The Effect of Paternal Skin-to-Skin Care: A Systematic Review and Meta-analysis of Randomized Control Trials.

BACKGROUND: Research about skin-to-skin care (SSC) experiences in early period after birth has focused on mothers and infants. PURPOSE: The purpose of this study was to determine the outcomes of paternal skin-to-skin care (P-SSC) in both fathers and infants. METHODS: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed/MEDLINE, Embase, CINAHL, PsycInfo, Airiti Library, and Google Scholar were searched for randomized controlled trials (RCTs) that reported outcomes of P-SSC in both fathers and infants. We calculated pooled mean differences (MDs) and 95% confidence intervals (CIs) using RevMan 5.3 for the meta-analysis [PROSPERO: CRD42018106790]. RESULTS: Seven RCTs including a total of 552 participants were eligible for inclusion. Compared to the maternal skin-to-skin care (M-SSC), fathers in the P-SSC exhibited no significant differences in salivary oxytocin levels (MD: -0.35 pg/mL; 95% CI: -0.75, 0.05), salivary cortisol levels (MD: 0.25 µg/dL; 95% CI: -0.82, 1.33), or anxiety scores (MD: -0.17; 95% CI: -0.57, 0.22) during the period of SSC. Similarly, there were no significant differences in the salivary cortisol levels (MD: -0.11 µg/dL; 95% CI: -0.05, 0.28) among preterm infants between the 2 groups. However, the crying time was less among full-term infants in the P-SSC group compared with infants in the incubator care or cot care groups. IMPLICATIONS FOR PRACTICE AND RESEARCH: P-SSC had similar effects as M-SSC on stress-related outcomes during and after SSC among fathers and infants in the early stages after birth. We recommend that P-SSC be implemented in the early stages after birth. Further RCTs with a longitudinal design and large samples are needed to better understand the long-term effects of P-SSC on fathers and infants.

COVID-19: Knowledge, anxiety, academic concerns and preventative behaviours among Australian and Indian undergraduate nursing students: A cross-sectional study.

AIMS AND OBJECTIVES: To compare knowledge, anxiety, academic concerns and preventative behaviours between undergraduate nursing students in Australia and India during the COVID-19 pandemic. BACKGROUND: Based on the World Health Organization's direction for containment of the novel coronavirus (COVID-19), countries implemented varying levels of restrictions including closure of university campuses and providing on line undergraduate education. METHODS: Students in NSW, Australia and Kerala, India completed an online survey assessing their (a) knowledge and source of information about COVID-19; (b) anxiety; and coping strategies; (c) academic concerns; and (d) preventative behaviours. Descriptive and inferential statistics were used to summarise the data. RESULTS: Data from 99 Australian and 113 Indian undergraduate nurses were analysed. Greater number of Indian students indicated having sufficient knowledge of COVID-19 (OR 0.22; 95% CI 0.08, 0.63), getting information about COVID-19 from social media (OR 0.03; 95% CI 0.01, 0.07) and being concerned about 'attending clinical placement' (MD-1.08; 95% CI -1.94, -0.23). Australian students reported significantly higher levels of anxiety (MD 1.99 95% CI 1.21, 2.78), difficulty sleeping (OR 18.00; 95% CI 6.76, 47.96), concentrating (OR 33.22; 95% CI 13.85, 79.67) and eating (OR 14.05; 95% CI 3.19, 61.84). Greater number of Australian students indicated that they would go to the University if they needed to meet with other students (OR 9.21; 95% CI 3.08, 27.55), had to access the library (OR 7.20; 95% CI 3.26, 15.90) or had a group assignment (OR 2.93; 95% CI 1.26, 6.77). CONCLUSIONS: Wide variations were present in knowledge, anxiety, academic concerns and preventative behaviours among undergraduate nursing students in two countries. RELEVANCE TO CLINICAL PRACTICE: Undergraduate students may benefit from additional support from the University and staff in the clinical setting with online learning and resources in order to adjust to the 'new normal' and enable them to achieve academic success.

Planning for a smooth transition: evaluation of a succession planning program for prospective nurse unit managers.

The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

Quality of life of community-based palliative care clients and their caregivers.

OBJECTIVE: This study aimed to investigate health-related quality of life of palliative care (PC) clients and their caregivers, at baseline and follow-up, following a referral to a community PC service. METHOD: Quality of life of clients and their caregivers was respectively measured using the McGill Quality of Life instrument (MQoL) and the Caregiver Quality of Life Cancer Index (CQoLC) instruments. Participants were recruited from June 8 to October 27, 2006. This study was undertaken in one zone of an Area Health Service in New South Wales, which has a diverse socioeconomic population. The zone covers an area of 6237 km2 and is divided into five sectors, each with a PC service, all of which participated in this study. RESULTS: Data were obtained from 49 clients and 43 caregivers at baseline, and 22 clients and 12 caregivers at 8 week follow-up. Twenty-one participants died and six moved out of the area during the study. At baseline, clients reported a low mean score for physical symptoms (3.3 ± 1.9) and a high score for support (8.7 ± 1.0). Caregivers scored a total CQoLC of 63.9 ± 21.4 and clients had a total QOL of 6.1 ± 1.3. At follow up, matched data for 22 clients and 13 caregivers demonstrated no statistical differences in quality of life. SIGNIFICANCE OF RESULTS: This study has provided evidence that health-related quality of life questionnaires show lower scores for physical health and higher scores for support, which can directly inform specific interventions targeted at the physical and support domains.

Congruence between the Indian Diabetes Risk Score and Australian Type 2 Diabetes Risk Assessment tool screening in Asian-Indians.

AIM: To evaluate the performance of the simplified Indian Diabetes Risk Score (IDRS) and the Australian Type 2 Diabetes Risk Assessment (AUSDRISK) instruments in predicting diabetes in Indian-Australians. BACKGROUND: Screening for diabetes in the general community is common and numerous scoring systems are being used to predict the risk of diabetes. DATA SOURCES: For this cross-sectional study, data were obtained from people attending the Australia India Friendship Fair. REVIEW METHODS: Data relating to risk factors for diabetes were obtained using a questionnaire and a random blood glucose level. The IDRS and AUSDRISK scores were calculated. Student's t-test, Pearson chi-square, and receiver-operating characteristic curves were used to compare the performance of the predictive scores. DISCUSSION: Data were analysed for 136 participants: 28 per cent of individuals considered to be low-risk and 35 per cent considered to be moderate-risk according to AUSDRISK were classified as moderate-risk and high-risk respectively by IDRS. CONCLUSION: The two models were not congruent in predicting diabetes risk among Asian-Indians. IMPLICATIONS FOR PRACTICE/RESEARCH: The results of this study have significant implications for education relating to diabetes screening.

Knowledge dissemination resulting from the Australian Cardiac Rehabilitation Association annual scientific meetings.

BACKGROUND: Publication of scientific work presented at national conferences underpins knowledge translation. However, no such data exists for cardiac rehabilitation abstracts presented at Australian conferences. We reviewed a series of conferences to determine the number of abstracts that resulted in subsequent full publication. METHODS: Australian Cardiac Rehabilitation Association (ACRA) Conference Proceedings for 2003-2007 were searched for oral and poster author details and abstract titles were searched in multiple databases for publication in a peer-reviewed journal and the results summarised. RESULTS: In total, 279 abstracts were presented at the five conferences, of which 186 were podium, 83 poster and 10 moderated poster presentations. The majority (42%) of abstracts were from Victoria (n=116), and were dominated by presentations from registered nurses (38%; n=107). Only 17 (9%) were subsequently published as full manuscripts in scientific journals with impact factors ranging from 0.55 to 7.92. The mean time from presentation to complete manuscript publication was 19±21.6 months. The median citation rate of the publications was 2.0 (range 0-12). CONCLUSIONS: Most abstracts presented at the ACRA scientific meetings were not published as manuscripts in journals. Failure to publish comprises research principles and progress healthcare. There is an urgent need to investigate the reasons for the low publication rates and develop effective strategies to redress the imbalance.

Quality-of-life trajectory of clients and carers referred to a community palliative care service.

Palliative care clients often have a reduced quality of life (QOL). The purpose of this study was to explore the QOL trajectory of clients and carers newly referred to a community palliative care service. A total of 49 clients and 43 carers respectively completed the McGill QOL scale (MQOL) and the caregiver QOL cancer scale (CQOLC) questionnaires. Baseline data relating to demographics, health status, and QOL are presented for the 49 participants and their 43 carers, and these are compared with follow-up data from 22 clients and 13 carers (matched pairs). On average, there were no significant differences between baseline and follow-up QOL scores in any respects for either clients or carers, including measures of burden, disruptiveness, positive adaptation, and financial concerns. Whether this indicates that the care administered succeeded in cancelling out the worsening of the clients' conditions or whether it indicates a shortcoming of the care was not assessed.

Perceptions of the impact of health-care services provided to palliative care clients and their carers.

A wide range of services are provided to palliative care clients to alleviate pain and improve their quality of life. The purpose of this study was to explore the perceptions of clients and their carers regarding palliative care services in New South Wales, Austalia. Ten patients and their carers (n = 7) were randomly selected from a sample of palliative care clients and were informed of the study and interviewed. Interview data were coded independently by three researchers and thematic analysis was undertaken. The themes identified were similar for both clients and carers and included: access to services; service provision; impact on way of life; usefulness of services; and staffing. An additional theme identified by clients was the burden of caregiving on carers. Knowledge of perceptions and concerns of client and carers is important to consider when planning palliative care services.

A pilot randomised controlled trial comparing a health-related lifestyle self-management intervention with standard cardiac rehabilitation following an acute cardiac event: Implications for a larger clinical trial.

PURPOSE: This pilot study was to assess the feasibility of the health-related lifestyle self-management (HeLM) intervention as a strategy to decrease cardiovascular risk following acute coronary syndrome. METHODS: Participants in this randomised controlled trial were recruited from a tertiary teaching hospital in metropolitan Sydney Australia. The multifaceted HeLM intervention, using the principles of the transtheoretical model, involved the use of bibliotherapy, a structured evidence-based approach to cardiovascular risk reduction, a communication strategy with general practitioners, three supportive telephone calls to participants and provision of behavioural prompts and a health record diary. Differences in behavioural and clinical outcomes between the HeLM intervention group (n=29) and the standard cardiac rehabilitation group (n=22) were assessed. RESULTS: A total of 125 participants screened were eligible for participation in the study. Fifty-one participants, mean age 57 years (+/-8.78) were randomised. At the 8-week follow-up, participants in the HeLM intervention group had a reduced systolic blood pressure compared to the standard care group (120.3 S.D.: 16.3 vs. 126.4 S.D.: 14.6). There were no significant differences in diastolic blood pressure and cholesterol levels between the two groups. Participants in both the intervention and control group had a reduction in waist circumference although when compared to baseline values, women in the HeLM intervention group had a greater reduction compared to those receiving standard care. Patients reported high levels of satisfaction with this intervention. CONCLUSIONS: Findings support the feasibility of implementing the health-related lifestyle self-management intervention for risk factor modification in patients with acute coronary syndrome. An adequately powered randomised controlled trial is required to test the impact of the intervention on cardiovascular risk reduction.

Does implementation of clinical practice guidelines change nurses' screening for alcohol and other substance use?

AIM: To examine the effectiveness of the implementation of a clinical practice guideline on nurses screening patients for alcohol and other substance use, providing brief interventions, and referring patients at risk for treatment. METHOD: Medical record audits were conducted in selected medical and surgical wards of two metropolitan hospitals in Sydney prior to and three months following the guideline implementation. RESULT: Seventy-nine (pre) and 84 (post) patient records were audited. There were no differences in screening rates for alcohol (28% and 29%), tobacco (29% and 23%) and illicit drug use (16% and 8%) before and after implementation of the guideline. PRACTICE IMPLICATION: Factors which may have limited the effectiveness of the clinical practice guideline dissemination included design of the education program, existing level of nurses' knowledge and competence, and strategies in place to ensure sustainability of the program. We also provided suggestions for improvement of screening for alcohol and other substance use.

Cardiac rehabilitation coordinators' perceptions of patient-related barriers to implementing cardiac evidence-based guidelines.

BACKGROUND: Coronary heart disease remains the leading cardiovascular cause of mortality and morbidity globally. Implementing evidence-based guidelines after a coronary event is vital to prevent recurrence of an acute episode. However, various barriers to guideline implementation have been identified. OBJECTIVE: This article presents the perspective of cardiac rehabilitation (CR) coordinators regarding patient-related barriers to implementing the evidence-based guidelines after an acute cardiac event. METHODS: Twenty CR coordinators from 4 geographic regions of New South Wales, Australia, participated in the study. A semistructured interview using open-ended questions was used to obtain the CR coordinator's perspectives of the patient-related barriers to guideline implementation. Interviews were transcribed, and content analysis was undertaken. FINDINGS: The most frequently identified patient-related barriers were (a) coming to terms with a diagnosis of heart disease, (b) challenges in changing behavior, (c) having heart disease is costly, and (d) other personal barriers. CONCLUSIONS: Despite CR coordinators having positive attitudes toward implementing evidence-based guidelines, several patient-related barriers were identified that obstructed the implementation process. The findings have important implications for nursing practice in terms of directing efforts at increasing participation in CR and engaging commitment of the patient to behavior change. Changes to health service policies that address identified barriers could further facilitate the provision of evidence-based care to patients with coronary heart disease.

Sociodemographic predictors and reasons for participation in an outpatient cardiac rehabilitation programme following percutaneous coronary intervention.

Evidence-based guidelines recommend participation in cardiac rehabilitation (CR) to reduce subsequent cardiovascular events following percutaneous coronary intervention (PCI). The objective of this study was to investigate the reasons for and the demographic characteristics of patients who participate in CR programmes following PCI in a single metropolitan setting in Australia. Logistic regression models were used to examine the data obtained using self-reports through mailed questionnaires from 202 patients 12-24 months following the index PCI. Thirty-five per cent of subjects reported to have participated in CR programmes, of whom less than a quarter were female. In this sample the main reason for programme participation was a recommendation given by the general practitioner (GP). The likelihood of participating in a CR programme decreased with age and absence of a partner. Additional research on determinants of participation in CR programmes among this cohort of patients could assist in the development of new strategies to encourage healthy behaviours and reduce the risk of further cardiac events.

Awareness of risk factors for coronary heart disease following interventional cardiology procedures: a key concern for nursing practice.

Cardiovascular risk factor modification to prevent progression of coronary heart disease is important for patients following percutaneous coronary intervention. The aims of this study were to assess patient's awareness of modifiable cardiac risk factors and examine if patients with modifiable risk factors were more likely to identify these risk as amenable to change. Awareness of risk factors was measured using the Indiana Cardiac Rehabilitation Knowledge Questionnaire in a cohort of prospective, consecutive participants post percutaneous coronary intervention. Completed questionnaires were received from 75% of the participants. The majority were able to identify high cholesterol (87%), smoking (83%) and hypertension (82%) as modifiable risk factors. Less than half (46%) of the respondents identified diabetes as a modifiable risk factor. Only a third of participants recognized all six modifiable risk factors. A large proportion of patients who were smokers, or who had high cholesterol or hypertension, identified these as risk factors. A third of people with documented diabetes did not recognize this condition as a risk factor for heart disease. The findings have important implications for nursing practice in terms of directing educational efforts for the modification of risk factors for coronary heart disease.

Administration of medications by enrolled nurses: perceptions of metropolitan and non-metropolitan registered nurses and nursing unit managers.

OBJECTIVE: The objective of this study was to investigate the views and current practices of registered nurses (RNs) and nurse unit managers (NUMs) working in metropolitan and non-metropolitan health facilities relating to medication administration by enrolled nurses (ENs). BACKGROUND: The advanced scope of practice role relating to medication administration is one area currently challenging Registered and Enrolled Nurses from the perspectives of the education, knowledge and skills required to support competence in this area of practice. METHOD: A self-administered survey comprising questions on participant demographics, their perceptions and their current practices relating to ENs administering medications was completed by 272 RNs and NUMs from metropolitan and non-metropolitan health care facilities within Australia. RESULTS: There were statistically significant differences among metropolitan and non-metropolitan based RNs relating to their views on the various routes by which ENs should be allowed to administer medications. Significantly more RNs from metropolitan hospitals indicated that they asked ENs to administer S3, S4 and S4D medications. Overall, a large proportion of RNs were opposed to ENs administering injectable medications. CONCLUSION: This study describes the current practices and view points of RNs relating to administration of medications by ENs.While the findings suggest that practice change could be slow, appropriate ongoing education for and consultation with RNs will support change of practice at the clinical level. Further formalising a medication administration role for ENs that acknowledges current practice will have potential organisational and patient safety benefits.

Effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery: a systematic review.

REVIEW OBJECTIVE: The objective of this review was to investigate the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on patients' health-related quality of life and hospital readmission. INTRODUCTION: Coronary heart disease is a major cause of death and disability worldwide, putting a great strain on healthcare resources. For the past two decades, population-wide primary prevention and individual healthcare approaches have resulted in a dramatic decline in overall cardiac mortality. Over the intervening years, surgical techniques in cardiology have also improved substantially. As a result, long-term outcomes in patients treated with coronary artery bypass graft surgery have established the treatment's effectiveness and survival benefit. Furthermore, participating in cardiac rehabilitation following coronary artery bypass graft surgery has also demonstrated a significant decrease in all-cause cardiac mortality in these patients. INCLUSION CRITERIA: This review included studies with participants aged 18 years and over, post coronary artery bypass graft surgery that evaluated nurse-led cardiac rehabilitation (CR) programs compared with usual care or other forms of CR. The outcomes of interest were the health-related quality of life and hospital readmissions following coronary artery bypass graft surgery and measured using validated scales. Randomized controlled trials reported in English between 2000 to June 2017 were considered for inclusion. METHODS: The search strategy aimed to find both published and unpublished studies using a three-step search strategy. An initial search of MEDLINE, CINAHL and Scopus was undertaken, followed by a search for unpublished studies including Dissertation Abstracts International, ProQuest Dissertations and Theses, Google Scholar, MedNar and ClinicalTrials.gov. Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to inclusion in the review using the standardized critical appraisal tools from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI SUMARI). Quantitative data was extracted from papers included in the review using the standardized data extraction tool from JBI-SUMARI. No meta-analysis was undertaken due to heterogeneity of the outcome measures. All results were subject to double data entry. Effect sizes expressed as risk ratio (for categorical data) and weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for analysis. RESULTS: Three trials involving 329 patients were included in the final review. The trials that investigated the effect of home based cardiac rehabilitation programs compared to usual care at six weeks, three months and six months follow-up demonstrated no statistically significant difference in health-related quality of life at any of the follow-up periods. However, one study demonstrated significantly higher scores related to health-related quality of life among those who received nurse-led home based cardiac rehabilitation (154.93 ±â€Š4.6) compared to those who received usual care (134.20 ±â€Š8.2) at two months follow-up. No trials were identified that compared the effectiveness of nurse-led cardiac rehabilitation programs following coronary artery bypass graft surgery on readmissions to hospital. CONCLUSION: There is not enough evidence to support or discourage nurse-led cardiac rehabilitation programs on health-related quality of life in patients following coronary artery bypass graft surgery. However, the sparse data available suggests improvements in health-related quality of life at two months follow-up among those who received a nurse-led program. Further large-scale multicenter trials with standardized methodology are needed to determine the effect of nurse-led cardiac rehabilitation programs on health-related quality of life and rates of readmission to hospital following coronary artery bypass graft surgery.

Portable MP3 players: innovative devices for recording qualitative interviews.

Digital technology has provided a new way of recording qualitative interviews, surpassing the clarity, usability and storage capabilities of conventional tape recorders. Ritin Fernandez and Rhonda Griffiths examine a technological resource that pervades modern social life and which can be used effectively for digitally recording interviews for qualitative research.

Computerised insulin dosing calculators for the management of continuous insulin infusions after cardiac surgery: A systematic review and meta-analysis.

OBJECTIVES: To investigate the effectiveness of computerised insulin dosing calculators for the management of continuous insulin infusions in adult patients who underwent cardiac surgery. METHOD: A systematic review was conducted. The CINAHL, MEDLINE and Cochrane databases were searched for primary studies that compared a computerised insulin dosing calculator to a paper protocol. The main outcome measures were mean Blood Glucose Level (BGL), time to achieve BGL target range, time spent within BGL target range, the incidence of hyperglycaemia and the incidence of hypoglycaemia. RESULTS: Five studies were included in the final review. Pooled data demonstrated significant improvements in mean BGL (MD -14.24, 95% CI -26.93 to -1.55), p=0.03 and significantly lower rates of hypoglycaemia (OR 0.038, 95% CI: 0.16-0.90), p=0.03 amongst the computer calculator groups in comparison to the paper protocol groups. No significant difference in the incidence of severe hypoglycaemia was demonstrated (OR 0.21, 95% CI 0.02-1.79), p=0.15. No difference was found in time (hours) to reach target blood glucose range (MD -1.47, 95% CI -3.75 to 0.81), p=0.21. CONCLUSION: There is some evidence to support the use of computerised insulin dosing calculators for insulin infusion management within critical care environments.

Effectiveness of rifampicin-streptomycin for treatment of Buruli ulcer: a systematic review.

BACKGROUND: Buruli ulcer (BU) disease is a chronic ulcerative skin disease caused by Mycobacterium ulcerans, which can lead to extensive destruction of the skin, soft tissues and occasionally of bones. Although several antibiotics have demonstrated bactericidal activity against M. ulcerans in vitro, no consensus on their clinical efficacy against M. ulcerans in humans has been reached. OBJECTIVES: The objective of the systematic review was to examine the clinical effectiveness of various antibiotic regimens for the treatment of BUs. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered trials that included patients of all ages with BUs. TYPES OF INTERVENTION(S): The current review considered trials that evaluated antibiotic regimens compared to no antibiotics or surgery in patients with BUs. TYPES OF STUDIES: The current review considered randomized and non-randomized controlled trials (RCTs). In the absence of RCTs, other research designs such as before and after trials and clinical trials with only an intervention arm were considered for inclusion in a narrative summary. OUTCOMES: The primary outcome of interest were the treatment success rates among the various antibiotics used. Secondary outcomes included changes in lesion size, recurrence of ulcers and incidence of adverse events. SEARCH STRATEGY: The search strategy aimed to find both published and unpublished trials. A three-step search strategy was utilized in this review and included English language trials published after 1990. A search across the major databases was conducted up to December 2014. METHODOLOGICAL QUALITY: Using the Joanna Briggs Institute (JBI) standardized appraisal tool, two reviewers independently assessed the methodological quality of the trials. A third independent reviewer was available to appraise trials if the two original reviewers disagreed in their assessments. There were no disagreements in findings between the two independent reviewers. DATA EXTRACTION: Data were extracted using the standardized JBI data extraction instruments. DATA SYNTHESIS: Statistical pooling was not possible due to heterogeneity, hence results have been presented in the narrative form. RESULTS: Seven studies involving a total of 712 patients were included in the final review. Higher treatment success rates ranging from 96% to 100% at the six months follow-up were reported among patients treated with rifampicin-streptomycin for eight weeks (RS8) in two studies. Treatment success with rifampicin-streptomycin for 12 weeks, with surgery at the 12 weeks follow-up, was 91%. In the two studies that investigated the effect of rifampicin-streptomycin for two weeks followed by rifampicin-clarithromycin for six weeks and rifampicin-streptomycin for four weeks followed by rifampicin-clarithromycin for four weeks, treatment success was reported to be 93% and 91%, respectively, at the 12 months follow-up. A significant decrease in the median lesion size at the eight weeks follow-up was reported in patients who were treated with RS8, and a 10-30% decrease in lesion size was reported in those treated with RS12 at the four weeks follow-up. CONCLUSION: Treatment success and reduction in lesion size were higher in patients treated with RS8 in the only RCT that compared rifampicin-streptomycin for four weeks followed by rifampicin-clarithromycin for six weeks to RS8, and there was no difference in outcomes, which indicates that local preferences could dictate the treatment option. Evidence obtained from this systematic review indicates that surgery will remain necessary for some ulcers; however, detection of early lesions and treatment with antibiotics would have a greater impact on the control of M. ulcerans disease. Further large multicenter RCTs investigating the type and optimal duration of oral antibiotic treatment for patients with M. ulcerans disease are urgently needed.

Effects of methods used to achieve hemostasis on radial artery occlusion following percutaneous coronary procedures: a systematic review.

BACKGROUND: Transradial access to percutaneous coronary procedures is becoming the preferred access route, and it is being increasingly used for emergent and elective procedures. However, radial artery occlusion (RAO) continues to remain an adverse occurrence following sheath removal or in the first 24 hours following sheath removal due to the smaller diameter of the artery. OBJECTIVES: The overall objective of this study was to synthesize the best available research evidence related to the effects of methods used to achieve hemostasis on RAO rates after percutaneous coronary procedures. INCLUSION CRITERIA TYPES OF PARTICIPANTS: The current review considered trials that included adult patients (18 years and over) who have had a coronary angiography or coronary re-vascularization intervention via the radial artery. TYPES OF INTERVENTION(S): The interventions of interest were the use of various hemostatic methods compared to traditional interventions to prevent RAO. TYPES OF STUDIES: All randomized and quasi-randomized controlled trials evaluating the effect of various hemostatic methods on RAO rates after percutaneous coronary procedures were included in the review. OUTCOMES: The primary outcome of interest was the incidence of RAO at the time of discharge and persistent occlusion at the time of follow-up. SEARCH STRATEGY: The search aimed to find published and unpublished trials through electronic databases, reference lists and key reports. An extensive search was undertaken for the following databases - CINAHL, Embase, PubMed and the Cochrane Central Register of Controlled Trials (CENTRAL). Databases were searched up to May 2016. The search for unpublished trials included Dissertation Abstracts International, World Cat, Clinicaltrials.gov, ProQuest Dissertation and Theses and MedNar. METHODOLOGICAL QUALITY: Methodological quality was assessed independently by two reviewers using the Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument (JBI-MAStARI) checklist. Disagreements that arose between the reviewers were resolved through discussion. DATA EXTRACTION: Quantitative data were extracted from papers included in the review by one reviewer using the standardized data extraction tool from JBI-MAStARI. The data extracted were checked by a second reviewer. Disagreements that arose between the reviewers were resolved through discussion. All results were subject to double data entry in Review Manager. DATA SYNTHESIS: Statistical pooling of the data was not possible due to the heterogeneity of the trials; therefore, the findings are presented in narrative form. However, figures have been used to illustrate the results. RESULTS: A total of seven trials were included in the review. One trial demonstrated a significant reduction in RAO rates in patients who had a mean arterial pressure (MAP)-guided TR band to a standard TR band (odds ratio [OR] 0.08; 95% confidence interval [CI] 0.02, 0.37). A statistically significant reduction in the incidence of RAO was observed among patients who received a biopolymer dressing (Chitosen) compared to those who received the TR band (OR 2.20; 95% CI 1.20, 4.02). No statistically significant difference in the incidence of RAO was reported between those who received the TR band and those who received either the elastic bandage (P = 0.08) or T band (P = 0.76). Similarly, no statistically significant difference in rates of RAO among patients was reported among those who had pro-coagulant dressings compared to those who had short or long manual compression. One trial that compared the TR band to a MAP-guided TR band demonstrated no statistically significant difference in the time taken to obtain hemostasis between the two groups (P = 0.61). A statistically significant reduction in the time taken to obtain hemostasis was observed among patients who received the hemostatic biopolymer dressing compared to the TR band. No statistically significant difference in the incidence of hematoma was identified among patients who received pneumatic compression or traditional compression to achieve hemostasis. CONCLUSION: There is limited evidence to support the use of any single hemostatic method to prevent RAO rates after percutaneous coronary procedures. Although used extensively, there is evidence of no effect of the pneumatic compression method using the TR band on the incidence of RAO at discharge or follow-up, the time taken to obtain hemostasis and the incidence of hematoma. The MAP-guided compression method and the Biopolymer dressing (Chitosen) were superior to the TR band compression method, and patent hemostasis was superior to hemoband in the prevention of RAO. However, these results are based on single trials and should be interpreted with caution. The evidence obtained from the review does not provide a concrete base for the development of practice guidelines. Until more robust evidence is available, practices will continue to be dictated by local preferences and available resources.

Determining the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant: a cross-sectional survey.

BACKGROUND: Globally, many nurses and midwives are working at an advanced practice level. The role of a Nurse and/or Midwife Consultant encompasses a diverse and complex interaction between five specified domains namely Clinical Service and Consultancy, Clinical Leadership, Research, Education, and Clinical Services Planning and Management. OBJECTIVE: The objective of this replication study was to identify the key drivers and mitigating factors that impact the role of Australian Nurse and/or Midwife Consultants. DESIGN: Cross-sectional survey. METHODS: The study was conducted in a large metropolitan health district in Sydney, Australia. Participants for this study consisted of all Nurse and/or Midwife Consultants working within a health district in New South Wales (NSW). Data were collected by an anonymous online survey. Key drivers and mitigating factors perceived to influence their role were identified using previously implemented instruments. Data were analysed using SPSS version 21. RESULTS: Responses were obtained from 122 Nurse and/or Midwife Consultants. The number of years of experience as a Nurse and/or Midwife Consultant ranged from 6 months to 25.5 years. Personal attributes which included personal motivation and own communication skills were identified as key drivers to role performance with a mean score of 7.7±0.6. Other key drivers included peer support, organisational culture, personal attributes, professional learning, Nurse and/or Midwife Consultant experience, and collaborative relationships. Of the 14 mitigating factors to the role, the most common factors were lack of resources to set up and develop the role (2.6 ± 0.9), lack of secretarial support (2.6 ± 1.1), lack of managerial support (2.45 ± 1.1), and lack of understanding of the role by other health professionals (2.40 ± 0.8). CONCLUSIONS: Understanding the key drivers and mitigating factors that influence the role of the Nurse and/or Midwife Consultant is important for healthcare managers. Given the changing landscape of nursing and midwifery practice, organisational strategies to provide ongoing support to address the mitigating factors are urgently needed. It is pivotal that nursing management implement strategies to empower Nurse and/or Midwife Consultants to perform and reach their potential to deliver advanced nursing care.