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Nudging as a Support for Behavioral Change in Lifestyle Medicine
Full text linkThe practice of lifestyle medicine and its emphasis on behavioral change continues to grow around the world. Yet much of the burden of disease weighing on healthcare systems from chronic, modifiable conditions remains stubbornly present. From a behavior change perspective, efforts to date have primarily focused on public health messaging and public health campaigns (global approaches) to interventions such as health coaching (individual approaches). There exists an opportunity to consider contextual elements which support behavioral change. The practice of “nudging” behavior in primary care and allied health settings is proposed as a means of responding to these contextual opportunities. Nudging does not assure change; however, it can invite curiosity about change and small behavioral efforts in the direction of a desired change. Furthermore, its nature conserves autonomy and patient choice while inviting a health-creating behavior. As such, when considered and applied in the context of public health and individual treatment options, it creates a consistent milieu in which behavior change is facilitated
Have Gloves and Gowns had their day? An Australian and New Zealand Practice and Attitudes Survey about Contact Precautions for MRSA and VRE Colonisation
No full textBackground ‘Contact precautions,’ are recommended for hospitalised patients with known methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) colonisation. Despite increasing observational evidence suggesting that gowns and gloves are of no added benefit over hand hygiene and environmental cleaning, guidelines continue to recommend them. Methods A cross-sectional online survey of infection prevention professionals, infectious diseases physicians and microbiologists in Australian and New Zealand hospitals was conducted. The purpose was to explore variations in current approaches to known MRSA and VRE colonisation, and determine clinical equipoise for a proposed randomised control trial (RCT) to withdraw the use of gowns and gloves in this setting. Results 226 responses from 122 hospitals across all Australian jurisdiction and multiple regions of New Zealand were received. While most hospitals implement contact precautions for MRSA (86%) and VRE (92%), variations based on MRSA and VRE subtypes are common. There was strong interest in removing glove and gown use for MRSA (72% and 73%, respectively) and VRE (70% and 68%, respectively). 62% of surveyed hospitals expressed interest in participating in a proposed cluster RCT comparing discontinuation of gown and glove use as part of contact precautions for MRSA and VRE, with their ongoing use. Conclusion The mandated use of PPE in the context of MRSA and VRE colonisation warrants further examination. An RCT is needed to definitively address this issue and to promote a widespread change in practice, if warranted
Risk of Organism Acquisition from Prior Room Occupants: An Updated Systematic Review
No full textBackground Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review. Methods A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies. Results From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53–3.93]. There was heterogeneity between the studies (I2 89%, P \u3c 0.001). Conclusion The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area
The Incidence of Nosocomial Bloodstream Infection and Urinary Tract Infection in Australian Hospitals Before and During the COVID-19 Pandemic: An Interrupted Time Series Study
No full textBackground
The COVID-19 pandemic has had a significant impact on healthcare including increased awareness of infection prevention and control (IPC). The aim of this study was to explore if the heightened awareness of IPC measures implemented in response to the pandemic influenced the rates of healthcare associated infections (HAI) using positive bloodstream and urine cultures as a proxy measure. Methods
A 3 year retrospective review of laboratory data from 5 hospitals (4 acute public, 1 private) from two states in Australia was undertaken. Monthly positive bloodstream culture data and urinary culture data were collected from January 2017 to March 2021. Occupied bed days (OBDs) were used to generate monthly HAI incidence per 10,000 OBDs. An interrupted time series analysis was undertaken to compare incidence pre and post February 2020 (the pre COVID-19 cohort and the COVID-19 cohort respectively). A HAI was assumed if positive cultures were obtained 48 h after admission and met other criteria. Results
A total of 1,988 bloodstream and 7,697 urine positive cultures were identified. The unadjusted incident rate was 25.5 /10,000 OBDs in the pre-COVID-19 cohort, and 25.1/10,000 OBDs in the COVID-19 cohort. The overall rate of HAI aggregated for all sites did not differ significantly between the two periods. The two hospitals in one state which experienced an earlier and larger outbreak demonstrated a significant downward trend in the COVID-19 cohort (p = 0.011). Conclusion
These mixed findings reflect the uncertainty of the effect the pandemic has had on HAI’s. Factors to consider in this analysis include local epidemiology, differences between public and private sector facilities, changes in patient populations and profiles between hospitals, and timing of enhanced IPC interventions. Future studies which factor in these differences may provide further insight on the effect of COVID-19 on HAIs
Knight, Arthur Lyndon (1926-2012)
No full textArthur Lyndon (Lyn) Knight was the founding member of the Association of Business and Professional Men, the driving force behind the journal Adventist Professional; founder of the Avondale College Foundation; fundraiser for Sydney Adventist Hospital; and pioneer of the “Carols by Candle” light program in Sydney as both the coordinator of the program and conductor of the choirs and orchestras
A Web- and Mobile App–Based Mental Health Promotion Intervention Comparing Email, Short Message Service, and Videoconferencing Support for a Healthy Cohort: Randomized Comparative Study
No full textBackground: The rapid increase in mental health disorders has prompted a call for greater focus on mental health promotion and primary prevention. Web- and mobile app–based interventions present a scalable opportunity. Little is known about the influence of human support on the outcomes of these interventions.
Objective: This study aimed to compare the influence of 3 modes of human support on the outcomes (ie, mental health, vitality, depression, anxiety, stress, life satisfaction, and flourishing) of a 10-week, Web- and mobile app–based, lifestyle-focused mental health promotion intervention among a healthy adult cohort.
Methods: Participants were recruited voluntarily using a combination of online and offline advertising. They were randomized, unblinded into 3 groups differentiated by human support mode: Group 1 (n=201): standard—fully automated emails (S); Group 2 (n=202): standard plus personalized SMS (S+pSMS); and Group 3 (n=202): standard plus weekly videoconferencing support (S+VCS), hosted by 1 trained facilitator. Participants accessed the intervention, including the questionnaire, on a Web-based learning management system or through a mobile app. The questionnaire, administered at pre- and postintervention, contained self-reported measures of mental well-being, including the “mental health” and “vitality” subscales from the Short Form Health Survey-36, Depression Anxiety and Stress Scale-21, Diener Satisfaction With Life Scale (SWLS), and Diener Flourishing Scale.
Results: Of 605 potential participants, 458 (S: n=157, S+pSMS: n=163, and S+VCS: n=138) entered the study by completing registration and the preintervention questionnaire. At post intervention, 320 out of 458 participants (69.9%; S: n=103, S+pSMS: n=114, and S+VCS: n=103) completed the questionnaire. Significant within-group improvements were recorded from pre- to postintervention in all groups and in every outcome measure (P≤.001). No significant between-group differences were observed for outcomes in any measure: mental health (P=.77), vitality (P=.65), depression (P=.93), anxiety (P=.25), stress (P.57), SWLS (P=.65), and Flourishing Scale (P=.99). Adherence was not significantly different between groups for mean videos watched (P=.42) and practical activity engagement (P=.71). Participation in videoconference support sessions (VCSSs) was low; 37 out of 103 (35.9%) participants did not attend any VCSSs, and only 19 out of 103 (18.4%) attended 7 or more out of 10 sessions. Stratification within the S+VCS group revealed that those who attended 7 or more VCSSs experienced significantly greater improvements in the domains of mental health (P=.006; d=0.71), vitality (P=.005; d=0.73), depression (P=.04; d=0.54), and life satisfaction (P=.046; d=0.50) compared with participants who attended less than 7.
Conclusions: A Web- and mobile app–based mental health promotion intervention enhanced domains of mental well-being among a healthy cohort, irrespective of human support. Low attendance at VCSSs hindered the ability to make meaningful between-group comparisons. Supplementing the intervention with VCSSs might improve outcomes when attendance is optimized
Holy Work with Children: Making Meaning Together
No full textHoly work with children : Making meaning together is the culmination of personal experience and qualitative research by Campen (2021), children\u27s ministry pastor and director of the Discipleship of the Rio Texas Conference of the United Methodist Church in San Antonio, Texas
Becoming Better People: Children\u27s Perceptions of how a School\u27s Garden Program has Impacted their Actualisation of Values
No full textEducation is perceived, among other things, to be a character-building enterprise. Since the beginning of the twenty-first century, a renewed emphasis on character development through values education has been on the agendas of Australian schools. Many schools now offer programs designed to inculcate values into the lives of students. Although values literacy is widespread in schools, there is less evidence to demonstrate that values actualisation, that is, making positive values the basis of behaviour at school and in life, has taken root. This case study in one primary school used focus groups to gather children’s perceptions of how they actualised values in the context of a school garden program. The garden program’s organisational elements were found to positively impact the actualisation of intrapersonal and interpersonal values
Where to go for a Christian Research Degree? Part 2 of a two-part Report
No full textAvondale University is committed to providing quality higher research degrees. Data on candidate and graduate experiences from the institution and across the sector are central in shaping good practice and informing policy, processes and systems designed to support candidate and supervisor research training (TEQSA, 2018) and employment opportunities (Bentley & Meek, 2018).
This paper reports on research conducted at our institution which focused on the following two questions: What were the differences between the way current candidates and graduates reported on their postgraduate learning experiences in the MPhil or PhD degrees at Avondale? And, what were the differences between the way males and females reported on their postgraduate learning experiences in the MPhil or PhD degrees at Avondale?
In this mixed methods research project questionnaires and interviews were used to determine what is valued by current and past HDR candidates of Avondale and which areas of our HDR programs need further development. This is the second of two papers that report the findings of this project and identifies future research which may further support HDR candidates’ holistic experiences
7 Dimensions of Wellness: Emotionally Thriving
No full textThe 7 Dimensions of Wellness is a 9-part short documentary series that explores pathways for enhancing our overall health and wellbeing. Join Darren Morton as he speaks to leading experts, conducts fun experiments and presents fascinating insights into how we can live our best life