Effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections: a systematic review and meta-analysis.

OBJECTIVE: The objective of this review was to synthesize the best available research evidence regarding the effectiveness of physical stimulation for reducing injection pain in adults receiving intramuscular injections. INTRODUCTION: Pain associated with intramuscular injections continues to be a challenge for nurses. Various physical stimulation methods to alleviate pain and improve satisfaction for patients receiving intramuscular injections have been reported; however, the evidence surrounding the effectiveness of these methods remains inconclusive. INCLUSION CRITERIA: This systematic review considered randomized and quasi-experimental studies that used any physical stimulation strategies (eg, skin tapping, manual pressure, massage, pinch, traction) for adults aged 18 years and over receiving intramuscular injections. Studies that evaluated pain using validated instruments were considered for inclusion. METHODS: A three-step search strategy was conducted. MEDLINE, Embase, CINAHL, the Cochrane Library (Cochrane CENTRAL), Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar were searched from inception until 2020. We restricted the inclusion of studies to trials published in English. Two independent reviewers conducted the critical appraisal of eligible studies using the JBI checklists for randomized controlled and quasi-experimental trials. Data were extracted using the JBI data extraction tool, and meta-analysis and subgroup analysis were undertaken, where appropriate. RESULTS: Twenty-five studies were included with a total sample size of 1956 patients. Pooled results demonstrated that pain was significantly less with the use of the Helfer skin tap technique compared to no intervention (two studies; RR 0.73; 95% CI 0.66, 0.81; P <0.00001) or standard intervention (three studies; SMD -2.25; 95% CI -3.65, -0.85; P =0.002). Intervention with acupressure using standard treatment as control showed significant reduction in pain intensity (MD -4.78; 95% CI -5.32, -4.24; P <0.00001). Similarly, pain was significantly lower with manual pressure (two studies; SMD -0.42; 95% CI -0.69, 0.15; P =0.002) when compared to standard treatment. Pain scores were significantly lower in patients who received pinch technique, ShotBlocker, massage, or combination intervention (skin traction, pressure, and rapid muscle release) compared with no intervention, standard treatment, or placebo control. CONCLUSIONS: The evidence from this review demonstrates that physical stimulation - particularly the Helfer skin tap technique, acupressure, manual pressure, pinch technique, ShotBlocker, massage, and combination - can significantly lower intramuscular injection pain; however, this is based on low or very low certainty of evidence. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168586.

Life during lockdown: Coping strategies used by preregistration nursing students during COVID-19.

AIM: To explore the coping strategies used by Australian preregistration nursing students during the COVID-19 pandemic 'lockdown' period. BACKGROUND: COVID-19 has had a significant impact on preregistration nursing students, both physically and psychologically. As campuses closed and online learning commenced, clinical placement access was reduced, with heightened concern about personal and family safety. As such, nursing students were forced to adopt coping strategies to manage their self and the environment. DESIGN: A descriptive qualitative study. METHODS: One hundred and fifty-five preregistration nursing students enrolled at a regional Australian university completed a self-administered online survey. RESULTS: Overwhelmingly, student responses revealed that staying connected was the key coping strategy to ensure emotional and mental health wellbeing. Heightened vigilance in infection control measures was also evident, personally and for others. Routines, including exercise, facilitated physical and mental wellbeing. Overall, coping strategies identified by nursing students demonstrated applied resilience during the isolation period. CONCLUSIONS: Understanding the adaptive coping strategies used by nursing students can enable nurse academics to understand how to best provide support. This study emphasises the importance of recognising that not all students are able to adapt and 'cope' without supports in place. Future studies should investigate the longer-term impact of COVID-19 within the broader preregistration nursing experience and how this might impact nursing students' future careers.

Medication Adherence Rate in Arab Patients With Cardiovascular Disease: A Systematic Review.

BACKGROUND: Cardiovascular disease (CVD) is one of the most common chronic illnesses in the Eastern Mediterranean. There have been few studies on medication adherence in Arab patients with CVD. AIM: To investigate the rates and the reasons for medication adherence in Arab patients with CVD. METHODOLOGY: The Joanna Briggs Institute methodology for prevalence systematic reviews was used. MEDLINE, EMCARE, CINAHL, Scopus, Science Direct, PsychINFO, and the Cochrane Central Register of Controlled Trials were searched. RESULTS: Thirteen quantitative studies on medication adherence in Arab adult CVD patients were included.Pooled data from nine studies demonstrated that 53.2% (95% confidence interval = [51.2%, 55.1%]) of patients were adherent to their medications. Reasons for nonadherence to medication include personal factors, understanding, and complexity of treatment regimes, medication knowledge and structural barriers. CONCLUSION: Medication adherence appears to have a social gradient, and families should be actively involved in future strategies to increase medication adherence.

The Adherence to Healthy Lifestyle Among Arab Patients With Cardiovascular Disease: Mixed-Method Review.

INTRODUCTION: Cardiovascular disease (CVD) accounts for 25% to 45% of deaths among Arab people. The purpose of this review was to investigate the level, predictors, motivators, and barriers to adherence to lifestyle recommendations among Arab patients with CVD. METHOD: A systematic search of the literature was conducted and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. MEDLINE, EMCARE, CINAHL, Scopus, and the Cochrane Central Register of Controlled Trials were searched. Studies that explored adherence to a healthy lifestyle among Arab adult patients with CVD were included. RESULTS: Twelve studies were included. Quantitative results showed low adherence among Arab people with CVD. Qualitative synthesized results revealed that internal motivators, personal desire as well as structural drivers impact the patient's ability to adhere to a healthy lifestyle. DISCUSSION: Multidimensional solutions that consider religion and culture and include active involvement of families are required to improve adherence.

Understanding the support needs of Australian nursing students during COVID-19: a cross-sectional study.

Background: COVID-19 has caused significant disruption. This has been particularly evident within the university student population where their traditional ways of learning were abruptly reorganised and support structures removed.Objective: This paper aims to explore undergraduate student nurses' perceptions of the support required from the university during COVID-19 using the Achievement Goal Theory framework.Design: Data were collected via an online survey of undergraduate student nurses from an Australian university. This paper is reporting the data from a single open-ended item asking participants about their support needs from the University. Data were analysed using thematic analysis.Results: Of the 178 students who responded 206 individual statements were provided about the support they would like from the university. Four primary themes emerged, Support beyond academia, Academic support, Online learning readiness and Clinical practice units and clinical placement. The students identified that their needs during this pandemic include financial needs, social isolation, needs for more communication and unpreparedness for online teaching.Conclusion: Several factors were identified by participants about the additional support required from the university during COVID-19. Understanding and addressing these factors have the potential to improve student support during COVID-19 and support students in future crises.Impact statement: Understanding what support students perceive they require from the university during significant disruption will assist in future crisis management planning.

Generational differences in psychological wellbeing and preventative behaviours among nursing students during COVID-19: a cross-sectional study.

BACKGROUND: Many nursing programmes have had to swiftly move online in response to COVID-19. Nursing students are often a heterogenous group that traverses generational boundaries. Exploring generational differences may assist in developing support systems for specific groups. This study sought to examine psychological wellbeing and preventative behaviours among nursing students from the iGeneration in comparison to older generations. METHOD: A prospective cross-sectional study was undertaken using a convenience sample of pre-registration nursing students studying at two Australian Universities, one regional and one metropolitan. About 631 pre-registration nursing students completed an online survey. RESULTS: An independent samples t-test revealed that students from the iGeneration possess higher anxiety compared to nursing students from older generations (p = .000). Compared to iGeneration participants, older generation participants had significantly higher scores for knowledge of COVID-19 (p = .015). iGeneration participants utilised social media to source information about COVID-19 far more than older generations (p = .008). iGeneration participants were significantly more concerned than older generations about the impact of COVID-19 on completing their clinical placement (p = .014). Older generations tended to have higher academic preventative behaviours, with significant mean scores for not attending university if they or others they knew had symptoms of COVID-19. CONCLUSION: Given the differences between generation groups with regard to psychological wellbeing, knowledge about COVID-19, and concerns about studying in an altered study environment, strategies should be targeted to generational groups. Anxiety negatively impacts the quality of life, educational performance and clinical practice and is experienced more frequently in the iGeneration. Therefore it is crucial for nursing educators to reflect on how they engage this generation in the online space to provide support, stability and a sense of connection. This will contribute towards ensuring a well-prepared future nursing workforce who may encounter other pandemics and isolating events. IMPACT STATEMENT: Compared with other generations, iGeneration students have a greater likelihood to experience mental health issues, isolation and insecurity. Nursing leaders and educators must be sensitive to such intergenerational differences, to ensure they are developing a skilled and productive workforce.

Reliability of the BCCT.core software in evaluation of breast cosmesis - A systematic review.

Breast cancer conservative treatment software (BCCT.core) has the potential to provide objective results using digital photographs, thus increasing the reliability, limiting the subjective interpretation and standardising the evaluation of breast cosmesis in patients. The aim of this systematic review was to summarise the empirical evidence regarding the agreement between the BCCT.core and other methods used by health professionals and patients to assess breast cosmesis. The Ovid MEDLINE, Embase, CINAHL, PsycINFO and Scopus databases were systematically searched for studies comparing the agreement between BCCT.core and other methods used to assess breast cosmesis. A total of 14 studies involving 2703 patients were included in the review. In studies where patients undertook self-assessment, the percentage agreement ranged from 69.2% to 74.8% and the kappa values ranged from slight (k = 0.12) to fair agreement. There was a low correlation between the BCCT.core and the Harvard scale when patients assessed cosmetic outcomes using photographs of their breasts (r = 0.165). A 75% and 42.8% agreement was reported in studies where clinicians assessed breast cosmesis by directly visualising the patients' breasts and photographs, respectively. Assessment of breast cosmesis by the expert panel using patient photographs reported a percentage agreement ranging from 25% to 83%. The results of this systematic review demonstrated an overall agreement of fair to moderate between the BCCT.core and the subjective scales used to assess breast cosmesis. However, clinician experience and patient values should be considered in clinical decision-making.

Adaptation of the MAUQ and usability evaluation of a mobile phone-based system to promote eye donation.

INTRODUCTION: Mobile Applications (apps) are commonly used in the health care settings to improve the quality of care, however prior to the release of the app it is vital to evaluate its usability. Therefore, the aim of this study is to adapt the mobile Health App Usability Questionnaire (MAUQ) and measure the usability of the Eye donor Aust App using the modified instrument (m-MAUQ). METHODS: The study was undertaken using a convenience sample of 94 patients and their carers attending three eye clinics and one outpatient department in a large hospital in Sydney Australia. The study was conducted in two phases. Phase 1 involved the adaptation of the MAUQ, and validity testing of the modified version. Phase 2 included the usability evaluation of the Eye donor Aust App using the modified MAUQ (m-MAUQ). RESULTS: The m-MAUQ comprised of 15 items and the content validity of the instrument was considered satisfactory. Exploratory factor analysis supported a three-factor structure namely: ease of use and satisfaction (nine items), usefulness in obtaining information (three items), and system information arrangement (three items). The internal consistency for the subscales and the total scale was high with Cronbach's alpha values greater than 0.90. The usability score for the Eye donor Aust App was high (mean 5.99; SD 0.74). The construct validity was supported as there were no differences in usability scores among males and females. Older people found the app less useful for obtaining information about eye donation. CONCLUSIONS: The results support the use of the m-MAUQ as a valid instrument to measure the usability of the Eye Donor Aust App. This instrument requires further testing in other groups of people. Usability testing of the Eye Donor Aust app demonstrated that the participants were satisfied with the content and functionality of the app stating that it was well organised, visually appealing and user friendly. This result could translate into more people using the app and thereby increasing their knowledge and attitude towards eye donation as well as registering to become a donor.

Preprocedural Anxiety in the Transradial Cardiac Catheterization Era.

BACKGROUND: Transradial cardiac catheterization is increasingly being used for the management of coronary artery disease given the low risk of procedural discomfort and complications with this approach. However, the evidence relating to preprocedural anxiety levels in these patients is scarce. OBJECTIVE: The aim of this study was to evaluate the anxiety levels and the predictors of anxiety in patients undergoing transradial cardiac catheterization procedures. METHODS: Data were collected using a self-administered survey. Anxiety was measured using the Spielberg's State-Trait Anxiety Inventory questionnaire. Multiple regression analysis was used to identify whether gender, age, family history of heart disease, smoking status, history of depression, and trait anxiety scores were predictors of preprocedural anxiety. RESULTS: A total of 198 patients participated in this study. More than half of the patients (53.5%) were classified as having a high state anxiety level. The mean (SD) preprocedural trait and state anxiety scores were 35.34 (9.8) and 36.43 (11.4), respectively. Female patients, those younger than 65 years, current smokers, and those with a family history of heart disease, a history of depression, and a history of anxiety had significantly higher anxiety scores. Having high trait anxiety scores was the only predictor of preprocedural anxiety. CONCLUSION: Although the transradial approach has a low procedural risk and causes less discomfort to the patient, anxiety persists in more than 50% of patients, with trait anxiety being the best predictor. Nurses should therefore try to decrease anxiety levels in the preprocedural phase to minimize postprocedural adverse outcomes in this group of patients.

The impact of mastectomy on Iranian women sexuality and body image: a systematic review of qualitative studies.

PURPOSE: Mastectomy in women is perceived as losing feminine identity and reducing sexual attraction. The aim of this review is to explore the perception and impacts of mastectomy on Iranian women with breast cancer on their sexuality and body image. METHODS: The review used a systematic literature search that followed the guidelines of the Joanna Briggs Institute (JBI). The data sources PubMed, Scopus, Web of Science, Google Scholar, SID, ProQuest, MEDLINE, and CINAHL (via the EBSCOhost) were systematically searched. Quality appraisal, data extraction, and findings from the included studies were pooled using meta-aggregation with the Qualitative Assessment and Review Instrument (JBI-QARI). RESULTS: Eight studies involving 163 women aged from 31 to 65 years, who had mastectomy, were included. A total of 31 findings were extracted and were aggregated into 4 categories and then further grouped into two synthesized findings: (1) fear of losing spouse's sexual monopoly and (2) overcoming the challenges of losing femininity. CONCLUSIONS: This review found even in Muslim countries such as Iran women's breasts are perceived as sexually attractive, and changes in body shape can lead to subsequent challenges in marital relationships.

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.

Social Support for Arab People with Chronic Conditions: A Scoping Review.

Social support can play a crucial role in psycho-social well-being of people with chronic conditions. There is limited information about the experiences, barriers and sources of social support of Arab people affected by chronic conditions. The purpose of this review is to explore the experiences, barriers and sources of social support of Arab people affected by chronic conditions. A scoping review of the literature, based on Preferred Reporting Items for Scoping Reviews and Meta-Analyses (PRISMA) guidelines. Articles (n = 13) were identified for appraisal based on a group of inclusion and exclusion criteria. Eight articles were included in the final analysis. Three broad themes were identified: (a) Social support benefits-physical, emotional and financial benefits; (b) Source of social support-family and friends support, and (c) Support services utilization-cultural barrier, Arab migrants language and unfamiliarity with the health system barriers. Appropriate future support programs should be tailored based on Arab cultural beliefs and the inherent responsibility of the family together inside the Arab community.

Teamwork and social cohesion are key: Nurses' perceptions and experiences of working in a new decentralised intensive care unit.

BACKGROUND: Decentralised nursing stations (DCNs) have gained popularity in new hospital designs owing to their positive impact on patient safety. However, the impact on the nurses' working environment and on continuity and quality of patient care is limited. OBJECTIVES: The objective of this study was to describe nurses' perceptions and experiences of the working environment and of patient care in a decentralised intensive care unit (ICU). METHODS: Twelve months after the establishment of the new decentralised ICU in a tertiary teaching hospital in Sydney, Australia, a prospective cross-sectional survey of registered nurses working in the unit was undertaken. Nurses' perceptions and experiences of the working environment and patient care were evaluated using a 56-item questionnaire comprising nine domains and optional open-ended comments. Quantitative data were analysed using SPSS, version 25. Qualitative data were used to enhance the quantitative data. RESULTS: A total of 128 nurses responded to the questionnaire. The mean scores for overall job satisfaction, nursing teamwork, social cohesion, continuity of patient care, and quality of patient care were 3.02 (±0.91), 2.78 (±1.05), 2.68 (1.02), 2.60 (±1.01), and 3.48 (±0.88), respectively, for a maximum obtainable score of 5. Overall mean scores for teamwork, social cohesion, and continuity of patient care were explained by nurses to be a direct result of the physical layout of the new DCN ICU. Nurses believed this influenced their ability to interact with other staff and impacted teamwork and social cohesion and in turn reflected in their current job satisfaction. CONCLUSIONS: Implementation of a new model of nursing care, whereby staff members are rostered together in a pod for a period of time, along with team-building exercises, is recommended to improve the social cohesion and teamwork within the DCN ICU. Further research on nurses' experiences within a DCN ICU is required to produce robust evidence and generalisability.

Perceptions of Aboriginal and Torres Strait Islander Australians toward cardiovascular primary prevention programs: A qualitative systematic review.

OBJECTIVE: To synthesize the best available qualitative evidence on the perceptions of Aboriginal and Torres Strait Islander Australians (hereafter, respectfully referred to as Indigenous Australians) toward participation in cardiovascular primary prevention programs. BACKGROUND: In 2017, cardiovascular disease was the leading cause of premature mortality in Indigenous Australians, accounting for 11.5% of all deaths. Health risk behaviors such as smoking, physical inactivity, poor nutrition, and obesity largely contribute to this burden of disease. METHODS: A search using MEDLINE, CINAHL, EMBASE, PubMed, Google Scholar, MedNar, ProQuest and Index to Theses for published and unpublished studies was conducted in January 2020. The methodological quality of the included studies was independently assessed by two reviewers using the Joanna Briggs Institute (JBI) critical appraisal tool. Data extraction and meta-aggregation were conducted in accordance with JBI methodology. RESULTS: Eleven studies were included. Three synthesized findings were developed (a) social and community support affect participants' experiences of prevention programs; (b) structural drivers and social determinants influence Indigenous Australians experiences and participation in prevention programs and health risk behavioral change; and (c) a personal desire to change behaviors and participate in prevention programs requires development of knowledge regarding healthy lifestyles and creation of new social norms. CONCLUSIONS: Indigenous Australians participation in primary prevention for cardiovascular risk factors and adoption of a healthy lifestyle are influenced by social support, social determinants, and personal desire. Future programs need to tackle the structural drivers and facilitate a supportive environment to assist in health risk behavior change.

Effective communication is key to intensive care nurses' willingness to provide nursing care amidst the COVID-19 pandemic.

BACKGROUND: The COVID-19 pandemic posed and continues to pose challenges for health care systems globally, particularly to Intensive Care Units (ICU). At the forefront of the ICU are highly trained nurses with a professional obligation to care for patients with COVID-19 despite the potential to become infected. The aim of this study was to explore ICU nurses' willingness to care during the COVID-19 pandemic. METHODS: A prospective cross-sectional study to explore ICU nurses' willingness to provide care during the COVID-19 pandemic was undertaken between 25 March and 3 April 2020 at a large principal and referral teaching hospital in Sydney, NSW Australia. RESULTS: A total of 83 ICU nurses completed the survey. Approximately 60% reported receiving sufficient information from managers regarding COVID-19 and about caring for a patient with COVID-19. Ninety percent of nurses were concerned about spreading COVID-19 to their family. Sixty one percent of the nurses indicated that they were willing to care for patients with COVID-19. Receiving timely communication from managers was the only predictor of willingness to care among ICU nurses. CONCLUSIONS: Effective communication is a vital component during a public health emergency in order to promote nurses' willingness to care for patients in the ICU.

Effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections: a systematic review protocol.

OBJECTIVE: The objective of this review is to evaluate the effectiveness of physical stimulation on injection pain in adults receiving intramuscular injections. INTRODUCTION: Intramuscular injections are the most commonly used modality for administration of pharmacological treatments. Despite this, pain from intramuscular injections is the most commonly reported side effect. Reducing patients' pain from intramuscular injections is important; however, the challenge is in selecting from the current methods available to alleviate pain, which are varied. The findings of this review may identify the most effective physical stimulation method to reduce the side effect of pain from an intramuscular injection. INCLUSION CRITERIA: This review will consider studies that include adults aged 18 years and over that use physical stimulation interventions during intramuscular injections. Any physical stimulation strategies used during intramuscular injections including devices, skin tapping, manual pressure, massage, pinch, and traction will be considered. Studies that evaluate pain using validated tools such as pain scales will be included. METHODS: The review will undertake to find both published and unpublished studies. The key information sources to be searched are MEDLINE, Embase, CINAHL, the Cochrane Library, Cochrane Central Register of Controlled Trials, Google Scholar, Dissertation Abstracts International, ProQuest Dissertations and Theses, and MedNar. Two independent reviewers will conduct a critical appraisal of eligible studies, assess the methodological quality, and extract the data. Studies will, where possible, be pooled in a statistical meta-analysis. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42020168586.

Implications for COVID-19: A systematic review of nurses' experiences of working in acute care hospital settings during a respiratory pandemic.

BACKGROUND: Pandemics and epidemics are public health emergencies that can result in substantial deaths and socio-economic disruption. Nurses play a key role in the public health response to such crises, delivering direct patient care and reducing the risk of exposure to the infectious disease. The experience of providing nursing care in this context has the potential to have significant short and long term consequences for individual nurses, society and the nursing profession. OBJECTIVES: To synthesize and present the best available evidence on the experiences of nurses working in acute hospital settings during a pandemic. DESIGN: This review was conducted using the Joanna Briggs Institute methodology for systematic reviews. DATA SOURCES: A structured search using CINAHL, MEDLINE, EMBASE, PubMed, Google Scholar, Cochrane Library, MedNar, ProQuest and Index to Theses was conducted. REVIEW METHODS: All studies describing nurses' experiences were included regardless of methodology. Themes and narrative statements were extracted from included papers using the SUMARI data extraction tool from Joanna Briggs Institute. RESULTS: Thirteen qualitative studies were included in the review. The experiences of 348 nurses generated a total of 116 findings, which formed seven categories based on similarity of meaning. Three synthesized findings were generated from the categories: (i) Supportive nursing teams providing quality care; (ii) Acknowledging the physical and emotional impact; and (iii) Responsiveness of systematised organizational reaction. CONCLUSIONS: Nurses are pivotal to the health care response to infectious disease pandemics and epidemics. This systematic review emphasises that nurses' require Governments, policy makers and nursing groups to actively engage in supporting nurses, both during and following a pandemic or epidemic. Without this, nurses are likely to experience substantial psychological issues that can lead to burnout and loss from the nursing workforce.

Effectiveness of Oseltamivir Prophylaxis in Influenza Outbreaks in Residential Aged Care.

Influenza outbreaks in Aged Care Facilities (ACFs) can lead to hospitalizations and deaths. Influenza can spread rapidly through ACFs if precautionary measures are not taken. Along with influenza vaccination and precautionary hygiene measures, Oseltamivir Prophylaxis (OP) may be effective in reducing the attack rate of influenza by preventing new cases. A cohort study was carried out to investigate the effectiveness of OP use during influenza outbreaks in ACFs located within South Western Sydney Local Health District from 1 January 2015 to 31 December 2018. The main outcome assessed was the rate of OP failure (new cases of influenza in patients treated with OP) among ACF residents. Subgroups and various predictors of OP failure were investigated including presence of a dementia ward, high care ward, and days to Public Health Unit (PHU) notification. The cohort consisted of 86 ACF outbreaks involving 10,064 residents. OP prevented 90% of influenza cases during influenza outbreaks [0.1 RR (95% confidence interval (CI): 0.08-0.12); P < 0.0001]. ACFs with dementia wards had a 44% (0.56 relative risk (RR) (95% CI: 0.34-0.93); P < 0.05) lower OP failure rate. ACFs with high level care had an 87% (0.13 RR (95% CI: 0.05-0.38); P < 0.05) lower OP failure rate. OP is highly effective in preventing new cases of influenza during outbreaks in ACFs, especially in ACFs with dementia or high care wards. Mandatory reporting of influenza outbreaks to PHUs would ensure that ACFs are supported throughout the outbreak, which will facilitate reductions in hospitalizations and mortality.

Is it or is it not? Lessons learned from a case of suspected vaccine strain measles.

OBJECTIVE: Measles continues to be a threat to Australia. While post-eradication risks are low, imported measles cases from overseas travellers who are non-immune can cause small outbreaks. This case report discusses the challenge of identifying wild-type measles in an individual who was recently vaccinated with measles-containing vaccine (MCV). METHODS: A positive polymerase chain reaction (PCR) result for measles for an adult who had recently received a measles-containing vaccine was notified. Investigation revealed no known epidemiological link, recent overseas travel or contact with recent measles cases during the incubation period. RESULTS: The results of the initial sequencing to distinguish between wild-type and vaccine-strain measles were inconclusive. A decision was made to re-run the genotyping, collect additional specimens and quarantine the case until a definitive result was obtained. Sequencing and genotyping revealed that this indeed was a wild-type measles strain. CONCLUSIONS: Changing epidemiology of measles means distinguishing between wild-type and vaccine-strain measles has become a new challenge. Implications for public health: The reflection of the public health management of this case has provided a valuable teaching tool for public health professionals globally, particularly in low incidence measles countries.