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Nurse-surgeons in the Australian public health system: A descriptive quantitative survey
No full textBackground: With over five billion people worldwide lacking access to surgery, innovative solutions are vital to address the global surgical crisis. Nurse-surgeons present a promising innovation. Considering their contribution worldwide and impact on surgical care in Australia, an exploration of these advanced practice nurses is timely.
Objective: To investigate the roles, training, education, and perceptions of career prospects and support received by practicing nurse-surgeons in the Australian public health system.
Design: Non-experimental descriptive national survey.
Methods: The target population was nurse-surgeons practicing within the Australian public health system. The survey questionnaire comprised of four sections containing questions on nurse-surgeon demographics, roles, training, and perceptions of career prospects and support received. Data collection was conducted through emailing of public hospitals, crowdsourcing, and snowballing. Descriptive analysis was used to report the findings.
Results: Twenty-eight nurse-surgeons participated in the study, 22 females and six males. Most commonly, participants (n = 10) held master’s degrees and trained to become nurse-surgeons for an average of 2⋅27 years (95 % CI [1⋅47,3⋅07]). Training programs varied but were all surgical specialty-specific, and usually included a practical component, theoretical component, and competency assessment prior to independent practice. Participants rated employment prospects for nurse-surgeons as poor to average due to limited work opportunities, politics, and strong pushbacks from Australian medical societies. The support received from nurses, surgeons and management was rated by participants as good providing reasons such as supportiveness, value recognition, jealousy, and resentment. The participants were very likely (95 % CI [7.436 – 9.364] to continue practicing due to positive job satisfaction but recommended the standardising of training and practice to ensure role futureproofing.
Conclusions: Nurse-surgeons have been practicing in Australia for decades, yet no standard training and credentialing pathway exist for them. This study identified the various roles, nonstandard training, and perceptions of nurse-surgeons in the Australian public health system. The findings of this study will have an impact on policymakers and stakeholders to develop standard national credentialing pathway for nurse-surgeons in Australia to enhance clinical practices and ensure a consistent framework for recognition and development of these advanced practice nurses
Calciphylaxis Episodes in the Australia and New Zealand Dialysis and Transplant Registry
No full textIntroduction: Calciphylaxis is a rare disorder associated with significant morbidity and mortality. Data registries are an invaluable source of information for rare diseases. We reviewed cases of calciphylaxis recorded in the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) and evaluated associations and outcomes of this condition.
Methods: Data was obtained on all cases of calciphylaxis reported between 2019 and 2022 in Australian and New Zealand patients on kidney replacement therapy (KRT). This cohort was compared to all patients in the registry who received KRT from 2019 to 2022 without an episode of calciphylaxis. Cox proportional hazards regression including a time-varying covariate for calciphylaxis episode was conducted for mortality with models restricted to patients on dialysis only.
Results: From 2019 to 2022, 333 patients had calciphylaxis episodes reported. Overall incidence rate for patients on dialysis was 4.5 (4.1–5.1) episodes per 1000 patient-years on dialysis. Median age was 63 (interquartile range [IQR]: 55–73) years, 54% were female, 66% had diabetes, 59% were obese (body mass index [BMI] $ 30 kg/m2 ) and 77% were receiving hemodialysis (HD) treatment. Compared to patients without calciphylaxis (n ¼ 46,526), patients with calciphylaxis were more likely to be older, female, and have diabetes, greater BMI, coronary artery, and peripheral vascular disease. The median time to calciphylaxis was 3.2 (IQR: 0.9–6.7) years after KRT commencement. Half of the patients with calciphylaxis died by 12 months from diagnosis. Adjusted hazard ratio (HR) of mortality for patients on dialysis with calciphylaxis \u3c1 year and 1 to 4 years after an episode was 5.8 (4.9–6.9) and 1.5 (1.0–2.1), respectively compared to patients on dialysis without calciphylaxis.
Conclusion: Calciphylaxis is a rare but life-threat
Psychometric properties of the adolescent motor competence questionnaire for Norwegian adolescents
No full textThe objective of this study was to examine the psychometric properties of the Adolescent Motor Competence Questionnaire (AMCQ) for Norwegian adolescents. To this end, a sample of 349 Norwegian-speaking adolescents (13– 16 years old) were recruited and completed the AMCQ. Initial results showed that confirmatory factor analysis (CFA) did not indicate statistical support for previous statistical models reported in the literature. Further analysis indicated factorial validity for a novel three-factor model identified through exploratory factor analysis, encompassing measures of fine motor skill (α = 0.65), gross motor skill (α = 0.74), and activities of daily living (ADL; α = 0.79) with acceptable internal consistency coefficients. Subsequent analysis indicated indices of measurement invariance in the study sample, as males rated their competence higher compared to females in 19 of the 27 items, and better model fit was obtained for the female adolescents. Strong invariance was tenable, and no factor mean differences were found across older and younger adolescents or across BMI scores. Overall results thus suggested that the AMCQ has acceptable psychometric properties and can be confidently used in further work with perceived motor competence in Norwegian 13–16 years-old adolescents
University staff perspectives on determinants of high-quality health professions student placements in regional, rural and remote Australia: Protocol for a mixed-method study
No full textIntroduction: In rural areas, work-integrated learning in the form of health student placements has several potential benefits, including contributing to student learning, enhancing rural health service capacity and attracting future rural health workforce. Understanding what constitutes a high-quality rural placement experience is important for enhancing these outcomes. There is no current standardised definition of quality in the context of rural health placements, nor is there understanding of how this can be achieved across different rural contexts. This study is guided by one broad research question: what do university staff believe are the determinants of high-quality health professions student placements in regional, rural and remote Australia?
Methods and analysis: This study will adopt a convergent mixed-method design with two components. Component A will use explanatory sequential mixed methods. The first phase of component A will use a survey to explore determinants that contribute to the development of highquality health student placements from the perspective of university staff who are not employed in University Departments of Rural Health and are involved in the delivery of health student education. The second phase will use semistructured interviews with the same stakeholder group (non-University Department of Rural Health university staff) to identify the determinants of high-quality health student placements. Component B will use a case study Employing COnceptUal schema for policy and Translation Engagement in Research mind mapping method to capture determinants that contribute to the development of highquality health student placements from the perspective of University Department of Rural Health university staff.
Ethics and dissemination: The University of Melbourne Human Ethics Committee approved the study (2022-23201-33373-5). Following this, seven other Australian university human research ethics committees provided external approval to conduct the study. The results of the study will be presented in several peer-review publications and summary reports to key stakeholder groups
Association between long-term use of calcium channel blockers (CCB) and the risk of breast cancer: A retrospective longitudinal observational study protocol
No full textIntroduction: Calcium channel blockers (CCB), a commonly prescribed antihypertensive (AHT) medicine, may be associated with increased risk of breast cancer. The proposed study aims to examine whether long-term CCB use is associated with the development of breast cancer and to characterise the dose–response nature of any identified association, to inform future hypertension management.
Methods and analysis: The study will use data from 2 of Australia’s largest cohort studies; the Australian Longitudinal Study on Women’s Health, and the 45 and Up Study, combined with the Rotterdam Study. Eligible women will be those with diagnosed hypertension, no history of breast cancer and no prior CCB use at start of follow-up (2004–2009). Cumulative dose-duration exposure to CCB and other AHT medicines will be captured at the earliest date of: the outcome (a diagnosis of invasive breast cancer); a competing risk event (eg, bilateral mastectomy without a diagnosis of breast cancer, death prior to any diagnosis of breast cancer) or end of follow-up (censoring event). Fine and Gray competing risks regression will be used to assess the association between CCB use and development of breast cancer using a generalised propensity score to adjust for baseline covariates. Timevarying covariates related to interaction with health services will also be included in the model. Data will be harmonised across cohorts to achieve identical protocols and a two-step random effects individual patient-level meta-analysis will be used.
Ethics and dissemination: Ethical approval was obtained from the following Human research Ethics Committees: Curtin University (ref No. HRE2022-0335), NSW Population and Health Services Research Ethics Committee (2022/ETH01392/2022.31), ACT Research Ethics and Governance Office approval under National Mutual Acceptance for multijurisdictional data linkage research (2022.STE.00208). Results of the proposed study will be published in high-impact journals and presented at key scientific meetings
A pilot study of intraoperative application of cooled radiofrequency to reduce post-operative pain following total knee arthroplasty
Get PDFBackground: Total Knee Arthroplasty (TKA) is a successful treatment for end stage knee osteoarthritis (OA), but can be associated with significant pain in the early post-operative period. Cooled radiofrequency ablation (CRFA) has reported to reduce knee OA pain by targeting the periarticular nerves. The objective of this pilot study was to assess the effectiveness of intra-operative CRFA for reducing pain and opiate use after TKA.
Methods: This was a non randomised prospective study with control group. Participants were sequentially recruited preoperatively and underwent TKA, with CRFA to 6 targeted sites prior to cementing of implants, and were compared to controls who underwent TKA without CRFA. The primary outcome was Day 3 pain scores, and secondary outcomes included week one pain scores, and opiate use up to six weeks post-operative.
Results: 17 participants were recruited to the control group and 12 were recruited to the CRFA group. There was no significant difference in demographics or baseline pain scores between the groups. On day 2 the CRFA group had a lower mean pain VAS score of 3.2 compared to 4.4 in the control group (p = 0.03). The mean post operative VAS pain score did not differ between the groups for Day 1, 3, 4, or any other time points up to 6 weeks. There were no significant reduction in opiate use in the CRFA group compared to the control group. There were no adverse events.
Conclusion: This study demonstrated intra-operative CRFA was not effective in reducing pain by 50% after TKA in a pilot study
Short waits, happy patients and expert care, moving basic musculoskeletal care from the emergency department to a physiotherapist-led diversion pathway
No full textObjective
Patients with musculoskeletal conditions (MSKCs) are highly prevalent in ED. This project explores the impact of the pilot phase of a ‘diversion pathway’, which directed patients with MSKCs from the ED waiting room to an outpatient clinic led by advanced-scope physiotherapists. Methods
A prospective intervention study comparing care outcomes between patients in the ‘diversion pathway’ with usual ED care. The characteristics of patients considered eligible and non-eligible are described. Results
Between May and December 2022, 1099 patients were diverted. For diverted patients, mean length of stay (LOS) in ED was reduced by 110 (95% confidence interval [CI]: 99–120) min and 4 h rule compliance improved by 19.3% compared to usual ED care. There were fewer patients who ‘did not wait’ (DNW) with the diversion pathway. The diverted group was young (median age 22 years and 41% paediatric), mostly low urgency, self-referred and arrived by private transport with minor limb trauma. The diversion pathway triage process appropriately identified 182 patients ineligible for diversion. 96.7% of patients reported satisfaction with care received from the diversion pathway. There was no change in ED representation rates for diverted patients. Conclusions
A new pathway resulted in reduced LOS, reduced DNW, high patient satisfaction and more people being discharged within 4 h for diverted patients compared to usual ED care. The pathway increased ED capacity, improved key ED performance metrics and safely expedited care delivery for patients
Vulnerability to environmental and climatic health provocations among women and men hospitalized with chronic heart disease: insights from the RESILIENCE TRIAL cohort
Get PDFAims: We aimed to recruit a representative cohort of women and men with multi-morbid chronic heart disease as part of a trial testing an innovative, nurse-co-ordinated, multi-faceted intervention to lower rehospitalization and death by addressing areas of vulnerability to external challenges to their health. Methods and results: The prospective, randomized open, blinded end-point RESILIENCE Trial recruited 203 hospital inpatients (mean age 75.7 ± 10.2 years) of whom 51% were women and 94% had combined coronary artery disease, heart failure, and/or atrial fibrillation. Levels of concurrent multi-morbidity were high (mean Charlson Index of Comorbidity Score 6.5 ± 2.7), and 8.9% had at least mild frailty according to the Rockwood Clinical Frailty Scale. Including the index admission, 19–20% of women and men had a pre-existing pattern of seasonally linked hospitalization (seasonality). Detailed phenotyping revealed that 48% of women and 40% of men had ≥3 physiological factors, and 15% of women and 16% of men had ≥3 behavioural factors likely to increase their vulnerability to external provocations to their health. Overall, 61–62% of women and men had ≥4 combined factors indicative of such vulnerability. Additional factors such as reliance on the public health system (63 vs. 49%), lower education (30 vs. 14%), and living alone (48 vs. 29%) were more prevalent in women. Conclusion: We successfully recruited women and men with multi-morbid chronic heart disease and bio-behavioural indicators of vulnerability to external provocations to their health. Once completed, the RESILIENCE TRIAL will provide important insights on the impact of addressing such vulnerability (promoting resilience) on subsequent health outcomes
Identification of predictors of metastatic potential in paragangliomas to develop a prognostic score (PSPGL)
No full textContext: Paragangliomas (PGLs) are rare tumors in adrenal and extra-adrenal locations. Metastasis are found in approximately 5% to 35% of PGLs, and there are no reliable predictors of metastatic disease.
Objective: This work aimed to develop a prognostic score of metastatic potential in PGLs.
Methods: A retrospective analysis was conducted of clinical data from a cohort with PGLs and tumor histological assessment. Patients were divided into metastatic PGL (presence of metastasis) and nonmetastatic PGL (absence of metastasis ≥96 months of follow-up) groups. Univariate and multivariable analysis were performed to identify predictors of metastatic potential. A prognostic score was developed based on coefficients of multivariable analysis. Kaplan-Meier curves were generated to estimate disease-specific survival (DSS).
Results: Out of 263 patients, 35 patients had metastatic PGL and 110 patients had nonmetastatic PGL. In multivariable analysis, 4 features were independently related to metastatic disease and composed the Prognostic Score of Paragangliomas (PSPGL): presence of central or confluent necrosis (33 points), more than 3 mitosis/10 high-power field (HPF) (28 points), extension into adipose tissue (20 points), and extra-adrenal location (19 points). A PSPGL of 24 or greater showed similar sensitivity with higher specificity than the Pheochromocytoma of the Adrenal Gland Scaled Score (PASS) and Grading System for Adrenal Pheochromocytoma and Paraganglioma (GAPP). PSPGL less than or equal to 20 was associated with a risk of metastasis of approximately 10%, whereas a PSPGL of 40 or greater was associated with approximately 80%. The presence of metastasis and Ki-67 of 3% or greater were related to lower DSS.
Conclusion: The PSPGL, composed of 4 easy-to-assess parameters, demonstrated good performance in predicting metastatic potential and good ability in estimating metastasis risk
Prevalence of technology and connectivity issues in general practices in rural New South Wales and their impact on staff capability to perform their job
No full textObjective: To identify the technology and connectivity issues in rural and remote general practices, and the factors independently associated with these issues that negatively impact staff\u27s capability to perform their job.
Methods: An annual cross-sectional survey of rural and remote general practice managers. Dependent variables included demographic data, practice size, geographic location, connection type and frequency of connectivity issues. Descriptive statistics are presented, and bivariate logistic regression was under-taken to determine factors independently associated with connectivity issues that negatively impact staff\u27s capability to perform their job.
Participants: One hundred sixty-eight general practice managers from rural and remote New South Wales.
Results: The majority of respondents (87%, n = 146) indicated that technology and connectivity issues had impacted staff\u27s capability to perform their job. Internet problems were the most frequently reported issue (36%, n = 61). In bi-variate analysis, practices that had a total clinical staff headcount between 5 and7 (OR 0.27; 95% CI 0.10–0.67; p = 0.005) or between 8 and 11 (OR 0.39; 95% CI0.16–0.95; p = 0.038) were significantly less likely to report technology and connectivity issues that negatively impact staff\u27s capability to perform their job, com-pared with practices with a total clinical headcount of less than five.
Conclusions: Technology and connectivity issues persist in rural and remote general practices. This is the first study to demonstrate that technology and connectivity issues impact on rural staff\u27s capability to perform their job. Furthermore, smaller practices face more technology and connectivity issues that negatively impact staff\u27s capability to do their job than larger practices. Further research is required to find solutions to address these challenges