Efficacy of a student-led interprofessional health clinic in regional Australia for preventing and managing chronic disease.

Increasing chronic disease rates in regional Australian communities necessitates innovative models of healthcare. We evaluated the efficacy of an interprofessional chronic disease program, delivered within a regional student-led nursing and allied health clinic in Southern Queensland, Australia. Changes to anthropometric, aerobic fitness and strength, and quality of life outcomes were examined at four time points spanning 16 months: intake, program transition (4 months), 6 and 12 months (post-transition). Our primary aim was to investigate whether the health improvements achieved during the program were sustained at 12 months in a subset of participants who provided complete data. Significant improvements were found in 6 of 11 measures, including the 6-minute walk test, grip strength, and self-reported quality of life across physical and psychosocial dimensions, with these improvements maintained to final review. No significant changes were found in body mass index (BMI), waist circumference, fat mass, or muscle mass. This is the first health clinic in regional Australia to deliver a student-led model of interprofessional and collaborative service to tackle the increasing burden of chronic disease in the community. The cost-effectiveness of this service and other potential clinical and social benefits remain to be investigated.

Sample test array and recovery (STAR) platform at the National Ignition Facility.

We have developed the Sample Test Array and Recovery (STAR) platform for the National Ignition Facility (NIF) for studying the thermal and hydrodynamic responses of materials in extreme environments. The STAR platform expands the range of obtainable fluences and quadruples the rate that materials experiments can be conducted at the NIF. Example configurations are demonstrated for fluences spanning 0.56-34 J/cm2 with environmental isolation for post-shot material recovery and inspection and up to 1740 J/cm2 without isolation, with surface heating rates of up to 2 × 1014 K/s. An example experiment involving thermally driven shock and spallation of aluminum alloy 7075 is briefly discussed.

"Sage on the stage or guide on the side"-Undergraduate nursing students' experiences and expectations of bioscience tutors in a blended learning curriculum: A qualitative study.

AIMS AND OBJECTIVES: This study sought to explore undergraduate nursing students' perceptions of the role and value of their bioscience tutors in a blended learning curriculum. BACKGROUND: Blended learning approaches typically have reduced face-to-face contact with tutors-particularly in bioscience subjects which nursing students have traditionally found difficult, and the move to more web-based learning resources may compound this difficulty. DESIGN: Qualitative descriptive study. METHODS: This qualitative study was conducted with 19 undergraduate nursing students enrolled in bioscience subjects, at a large university in outer metropolitan Sydney, Australia in 2016. Semi-structured interviews were conducted over the telephone or face-to-face. Duration of interviews ranged from 13 to 71 min. Results were thematically analysed. EQUATOR guidelines for qualitative research (COREQ) applied. RESULTS: Two main themes with accompanying sub-themes were identified. The first theme identified the importance of the tutor in bioscience, including their qualities, expertise and contextualisation of learning. The second theme provided insights into students' perceptions of what they considered good and poor approaches to learning. CONCLUSIONS: This study has clearly shown that while nursing students appreciated the flexibility offered by the online component of a blended learning curriculum, they still wanted an experienced bioscience tutor with clinical experience for their face-to-face classes. While the tutor was seen as crucial to providing clarification and context for content that was often challenging, they also played a key role in engaging and motivating students and creating a learning environment where students felt empowered to ask questions and debate issues with their peers. Given the increased use of online learning, further research could determine if the current study findings are also applicable in nonscience areas of study. RELEVANCE TO CLINICAL PRACTICE: The importance of students having a sound understanding of the biosciences for safe, effective clinical practice cannot be underestimated.

Seasonality of hip fracture and vitamin D deficiency persists in a sub-tropical climate.

Both hip fractures and vitamin D (25-hydroxyvitamin D (25-OHD)) deficiency are more common in winter in regions with temperate climates, but few data exist for a sub-tropical climate. In a South East Queensland tertiary hospital over a 7-year period, there were significantly more hip fractures in winter than the other three seasons (analysis of variance P = 0.003), with associated higher frequency of 25-OHD deficiency - 42.5% in winter compared to 28.5% in summer, odds ratio 1.86 (95% confidence interval 1.35-2.56), P = 0.0001. Seasonality of hip fracture and 25-OHD deficiency occurs even in a sub-tropical climate.

Actionable Adherence Monitoring: Technological Methods to Monitor and Support Adherence to Antiretroviral Therapy.

PURPOSE OF REVIEW: Current digital technologies are being used for "actionable adherence monitoring"; that is, technologies that can be used to identify episodes of non-adherence to ART in a timely manner such that tailored interventions based on adherence data can be provided when and where they are needed most. RECENT FINDINGS: Current digital communication technologies used to monitor ART adherence include electronic adherence monitors (EAMs), digital ingestion monitors, cellular phones, and electronic pharmacy refill tracking systems. Currently available real-time adherence monitoring approaches based on cellular technology allow for the delivery of interventions precisely when and where they are needed. Such technology can potentially enable significant efficiency of care delivery and impact on adherence and associated clinical outcomes. Standard digital advances, such as automated reminders in EAM and electronic pharmacy records, may also achieve improvements with relatively lower cost and easier implementation. Future research is needed to improve the functionality of these approaches, with attention paid to system-level issues through implementation science, as well as acceptability and ethical considerations at the individual level.

Factors associated with the successful removal of indwelling urinary catheters post-operatively in the fragility hip fracture patient.

INTRODUCTION: Patients presenting to hospital with a fragility hip fracture are routinely catheterized in the emergency department. Studies have found that the duration of catheterization is the greatest and most important risk factor for developing a urinary tract infection. Whilst there is a considerable body of evidence around correct techniques for insertion of urinary catheters, there appears to be little evidence as to the timing of their removal. AIM OF THE STUDY: To describe the current practice of indwelling catheter (IDC) removal post operatively in the fragility hip fracture patient and to identify factors associated with the successful removal of IDCs post operatively in the same cohort of patients. METHODS: This study was a retrospective cohort analysis of patients admitted to a large, tertiary hospital with an established ortho-geriatric model of care. RESULTS: Aperient regime was the only factor that appeared to have a significant impact on the successful IDC removal. The patient commenced on the aperient regime was three times more likely to have an unsuccessful IDC removal than the patient on a limited or no aperient regime. CONCLUSION: This study highlights the need for redesigning care that is patient focused, evidence-based, effective and efficient. The argument that a patient's bowel is required to be emptied prior to the successful removal of an IDC appears to be false, as in this study it was not identified as a predictor of successful IDC removal. A prospective clinical trial may be the next step forward in developing a clinical guideline for the successful removal of IDCs in the fragility hip fracture patient and/or surgical patient. Nurses have a crucial role to play in contributing to evidence-based practice and are continually challenged to do so.

Can geriatric hip fractures be managed effectively within a level 1 trauma center?

OBJECTIVES: To determine whether geriatric hip fractures can be managed effectively within a level 1 trauma center. DESIGN: A prospective observational cohort study with a historical control group. SETTING: Level 1 trauma center. PATIENTS: A total of 199 patients admitted under our hip fracture service were prospectively identified from 2011-2012. These were compared with 191 hip fracture patients who were admitted before the service. INTERVENTION: The hip fracture service includes coadmission under an orthopaedic and a geriatric team. A daily, consultant-led operating list was made available for hip fracture surgery. A "neck of femur" nurse was employed to coordinate patient care. MAIN OUTCOME MEASUREMENTS: Time to surgery, length of stay, discharge destination, and mortality. A cost-benefit analysis and a comparison with a lower acuity hospital were also performed. RESULTS: Since the hip fracture service, more patients underwent surgery within 48 hours (67% vs. 52%; P = 0.004), the length of stay significantly decreased from 26 to 22 days (P = 0.004), significantly more patients were admitted to the rehabilitation unit (58.7% vs. 3.5%; P < 0.001) and ultimately discharged to their own residence (51.6% vs. 40.5%; P = 0.034). Inpatient mortality rates did not change significantly (7.5% vs. 6.8%; P = 0.780). The estimated cost saving in 2011 was $981,040. CONCLUSIONS: Only minor changes are required to significantly improve the management of geriatric hip fracture patients. These patients can be managed effectively within a level 1 trauma center when an organized service prioritizing these patients is used. LEVEL OF EVIDENCE: Therapeutic level III. See Instructions for authors for a complete description of levels of evidence.

Magnetized laboratory plasma jets: experiment and simulation.

Experiments involving radial foils on a 1 MA, 100 ns current driver can be used to study the ablation of thin foils and liners, produce extreme conditions relevant to laboratory astrophysics, and aid in computational code validation. This research focuses on the initial ablation phase of a 20 µm Al foil (8111 alloy), in a radial configuration, driven by Cornell University's COBRA pulsed power generator. In these experiments ablated surface plasma (ASP) on the top side of the foil and a strongly collimated axial plasma jet are observed developing midway through the current rise. With experimental and computational results this work gives a detailed description of the role of the ASP in the formation of the plasma jet with and without an applied axial magnetic field. This ∼1 T field is applied by a Helmholtz-coil pair driven by a slow, 150 µs current pulse and penetrates the load hardware before arrival of the COBRA pulse. Several effects of the applied magnetic field are observed: (1) without the field extreme-ultraviolet emission from the ASP shows considerable azimuthal asymmetry while with the field the ASP develops azimuthal motion that reduces this asymmetry, (2) this azimuthal motion slows the development of the jet when the field is applied, and (3) with the magnetic field the jet becomes less collimated and has a density minimum (hollowing) on the axis. PERSEUS, an XMHD code, has qualitatively and quantitatively reproduced all these experimental observations. The differences between this XMHD and an MHD code without a Hall current and inertial effects are discussed. In addition the PERSEUS results describe effects we were not able to resolve experimentally and suggest a line of future experiments with better diagnostics.

Effect of a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma non-hip fracture: a systematic review.

UNLABELLED: The aim of this study was to identify the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. A dedicated osteoporosis health professional improved investigation and management of osteoporosis. Osteoporosis management was enhanced, leading to the potential for future fracture prevention. PURPOSE: This study aimed to review the effect a dedicated osteoporosis health professional on screening and treatment in outpatients presenting with acute low trauma fracture. METHODS: We searched the electronic databases of Medline, EMBASE, CINAHL, Current Contents Connect, Joanna Briggs Institute EBP, and Cochrane from database development to April 2013, examined grey literature, and completed manual searches of reference lists to identify English language research that examined the effect that dedicated health professional input had on osteoporosis management with acute low trauma non-hip fracture in the outpatient setting. Outcomes were defined as the proportion of patients with investigation (bone mineral density (BMD) or blood screen); treated with vitamin D supplementation or antiresorptive agent; documented BMD reading change; recurrent fracture occurrence; or referral to specialist bone (osteoporosis) clinic. RESULTS: All studies with a suitable control group showed an increase in BMD screening in the intervention group (odds ratio (OR) 5.4, 95% confidence interval (CI) 4.3-6.9, P<0.0001). The effect on treatment initiation showed a significantly increased rate of antiresorptive±vitamin D therapy (OR 5.3, 95% CI 4.1-6.8, P<0.0001). No studies examined improvement or decline in BMD guiding clinical practice as an outcome. Two studies showed reduced fracture recurrence. The osteoporosis health professional significantly increased referrals to a specialist bone clinic (OR 9.6, 95% CI 6.2-14.6, P<0.0001). CONCLUSIONS: The presence of a dedicated osteoporosis health professional coordinating a targeted intervention for outpatients with low trauma non-hip fracture improves investigation and management of osteoporosis, resulting in the potential for future fracture prevention.

The lived experiences of people diagnosed with multiple sclerosis in relation to exercise.

The purpose of this study was to examine the lived experiences of people diagnosed with Multiple Sclerosis (MS). Seven active exercisers with MS participated in semi-structured interviews regarding their exercise experiences since diagnosis. Data were analysed using Interpretative Phenomenological Analysis (IPA; Smith & Osborn, 2003 ). Interpretive Phenomenological Analysis. The results and interpretations of narratives revealed a number of functional limitations due to the severity of MS symptoms, which were found to have a major effect on the ability of the participants to exercise. Furthermore, psychological problems and the heightened behavioural adjustments to the progressive disability led to re-appraisal of ability to exercise. Previous, relevant exercise experience made participants more determined to continue to be able to exercise after diagnosis. The wider exercise experience narratives were related to concerns about safety, dependability on others to overcome the challenges, and potential environmental hazards. The loss of spontaneous opportunities to exercise because of these actual and perceived barriers was key to this population. This research highlighted the need to rethink the health and social service arrangements in relation to exercise provision for individuals with MS.