Comparing thermal conditions inside and outside lactating dairy cattle barns in Canada.

The health, longevity, and performance of dairy cattle can be adversely affected by heat stress. This study evaluated the in-barn condition [i.e., temperature, relative humidity, and resulting temperature-humidity index (THI)] at 9 dairy barns with various climates and farm design-management combinations. Hourly and daily indoor and outdoor conditions were compared at each farm, including both mechanically and naturally ventilated barns. On-site conditions were compared with on-farm outdoor conditions, meteorological stations up to 125 km away, and NASA Power data. Canadian dairy cattle face periods of extreme cold and periods of high THI, dependent on the regional climate and season. The northernmost location (53°N) experienced about 75% fewer hours of THI >68 compared with the southernmost location (42°N). Milking parlors had higher THI than the rest of the barn during milking times. The THI conditions inside dairy barns were well correlated with THI conditions measured outside the barns. Naturally ventilated barns with metal roofs and without sprinklers fit a linear relationship (hourly and daily means) with a slope <1, indicating that in-barn THI exceeded outdoor THI more at lower THI and reached equality at higher THI. Mechanically ventilated barns fit nonlinear relationships, which showed the in-barn THI exceeded outdoor THI more at lower THI (e.g., 55-65) and approached equality at higher THI. In-barn THI exceedance was greater in the evening and overnight due to factors such as decreased wind speed and latent heat retention. Eight regression equations were developed (4 hourly, 4 daily) to predict in-barn conditions based on outdoor conditions, considering different barn designs and management systems. Correlations between in-barn and outdoor THI were best when using the on-site weather data from the study, but publicly available weather data from stations within 50 km provided reasonable estimates. Climate stations 75 to 125 km away and NASA Power ensemble data gave poorer fit statistics. For studies involving many dairy barns, the use of NASA Power data with equations for estimating average in-barn conditions in a population is likely appropriate especially when public stations have incomplete data. Results from this study show the importance of adapting recommendation on heat stress to the barn design and guide the selection of appropriate weather data depending on the aim of the study.

Support for people with dementia experiencing severe responsive behaviours: Unpacking the disconnect between policy and practice.

OBJECTIVE: The Severe Behaviour Response Team (SBRT) program, which was established in 2015 to support aged care residents with dementia experiencing very severe and extreme responsive behaviours received far fewer referrals than projected during its first year. This article describes the outcomes of a brief survey to identify potential barriers to referrals and identify opportunities to improve the uptake of the service. METHODS: A pragmatic, quasi-experimental study was conducted involving clinical leads working in a representative sample of care homes that had not used the SBRT. The study was part of the formative evaluation activities of an ongoing program evaluation. RESULTS: Of the 53 clinical leads that participated in the survey, one-third had not heard of the SBRT prior to being contacted. The remaining two-thirds (n = 36) had not used the service due to the availability of existing resources and concerns regarding responsiveness of, and access to, the new service. CONCLUSIONS: Three themes emerged from the study relating to awareness of the service, responsiveness and the interface between local aged care and health services. Referrals increased following interventions to address the first two themes; however, they continue to remain well below the number projected. This indicates a fundamental disconnection between the policy design process and the day-to-day experience of residential aged care. The study highlights the importance of aged care clinical leads being engaged in dementia policy and program development processes to support improved targeting of resources.

Implementation of a Pilot SMS-Based Crisis Support Service in Australia.

Background: Australia's first short message service (SMS) crisis support service was launched by Lifeline Australia in July 2018. The pilot program was independently evaluated over a 240-day period. Aims: We aimed to examine the experiences of key staff employed in the Lifeline Text pilot and identify the skills and types of support required to deliver a high-quality SMS-based crisis support service. Method: In total, 22 interviews were conducted with 14 Lifeline Text crisis supporters and in-shift supervisors (supervisors) at two time points in September 2018 and March 2019. A modified framework approach was adopted to undertake qualitative data analyses. Results: Delivering crisis support via text was initially challenging as a result of the need to translate skills from telephone crisis support to the SMS platform. This was compounded by the high degree of suicidality of help-seekers and volatility in demand for the service. Limitations: The independent evaluators were not involved in the design of the pilot. Conclusion: Lifeline text is providing an important and necessary service, using a novel mode of delivery in Australia. Maintaining service quality at peak demand, with many distressed and suicidal help-seekers, requires specialized training, experience, and exceptional skills.

Evaluation of Outcomes for Help Seekers Accessing a Pilot SMS-Based Crisis Intervention Service in Australia.

Background: In July 2018, Lifeline Australia launched Australia's first short message service (SMS) crisis support service. Lifeline Text aims to reduce psychological distress and increase coping and social connectedness among help seekers, particularly those who prefer text-based communication. Aims: We aimed to independently evaluate the pilot SMS service over a 240-day period. Method: The service evaluation used operational data, pre and postconversation automated questions, and an online survey to assess outcomes. Results: There were 7,315 contacts during operational hours, of which 5,266 progressed to the queue and 99.2% were answered. Suicide was actively being considered by 1,554 help seekers, and 171 were assessed at imminent risk. Commonly discussed topics were mental health problems, issues relating to the self and identity, and family relationship difficulties. Limitations: This was an evaluation of a pilot service focusing on demand and short-term outcomes. Conclusion: The service succeeded in reaching some under-served groups. On average, help seekers were significantly less distressed, felt more confident in their ability to cope and felt greater connection to others, following the text intervention. The demand for Lifeline Text and the high level of suicidality of help seekers show it is meeting urgent needs in the community.

Acute psychosocial care of families in paediatric resuscitation settings: Variables associated with parent emotional response.

BACKGROUND: Family presence in paediatric resuscitation settings is now accepted practice. However, there is limited evidence to guide psychosocial care of these families. This study aimed to increase the understanding of family demographics and needs for psychosocial care at the Royal Children's Hospital, Melbourne, Australia and to identify the factors that impact on families at this time of emotional and social distress. METHOD: A retrospective clinical data-mining methodology was utilised (n = 1123). Descriptive and inferential data analysis was undertaken using STATA software to identify population demographics, patterns in service usage and family experience, and to identify factors associated with parents' emotional responses. FINDINGS: Four areas were identified that support evidence-informed psychosocial care for families in paediatric resuscitation contexts: 1) family and parent dynamics 2) families' experiences of distress in relation to patient diagnostic category 3) systemic nature of family response, and 4) the identification and analysis of family emotional support needs, which is central to the psychosocial response.

The Australian National Aged Care Classification (AN-ACC): a new casemix classification for residential aged care.

OBJECTIVE: To develop a casemix classification to underpin a new funding model for residential aged care in Australia. DESIGN, SETTING: Cross-sectional study of resident characteristics in thirty non-government residential aged care facilities in Melbourne, the Hunter region of New South Wales, and northern Queensland, March 2018 - June 2018. PARTICIPANTS: 1877 aged care residents and 1600 residential aged care staff. MAIN OUTCOME MEASURES: The Australian National Aged Care Classification (AN-ACC), a casemix classification for residential aged care based on the attributes of aged care residents that best predict their need for care: frailty, mobility, motor function, cognition, behaviour, and technical nursing needs. RESULTS: The AN-ACC comprises 13 aged care resident classes reflecting differences in resource use. Apart from the class that included palliative care patients, the primary branches were defined by the capacity for mobility; further classification is based on physical capacity, cognitive function, mental health problems, and behaviour. The statistical performance of the AN-ACC was good, as measured by the reduction in variation statistic (RIV; 0.52) and class-specific coefficients of variation. The statistical performance and clinical acceptability of AN-ACC compare favourably with overseas casemix models, and it is better than the current Australian aged care funding model, the Aged Care Funding Instrument (64 classes; RIV, 0.20). CONCLUSIONS: The care burden associated with frailty, mobility, function, cognition, behaviour and technical nursing needs drives residential aged care resource use. The AN-ACC is sufficiently robust for estimating the funding and staffing requirements of residential aged care facilities in Australia.

Rapid response teams to support dementia care in Australian aged care homes: Review of the evidence.

OBJECTIVES: To identify attributes of rapid response services designed to support people with very severe and extreme responsive behaviours, otherwise known as behavioural and psychological symptoms of dementia, in aged care homes. METHODS: A rapid evidence assessment was conducted to inform the evaluation of the Severe Behaviour Response Team (SBRT) service, including a targeted search of peer-reviewed academic literature and an Internet-based search of government, service provider, peak body and university websites. RESULTS: A number of localised rapid response services targeting people with similar clinical profiles were identified, but none operated on the scale of the SBRT. Five operational attributes in common were as follows: clearly defined parameters and processes; provision of clinical expertise and knowledge translation activities; person-centred philosophy; relationship-oriented approach to stakeholders; and generalisable and sustainable outcomes. CONCLUSIONS: The five attributes provided a useful framework to guide the evaluation of the SBRT and clarify opportunities for continued service development.

A psychometric analysis of the Caring Assessment Tool version V.

AIM: The aim of this study was to examine the factor structure and construct validity of the Caring Assessment Tool version V (CAT-V) for patients in Australian hospitals. DESIGN: Secondary analysis of CAT-V surveys from the Australian Nursing Outcomes Collaborative (AUSNOC) data set was used. The CAT was originally developed in the United States of America. METHODS: The 27-item CAT-V was administered to patients prior to discharge from eight wards in three Australian hospitals in 2016. The psychometric properties of the CAT were evaluated using item analysis and exploratory factor analyses. RESULTS: Item analysis of surveys from 476 participants showed high levels of perceived caring behaviours and actions. Exploratory factor analysis revealed a two-factor structure consisting of: Nurse-patient communication; and Feeling cared for. The CAT-V is a reliable and valid instrument for measuring patients' perceptions of the attitudes and actions of nurses in Australia.

Development of a data registry to evaluate the quality and safety of nursing practice.

AIM: To describe the development, testing, and implementation of a data registry of nursing-sensitive indicators for measuring the quality and safety of nursing practice. BACKGROUND: Recent research has established causal links between nurse staffing and patient outcomes. Unit level data is necessary for implementation of evidence-based strategies on nurse staffing and nursing care processes. DESIGN: Multi-site, cross-sectional design. METHODS: Retrospective data were collected from administrative data sets on nurse staffing, patient flow, and adverse events in three hospitals in 2016. Periodic observational surveys on pressure injury prevalence, hand hygiene practices, and documentation of processes of care were also conducted. Prospective data were collected from patients at time of discharge using the Caring Assessment Tool. Nurses' perceptions of their practice environment were assessed using the Nursing Work Index - Revised: Australian. Data from annual Press Ganey® surveys on patient satisfaction/experience were obtained. RESULTS: The Australian Nursing Outcomes Collaborative (AUSNOC) data registry was developed in three phases. Phase 1 involved development of a data codebook; phase 2 involved development and testing of data collection methods; and phase 3 involved development of data reports and data dissemination strategies. This paper gives an overview of these phases and includes a summary of the descriptive statistics from the indicator set. CONCLUSION: Unit level data is pivotal for measuring the quality and safety of nursing care. Data from the Australian Nursing Outcomes Collaborative (AUSNOC) can be feasibly collected and used to benchmark nursing performance, evaluate patient outcomes, and identify areas for practice improvement.

Psychosocial Care Models for Families of Critically Ill Children in Pediatric Emergency Department Settings: A Scoping Review.

PROBLEM: Critical illness in children is a significant and stressful life event for families. Within pediatric emergency department (ED) settings it is acknowledged that these crises are challenging for both the families of these children, and for the clinical staff treating the child. Literature recommends routine care should include an offer to the family to be present with their critically ill child, however there is a lack of clarity regarding specific family care models or evidence-based interventions to guide clinical practice. ELIGIBILITY CRITERIA: Peer reviewed articles written in English, published between 2006 and 2016, proposing or testing psychosocial care models in pediatric (or mixed) emergency settings. SAMPLE: Nine articles met inclusion criteria. RESULTS: Search results showed limited evidence available in the literature at this time. Thematic analysis of article content and proposed model showed strong support for the benefit of family presence, including shifting the family role from passive to active, needing to be inclusive of the psychological impact of critical health events, importance of multidisciplinary education, and the need for additional exploratory and empirical research to evaluate and refine proposed care models. CONCLUSIONS: Pediatric emergency health events are challenging for both families and staff, and care models provide staff with a consistent, evidence-informed approach to caring for families in challenging situations. IMPLICATIONS: There is a need to find common ground from specific discipline guidelines into a multidisciplinary team approach for the care of families within emergency care.

Nicotinic acids: liver-targeted SCD inhibitors with preclinical anti-diabetic efficacy.

An in vitro screening protocol was used to transform a systemically-distributed SCD inhibitor into a liver-targeted compound. Incorporation of a key nicotinic acid moiety enables molecular recognition by OATP transporters, as demonstrated by uptake studies in transfected cell lines, and likely serves as a critical component of the observed liver-targeted tissue distribution profile. Preclinical anti-diabetic oGTT efficacy is demonstrated with nicotinic acid-based, liver-targeting SCD inhibitor 10, and studies with a close-structural analog devoid of SCD1 activity, suggest this efficacy is a result of on-target activity.

The social system as site of disaster impact and resource for recovery

Emergencies create widespread social disruption, which easily translates into degraded quality of life and undermines the social fabric of the affected community. A clearer understanding of these social processes may assist in conceptualising important dimensions of the impact of disaster and point the way to developing strategies to manage the social environment during recovery. This paper reflects on community and clinical observations of people in various emergencies and offers an analysis of some effects of emergencies on social fabric and suggests recovery strategies. (AU)

Bali 12 months on.... Providing for continuing care and recovery.

BACKGROUND: Traumatic events such as the bombings in Bali may cause many people to develop post-traumatic stress, traumatic grief, anxiety or depression. OBJECTIVE: This article outlines the requirements of recovery, indications of its progress and the role of general practitioners in preventive care, support and referral. DISCUSSION: Research indicates that more than half of those involved in traumatic events can expect to recover without developing a disorder. However, even optimal recovery from tragedy is a protracted and arduous task that severely taxes physical, emotional and social health. The consequences of this may show as degraded health in the second year following a tragedy.