and formed part of a larger qualitative exploratory study of the CIN role. RESULTS: Thirty-six interviews were conducted across the three sites. There was no statistical difference between groups for hospital site, ED experience or Clinical Nurse Specialist grade. Three main themes were identified from the data and included (i) managing the waiting room patient; (ii) benefits of being the CIN; and (iii) situational barriers impacting on the CIN role. CONCLUSION: We have provided a deeper understanding of the CIN role and of contextual factors operating in everyday practice. Further research is needed to determine how nursing roles can be sustained, learned, enjoyed and optimised to meet future healthcare goals.

The prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital.

BACKGROUND: Globally, severe infection and or sepsis is a problem that is costing billions of dollars, using hundreds of hospital beds, and often results in patient death. Any infection can potentially develop a sepsis health trajectory if left unrecognised and unmanaged. METHODS: We conducted a 12 month retrospective descriptive exploratory study. Our research explored the prevalence and triage characteristics of patients presenting with infection to one tertiary referral hospital. Electronic medical records were reviewed to identify patients that had a primary diagnosis related to infection. RESULTS: The study identified that 16% (n=7756) of adult presentations had a discharge diagnosis related to infection. A significant difference (X(2)=297.83, df=4, p≤.001) in Triage Code allocation for the infection group was identified compared with the non-infection patient group. Thirty-nine percent (n=3027) of patients with infections were admitted to hospital. Of the patients (n=1930; 4%) admitted to a critical care area, 6% (n=122) had a primary diagnosis related to infection. Of the ED deaths (n=81), 12% (n=10) had a primary diagnosis related to infection. CONCLUSION: The study provides a detailed analysis of the prevalence and triage characteristics of patients with infection presenting to one ED. Further research is needed to identify strategies to improve the triage nurse's recognition of severe infection and consistency of urgency code allocation to prevent patient deterioration.