Hospital Testing of the Effectiveness of Co-Designed Educational Materials to Improve Patient and Visitor Knowledge and Confidence in Reporting Patient Deterioration.

BACKGROUND: Co-designed educational materials could significantly improve the likelihood of patients and visitors (consumers) escalating care through hospital systems. The objective was to investigate patients' and visitors' knowledge and confidence in recognizing and reporting patient deterioration in hospitals before and after exposure to educational materials. METHODS: A multimethod design involved a convenience sample of patients and visitors at a South Australian hospital. Knowledge and confidence of participants to report patient deterioration was assessed using a validated questionnaire. Baseline group was surveyed, and a second group was surveyed after exposure to a poster and on-hold message relating to consumer-initiated escalation-of-care. Nominal data were examined using chi-square analysis, and ordinal data using the Mann-Whitney U test. Open-ended questions were examined using thematic analysis. RESULTS: A total of 407 participants completed the study, 203 undertook the baseline survey, and 204 the postintervention survey. Respondents exposed to the educational materials reported significantly higher recognition of responsibility to report concerns about patient deterioration compared to controls (86.3% vs. 73.1%; p = 0.007). Respondents exposed to the educational materials also had better ability to identify signs that a patient was becoming sicker compared to controls (77.5% vs. 71.3%, p = 0.012). Four overarching themes emerged from the questions: patient/visitor understanding of key messages, patient/visitor recognition of deterioration, patient/visitor response to deterioration and patient/visitor recommendations. CONCLUSION: Following educational interventions, patients and visitors report improved awareness of their role in recognizing and responding to clinical deterioration. They advise additional active interventions and caution that the materials should accommodate language, cultural, and disability needs.

You're Worried, We're Listening: Online Testing of the Effectiveness of Education Materials to Improve Consumer Knowledge and Confidence in Reporting Patient Deterioration.

OBJECTIVES: Early identification of patient deterioration in hospital is important to reduce mortality, avoidable morbidity, length of stay, and associated healthcare costs. By closely observing physical and behavioral changes, deteriorating patients are more likely to be identified. Patients and family at the bedside can play an important role in reporting deterioration if made aware of how to do so. Therefore, the objective of this study was to undertake an online evaluation of educational materials designed to improve consumers' knowledge and confidence to report patient deterioration. METHODS: A convenience sample was used to recruit community-based participants for an online survey. A self-designed validated instrument was used to undertake a preintervention and postintervention test involving 3 types of educational materials. Quantitative data were analyzed with Wilcoxon signed rank test to compare participants' knowledge and confidence before and after exposure to the intervention. Conventional content analyses examined responses on key messages and recommendations to improve the educational materials. RESULTS: A total of 84 respondents completed both prequestionnaires and postquestionnaires. After exposure to the education materials, analyses confirmed that knowledge and confidence scores were significantly higher than baseline measures. Content analyses indicated a clear understanding of the key messages presented in the materials. Four main recommendations were made regarding the education materials. CONCLUSIONS: Participants readily identified the key messages in the educational materials and demonstrated increased knowledge and confidence to report concerns about deterioration. Further research is required to determine the efficacy of the educational materials in relation to consumer behavior.

Development and Validation of an Evaluation Tool of Consumers' Knowledge and Confidence to Report Patient Deterioration in Hospitals.

OBJECTIVES: Studies have shown that many preventable hospital deaths may be reduced through early reporting of deterioration by patients and their visitors to health professionals. Engagement of patients and families for safer health care was recommended by the World Health Organization. As no validated tool was identified, the objective of the study was to develop and validate a tool to measure the impact of messages contained in self-developed educational materials on consumers' knowledge and confidence to report patient deterioration. METHODS: A tool was created using consumer-based input. A test-retest methodology was used 2 weeks apart, using 37 participants sourced from consumer groups. Fourteen 5-point Likert scale questionnaire items were categorized into knowledge and confidence components to identify the impact of the materials in both of these areas. RESULTS: Test-retest reliability confirmed 10 of the 14 proposed questionnaire items (4 knowledge items and 6 confidence) had at least moderate κ agreement ranging from 0.42 to 0.69 and an intraclass correlation coefficient of 0.66. An exploratory factor analysis of the 10 remaining items indicated a 2-factor solution had the best interpretability accounting for 96.9% of variability. The Cronbach α and factor loadings for the factors, knowledge, and confidence suggested an acceptable level of reliability and validity. CONCLUSIONS: The study confirms our tool for assessment of educational materials to be a reliable, context-specific, and validated instrument. The tool is an appropriate instrument to assess the effectiveness of educational materials in public awareness campaigns that focus on consumer reporting of patient deterioration within hospitals.

Taking the alternative route: Women's experience of intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia.

OBJECTIVE: To compare women's experience of receiving either intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for labour analgesia. DESIGN: A content analysis was undertaken as part of the third phase of a larger randomised controlled trial, using the per-protocol dataset to examine women's experiences of treatment received. Healthy women birthing at term, who received intranasal fentanyl (n=41), subcutaneous fentanyl (n=37) and/or intramuscular pethidine (n=38) for labour analgesia, were contacted at 6 weeks postpartum to complete a phone questionnaire. SETTING: A tertiary and regional maternity unit in South Australia. FINDINGS: Over 80% of women who received intranasal or subcutaneous fentanyl reported that they would use the treatment again compared to 44.8% of women who had received pethidine (self-administered intranasal fentanyl provided more expressive responses emphasising the route provided a strong sense of control and enablement. KEY CONCLUSIONS: Route of administration influenced the women's experience, more women who self-administered intranasal fentanyl reported positive emotional responses, with women reporting increased autonomy and satisfaction. Whereas, women who relied on the midwife to administer subcutaneous fentanyl or intramuscular pethidine, were more often focused on the physical effect of the drug. Pethidine was the least preferred option due to adverse effects. IMPLICATIONS FOR PRACTICE: For women requesting parenteral analgesia, fentanyl administered by less invasive routes offers women additional options that may better meet their emotional, cognitive and physical needs than the current practice of administering intramuscular pethidine.

The influence of intrapartum opioid use on breastfeeding experience at 6 weeks post partum: A secondary analysis.

OBJECTIVE: To examine breastfeeding experiences up to 6 weeks postpartum for mothers administered intranasal fentanyl, subcutaneous fentanyl or intramuscular pethidine for intrapartum analgesia. DESIGN: A secondary analysis was undertaken using the per-protocol dataset to examine the third phase of a larger randomised controlled trial. This phase of the study examined breastfeeding intention and experience from the first hour of birth to 6 weeks postpartum. Medical records were audited and women were contacted at 6 weeks postpartum to complete a telephone questionnaire. SETTING: Two maternity hospitals in South Australia. PARTICIPANTS: Healthy women birthing at term received intranasal fentanyl (n=37), subcutaneous fentanyl (n=37), or intramuscular pethidine (n=35). FINDINGS: While maternal characteristics and birth outcomes were comparable between groups, women who received either intranasal fentanyl or subcutaneous fentanyl experienced fewer difficulties in establishing breastfeeding by 6 weeks postpartum when compared to intramuscular pethidine (p<0.01). KEY CONCLUSIONS: Women who received fentanyl reported that their neonates had less difficulties establishing breastfeeding, compared to those who received pethidine. Therefore, for woman who intend to breastfeed, fentanyl should be the preferred opiate, for the relief of pain in labour. IMPLICATIONS FOR PRACTICE: When providing education to women in relation to intrapartum pain relief it is important to consider the potential influence on breastfeeding experience. This research provides evidence that fentanyl is a suitable alternative to pethidine for women requesting parenteral analgesia in labour.

The relative contributions of function, perceived psychological burden and partner support to cognitive distress in bladder cancer.

OBJECTIVE: Bladder cancer is a genitourinary disease of increasing incidence. Despite improvements in treatment, outcomes remain equivocal with high recurrence rates. It is associated with poor psychosocial outcomes due to reduced functioning of the genitourinary system. The objective of these analyses was to query whether reported loss of function or the perception of psychological burden caused by this functional impedance was the key to understanding psychosocial outcomes. METHODS: The sample comprised 119 participants with a confirmed diagnosis of bladder cancer. They completed a self-report questionnaire comprising the Bladder Cancer Index, Mini-mental Adjustment to Cancer Scale, Psychosocial Adjustment to Illness Scale and standard sociodemographic details. Simple mediation and serial mediation were used to explore the potential for psychological burden to mediate associations between loss of function and cognitive distress, and the potential additional contribution of positive partner support on these relationships. Age and duration of cancer were considered as covariates. RESULTS: Simple mediation demonstrated that the association between function and cognitive distress was fully mediated by perceived psychological burden. Serial mediation, which allowed for the addition of partner support, again demonstrated full mediation, with partner support being the key predictive variable. CONCLUSIONS: These analyses emphasise the importance of an appreciation of individuals' interpretation of the burden occasioned by bladder cancer and the role of a supportive partner. The implications for management discussions and support services in alleviating negative psychological outcomes in bladder cancer are highlighted. Copyright © 2015 John Wiley & Sons, Ltd.

Subcutaneous administration of fentanyl in childbirth: an observational study on the clinical effectiveness of fentanyl for mother and neonate.

OBJECTIVE: to explore the maternal and neonatal effects of fentanyl administered subcutaneously to women during labour. DESIGN: two methods were used: (1) A retrospective audit of the birth register and maternal and neonatal records for the period from January 2000 to December 2007. (2) A pilot study was also conducted on a convenience sample of women between July 2008 and October 2008. SETTING: this study was conducted within a maternity unit at a rural South Australian hospital where approximately 350 babies are birthed each year. PARTICIPANTS: audit participants included women who had uncomplicated pregnancies and birthed at term (37-42 weeks gestation). Women in the experimental group consisted of those who had utilised only subcutaneous fentanyl for pain relief (n=75), or nitrous oxide and oxygen prior to being administered subcutaneous fentanyl (n=196). Stratified random selection based on parity and age was used to determine the control group, which consisted of women who used no pharmacological pain relief (n=196). The pilot study involved a convenience sample of women (n=10) assessed to have an uncomplicated pregnancy and labour occurring at term (≥37 weeks gestation). MEASUREMENTS: audit variables examined included the women's age, parity, labour duration, mode of birth (spontaneous or assisted), analgesia used, total dosage, time administered prior to birth, time of birth, neonatal Apgar scores, time to establish breathing, naloxone use, days spent in hospital post-birth and breast-feeding outcomes upon discharge. The pilot study explored maternal effects assessed pre- and 30 minutes post-administration of subcutaneously administered fentanyl by observing pain scores, vital signs, sedation levels, nausea/vomiting scores and anti-emetic use. To assess possible adverse effects in the neonate Apgar scores, time to establish respiration, naloxone use, transfer to neonatal nursery and breast-feeding outcomes upon discharge were recorded. FINDINGS: women in the experimental groups were more likely to be induced, experienced a longer duration of labour and had an increased likelihood of an assisted vaginal birth. The average total dose of fentanyl administered was 250 µg. Neonatal outcomes were comparable between groups when examining Apgar scores <7 at 1 and 5 minutes and time to establish breathing. There was, however, a significant difference with naloxone administration between the groups. There was no significant difference between groups in hospital stay or breast-feeding on discharge. The pilot study identified a clinically significant reduction in pain scores for 78% of women following the administration of subcutaneous fentanyl, with the average pain score decreasing from 8.4 (±1.4) to 7.2 (±1.1) (paired t-test, p=0.017). Vital signs were not affected, no anti-emetics were required and all women remained alert with no sedation noted. KEY CONCLUSIONS: the audit identified fentanyl use was associated with a longer length of labour, but this may be explained by more women in the experimental groups requiring induction of labour than those in the control group. However, length of hospital stay, breast-feeding rates and neonatal outcomes were comparable amongst the three groups. Results of the pilot study are consistent with those of the audit in relation to the effects on mother and neonate. In addition, the pilot study begins to provide evidence that fentanyl is efficacious in providing pain relief. IMPLICATIONS FOR PRACTICE: results of this study are the first to explore the effects of fentanyl administered subcutaneously to women during labour. This method of analgesia offers women an additional choice of pain relief during childbirth and may be particularly beneficial in remote and rural settings where resources are often limited and access to specialist services difficult. Further research, however, is required to be able to generalise the outcomes and provide further data to support the clinical effectiveness of this route of administration of fentanyl.

E-learning & information communication technology (ICT) in nursing education: A review of the literature.

OBJECTIVES: To examine primary research articles published between January 2001 and December 2012 that focused on the issues for students and educators involved with E-learning in preregistration nursing programs. The literature was systematically reviewed, critically appraised and thematically analyzed. BACKGROUND: E-learning is arguably the most significant change to occur in nursing education since the move from hospital training to the tertiary sector. Differences in computer and information literacy for both students and educators influence the success of implementation of E-learning into current curricula. DATA SOURCES: Online databases including CINAHL, MEDLINE, OVID, the ProQuest Central, PubMed, ERIC and Science Direct were used. METHODS: The criteria used for selecting studies reviewed were: primary focus on electronic learning and issues faced by nursing students and/or nurse educators from undergraduate preregistration nursing programs; all articles had to be primary research studies, published in English in peer reviewed journals between January 2001 and December 2012. RESULTS: Analysis of the 28 reviewed studies revealed the following three themes: issues relating to E-learning for students; use of information technologies; educator (faculty) issues involving pedagogy, workload and staff development in E-learning and associated technology. CONCLUSION: The review highlighted that commencing preregistration nursing students required ongoing education and support surrounding nursing informatics. This support would enable students to progress and be equipped with the life-long learning skills required to provide safe evidence based care. The review also identified the increased time and skill demands placed on nurse educators to adapt their current education methodologies and teaching strategies to incorporate E-learning.

Undergraduate nursing student's attitudes towards caring for people with HIV/AIDS.

The aim of this quantitative study was to determine the attitudes of Australian nursing students towards caring for people with HIV/AIDS. This research study was conducted among second year undergraduate nursing students at a university in South Australia, during August 2007. The survey tool consisted of six demographic questions and the AIDS Attitude Scale. This questionnaire was completed by 396 students, giving a response rate of 94.7%. The vast majority (95.7%) of students participating in this study demonstrated very positive attitudes towards caring for people with HIV/AIDS and only 4.3% demonstrated negative attitudes. No statistically significant differences were found in attitude score based on participants' age, gender, previous HIV/AIDS education, previous nursing experience or previous experience of caring for someone with HIV/AIDS. A statistically significant difference in AIDS attitude score was found in relation to participants' country/region of citizenship, with nursing students from China, East Asia, South East Asia, and Central Asia and Middle East having more negative attitudes than students from other countries/regions. As an increasing number of nursing students have been recruited to Australia from these countries/regions, nurse educators need to be aware of such differences when planning and delivering HIV/AIDS educational programs in tertiary institutions.

Non-axial administration of fentanyl in childbirth: a review of the efficacy and safety of fentanyl for mother and neonate.

OBJECTIVE: to investigate the use of fentanyl for pain relief during childbirth administered by routes other than epidural or spinal (non-axial). In particular, aspects relating to the efficacy and safety of fentanyl for mother and neonate are explored. BACKGROUND: currently, pethidine is the most widely used intramuscular opioid for the relief of labour pain but has been shown to have numerous side-effects on the mother and neonate. An alternative opioid, fentanyl, has been shown to have fewer side-effects on both mother and neonate than pethidine. Therefore, its use during childbirth was examined in this literature review. REVIEW METHODS: a search of articles relating to the administration of fentanyl via non-axial routes was conducted using electronic databases, key journals and reference lists of selected research papers and reviews. RESULTS: only studies of IV administration were identified from the literature findings from showed that IV administered fentanyl appeared to be a safe, efficacious opioid when administered for pain relief in childbirth. Fentanyl is a short-acting analgesic causing less sedation and nausea in adults than pethidine. In addition, no long-term fetal or neonatal effects of fentanyl were identified, with normal neonatal neurological and adaptive capacities at two hours and 24 hours after birth supporting its safe use in childbirth. KEY CONCLUSION: in the studies identified, fentanyl was found to be efficacious, providing prompt analgesia with minimal side-effects to both mother and infant when administered intravenously (IV) during childbirth. In addition, no long-term fetal effects were found. RECOMMENDATIONS FOR FURTHER RESEARCH: there is a paucity of research relating to the maternal, fetal and neonatal effects of non-axial administered fentanyl other than that of IV. Further research should explore alternate routes of administration such as subcutaneous, sublingual and nasal which are less invasive and can be administered by midwives. IMPLICATION FOR PRACTICE: in confirming the safe use of non-axial administration of fentanyl during childbirth, benefits include midwives being able to offer women an alternative option for pain relief. Alternative routes, such as subcutaneous, can be managed by midwives through a standing order, potentially reducing the need for additional resources. In particular, this will benefit midwifery practice in rural and remote settings where resources and access to specialised services are limited.

Termination of pregnancy and the over 30s: what are trends in contraception use 1996-2006?

There is a shift in fertility patterns with more women commencing childbearing over 30 years of age. Little is known about trends in contraception use by women in this age group seeking a termination of pregnancy. This research presents a trend analysis to determine if there were significant changes in trends in contraception use pre- and post-termination of pregnancy for women over 30 years of age from 1996 to 2006 in South Australia. Data were collected from 1996 to 2006 from a service in South Australia. Data were examined using simple linear regression. At the time of conception, 53% of women reported using some form of contraception. Additionally, there was a significant decline in women using natural family planning methods at conception. Post-operatively, there was a significant decline in hormone methods being chosen, and a significant increase in women not using any contraception. Women over 30 years of age used contraception at the time of conception pre- and post-operatively of having a pregnancy terminated over the 10 year period of the study. Health promotion activities need to be further developed to cater for this age group and to take into consideration changing fertility patterns.

Melatonin rhythms in the Australian freshwater crocodile (Crocodylus johnstoni): a reptile lacking a pineal complex?

The vertebrate pineal gland is the primary source of melatonin, the rhythmic secretion of which is influenced by environmental light and temperature, thereby providing animals with information about seasonally changing photoperiod and thermoperiod. Although pineal glands are present in the majority of vertebrate species, a discrete organ is reported to be absent in the Crocodilia. However, if the melatonin rhythm is crucial to the survival of the organism, it would be expected that the rhythm would be present in crocodiles. In the present study, we measured blood plasma melatonin over a 30-h period in aestivating Australian freshwater crocodiles (Crocodylus johnstoni) in their natural habitat at the end of the dry season (November) and found no discernible melatonin rhythm. However, another group of captive-reared C. johnstoni, maintained under natural light and temperature cycles and sampled in the early dry season (June) showed a clear melatonin rhythm. These results suggest that there is either an extrapineal source of melatonin in this crocodile species or that there is melatonin producing tissue elsewhere which heretofore has not been discovered. Further studies are needed to determine why the melatonin rhythm is intermittently expressed and whether this may be related to seasonal changes in the expression of the rhythm linked to tropical environments.

Thermocyclic and photocyclic entrainment of circadian locomotor activity rhythms in sleepy lizards, Tiliqua rugosa.

Australian sleepy lizards (Tiliqua rugosa) exhibit marked locomotor activity rhythms in the field and laboratory. Light-dark (LD) and temperature cycles (TCs) are considered important for the entrainment of circadian locomotor activity rhythms and for mediating seasonal adjustments in aspects of these rhythms, such as phase, amplitude, and activity pattern. The relative importance of 24 h LD and TCs in entraining the circadian locomotor activity rhythm in T. rugosa was examined in three experiments. In the first experiment, lizards were held under LD 12:12 and subjected to either a TC of 33:15 degrees C in phase with the LD cycle or a reversed TC positioned in antiphase to the LD cycle. Following LD 12:12, lizards were maintained under the same TCs but were subjected to DD. Activity was restricted to the thermophase in LD, irrespective of the lighting regime and during the period of DD that followed, suggesting entrainment by the TC. The amplitude of the TC was lowered by 8 degrees C to reduce the intensity and possible masking effect of the TC zeitgeber in subsequent experiments. In the second experiment, lizards were held under LD 12.5:11.5 and subjected to one of three treatments: constant 30 degrees C, normal TC (30:20 degrees C) in phase with the LD cycle, or reversed TC. Following LD, all lizards were subjected to DD and constant 30 degrees C. Post-entrainment free-run records revealed that LD cycles and TCs could both entrain the locomotor rhythms of T. rugosa. In LD, mean activity duration (alpha) of lizards in the normal TC group was considerably less than that in the constant 30 degrees C group. Mean alpha also increased between LD and DD in lizards in the normal TC group. Although there was large variation in the phasing of the rhythm in relation to the LD cycle in reversed TC lizards, TCs presented in phase with the LD cycle most accurately synchronized the rhythm to the photocycle. In the third experiment, lizards were held in DD at constant 30 degrees C before being subjected to a further period of DD and one of four treatments: normal TC (06:00 to 18:00 h thermophase), delayed TC (12:00 to 00:00 h thermophase), advanced TC (00:00 to 12:00 h thermophase), or control (no TC, constant 30 degrees C). While control lizards continued to free-run in DD at constant temperature, the locomotor activity rhythms of lizards subjected to TCs rapidly entrained to TCs, whether or not the TC was phase advanced or delayed by 6 h. There was no difference in the phase relationships of lizard activity rhythms to the onset of the thermophase among the normal, delayed, and advanced TC groups, suggesting equally strong entrainment to the TC in each group. The results of this experiment excluded the possibility that masking effects were responsible for the locomotor activity responses of lizards to TCs. The three experiments demonstrated that TCs are important for entraining circadian locomotor activity rhythms of T. rugosa, even when photic cues are conflicting or absent, and that an interaction between LD cycles and TCs most accurately synchronizes this rhythm.

Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review.

TITLE: Attitudes of nursing students towards caring for people with HIV/AIDS: thematic literature review. AIM: This paper is a report of a literature review conducted to examine current research studies into attitudes of nursing students towards caring for people with HIV/AIDS and to identify factors that influenced those attitudes to inform current nursing practice and to develop nursing education regarding care provided to people with HIV/AIDS. BACKGROUND: Attitudes of nurses towards people living with HIV/AIDS have long been scrutinized. Studies show that some nurses have negative attitudes and are reluctant to provide care to people with HIV/AIDS, resulting in poorer quality nursing support being provided. Attitudes of nursing students towards caring for people with HIV/AIDS is thus of vital importance since they become the future practising nurses. DATA SOURCES: Eight electronic data bases were searched from 1996-2008. REVIEW METHODS: Criteria used for study selection were: attitudes of nursing students towards caring for people with HIV/AIDS, primary research studies, published in English language in peer reviewed journals from 1996 to June 2008. Sixteen studies were identified for inclusion in this thematic review. RESULTS: The following themes were identified: education and knowledge of HIV/AIDS; fear of contracting HIV/AIDS; reluctance to care for people with HIV/AIDS; homophobia; and stigma associated with HIV/AIDS. CONCLUSION: There is reluctance on the part of some nursing students in specific regions of the world to provide care for people with HIV/AIDS. Educational programmes based on research evidence must play a leading role in developing strategies to help nursing students understand and overcome such attitudes.

Nursing assessment of obstructive sleep apnea in hospitalised adults: a review of risk factors and screening tools.

Obstructive sleep apnea (OSA) affects approximately 2-4% of the general population and may be more prevalent in obese adults. However, sleep apnea remains consistently under-diagnosed in the general population as well as in hospital wards. Nurse awareness of OSA during routine monitoring could allow specific observations of hospitalised adults to identify those at high risk and ensure appropriate referral. This integrative literature review analysed major risk factors for OSA and identified screening tools that nurses could utilise in hospital wards. The most important risk factors relevant to nursing practice in hospital settings were obesity, hypertension and sleep position. The most suitable screening tool was the Berlin Questionnaire, while there was some evidence to support measuring waist circumference. A nursing assessment flow chart was developed based on the literature reviewed. This paper highlights a role for nurses in recognising patients at risk of OSA and minimising complications in hospitalised adults.

Interseasonal variation in the circadian rhythms of locomotor activity and temperature selection in sleepy lizards, Tiliqua rugosa.

Few studies in non-mammalian vertebrates have examined how various effectors of the circadian system interact. To determine if the daily locomotor and behavioural thermoregulatory rhythms of Tiliqua rugosa are both controlled by the circadian system in different seasons, lizards were tested in laboratory thermal gradients in four seasons and in constant darkness. Circadian rhythmicity for both rhythms was present in each season, being most pronounced in spring and summer and least evident in autumn. Most lizards displayed a unimodal locomotor activity pattern across all seasons. However, some individuals presented a bimodal locomotor activity pattern in spring and summer. Seasonal variations in the phase relationships of both rhythms to the light:dark (LD) cycle were demonstrated. No seasonal differences in the free-running period lengths of either rhythm were detected, raising the possibility that a single circadian pacemaker drives both rhythms in this species. Our present results demonstrate that both rhythms are similarly controlled by the circadian system in each season. Although seasonal variations in the thermal preferences of reptiles both in the field and laboratory have previously been well documented, this study is the first to demonstrate circadian rhythms of temperature selection in a reptile species in each season.

Changing patterns in women seeking terminations of pregnancy: a trend analysis of data from one service provider 1996-2006.

OBJECTIVES: The purpose of this study was to assess emerging trends in five characteristics: age, first ever pregnancy, contraception at time of conception, contraception choices post-operatively and referral source of women presenting for a termination of pregnancy (1996-2006) from a southern service in Adelaide, South Australia. METHOD: A time-series study, from 1996 to 2006, using 3,434 cases from a termination of pregnancy service provider. Five characteristics associated with women attending for a termination of pregnancy were examined. Data were analysed using simple linear regression analyses and one-way ANOVA. RESULTS: There was a significant increase in women aged 30-50 years having a pregnancy terminated (ANOVA F1,9 = 5.901, p=0.041), with 67% of women using contraception at the time of conception. An increasing percentage of women chose not to use any contraception post-operatively (ANOVA F1,9 = 14.409, p=0.006), although 90% of women left the service with contraception. Additionally, there was a significant decline in women using natural family planning methods (ANOVA F1,9 = 13.654, p=0.006). Referral patterns changed significantly over the ten years, with fewer women being referred by a general practitioner (ANOVA F1,9 = 46.492, p=0.000) and family planning clinics (ANOVA F1,9 = 13.011, p=0.007). CONCLUSIONS AND IMPLICATIONS: Termination of pregnancy patterns from a hospital based regional termination service have changed over the past ten years in this study population. There are implications for policy, strategic plans and health promotion activities in the southern region of Adelaide.

Circadian rhythms of locomotor activity and temperature selection in sleepy lizards, Tiliqua rugosa.

This study examined whether the daily rhythms of locomotor activity and behavioural thermoregulation that have previously been observed in Australian sleepy lizards (Tiliqua rugosa) under field conditions are true circadian rhythms that persist in constant darkness (DD) and whether these rhythms show similar characteristics. Lizards held on laboratory thermal gradients in the Australian spring under the prevailing 12-hour light : dark (LD) cycle for 14 days displayed robust daily rhythms of behavioural thermoregulation and locomotor activity. In the 13-day period of DD that followed LD, most lizards exhibited free-running circadian rhythms of locomotor activity and behavioural thermoregulation. The predominant activity pattern displayed in LD was unimodal and this was retained in DD. While mean levels of skin temperature and locomotor activity were found to decrease from LD to DD, activity duration remained unchanged. The present results demonstrate for the first time that this species' daily rhythm of locomotor activity is an endogenous circadian rhythm. Our results also demonstrate a close correlation between the circadian activity and thermoregulatory rhythms in this species indicating that the two rhythms are controlled by the same master oscillator(s). Future examination of seasonal aspects of these rhythms, may, however, cause this hypothesis to be modified.

Effectiveness of non-pharmacological interventions for fatigue in adults with multiple sclerosis, rheumatoid arthritis, or systemic lupus erythematosus: a systematic review.

AIM: This paper reports a systematic review of non-pharmacological interventions for fatigue in adults with three common autoimmune conditions. BACKGROUND: A considerable proportion of people with multiple sclerosis, rheumatoid arthritis, and systemic lupus erythematosus experience compromised quality of life due to fatigue. Recent reviews of pharmacotherapies for fatigue in these conditions remain inconclusive, and systematic evidence for effectiveness of non-pharmacological interventions was unavailable. Our paper addresses this gap. METHODS: The literature search used the key words fatigue, energy, multiple sclerosis, rheumatoid arthritis and systemic lupus. It included 19 electronic databases and libraries, three evidence-based journals, two internet search engines, was dated 1987-2006, and limited to English. Non-pharmacological experimental studies about fatigue comprising more than five adults were included. Meta-analysis was not possible due to diverse interventions and outcome measures, therefore studies were analysed by types of interventions used to reduce fatigue. RESULTS: Of 653 hits, 162 papers were reviewed, and 36 met the inclusion criteria. Thirty-three primary studies reported 14 randomized controlled trials and 19 quasi-experimental designs. Most interventions were tested with people with multiple sclerosis. Exercise, behavioural, nutritional and physiological interventions were associated with statistically significant reductions in fatigue. Aerobic exercise was effective, appropriate and feasible for reducing fatigue among adults with chronic autoimmune conditions. Electromagnetic field devices showed promise. The diversity of interventions, designs, and using 24 different instruments to measure fatigue, limited comparisons. CONCLUSION: Low impact aerobic exercise gradually increasing in intensity, duration and frequency may be an effective strategy in reducing fatigue in some adults with chronic auto-immune conditions. However, fatigue is a variable and personal experience and a range of behavioural interventions may be required. Well-designed studies testing these promising strategies and consensus on outcome fatigue measures are needed.