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Is staging breast magnetic resonance imaging for invasive lobular carcinoma worthwhile?
No full textBackground: Invasive lobular carcinoma (ILC) is challenging to stage accurately using mammography (MG) and ultrasound (US) with undiagnosed ipsilateral and contralateral cancer resulting in poor patient outcomes including return to surgery. Our institution employs routine staging breast MRI in ILC for this reason. However, increased time for further imaging/biopsies contributes to patient anxiety and potentially delays definite management. We aimed to quantify the frequency of staging MRI-detected additional lesions requiring biopsy or follow-up, the added cancer detection rate and MRI prompted change in surgical management.
Methods: An observational study on staging breast MRI for newly diagnosed ILC at a tertiary Western Australian hospital from January 2019 to August 2022. Standardized 3T MRI protocol was performed, double read by unblinded fellowship-trained radiologists. Histopathology from biopsy, surgery, or first annual surveillance was the reference standard for additional MRI-detected lesions.
Results: One hundred ten MRI studies demonstrated 49 (45%) patients had at least one additional clinically significant MRI-detected lesion. Thirty-one patients had an additional ipsilateral lesion detected, of which 18 (58%) proved malignant; 14 (45%) multifocal and4 (13%) multicentric ILC. Additional work-up of MRI-detected lesions averaged a 9-daydelay to definitive surgery compared to patients with a negative or definitively benign MRI.MRI changed surgical planning in 11 of 110 cases from breast conservation surgery (BCS)to mastectomy and there were two contralateral cancers diagnosed. BCS reoperation rate was 11%.
Conclusion: Staging MRI for ILC identifies clinically significant lesions in nearly half of patients, predominantly ipsilateral multifocal disease, without significant delay to definitive surger
Prevalence of Peristomal Skin Complications in the First 12 Weeks Post-Discharge Following Urinary/Faecal Stoma Formation Surgery
Get PDFBackground
An ostomy is a surgically created opening and can be performed to divert faecal effluent by exteriorisation of a segment of the small bowel otherwise known as the ilium, or from the large bowel otherwise known as the colon. A urinary diversion of effluent generally involves exteriorisation of a segment of ileum into which the ureters have been anastomosed. The exteriorised segment of bowel is referred to as a stoma and individuals who have had a stoma created often refer to themselves as an ‘ostomate’. The skin surrounding a stoma is referred to as peristomal skin.
Peristomal skin complications (PSCs) in the immediate post-operative period are commonly reported and largely preventable and affect overall wellbeing and impairs quality of life (QoL) in addition, the costs of treatment can be significant and readmission to hospital is often required. The motivation for this study arose from the prevalence of PSCs experienced by the researcher in clinical practice and the experiential knowledge that they are largely preventable.
Aim
The aim of this study was to describe the number, type and aetiology of PSCs experienced by a cohort of ostomates in the first 12 weeks post-discharge from hospital following surgery to create a faecal or urinary stoma and the perceived impact on the QoL of ostomates.
Method
Stomal therapy nurses (STNs) collected baseline data from 19 patients who underwent surgery that resulted in formation of a stoma, in two large tertiary hospitals in Perth, Western Australia (WA). Baseline data was collected at commencement and prior to discharge. In person or telephone assessments for peristomal skin complications using the PRAT occurred weekly for 4 weeks then fortnightly until 12 weeks following discharge. Peristomal skin inspection was conducted, and photographic images taken by the ostomate or STN which were then forwarded to the researcher for assessment. Participants’ QoL scores were measured using a validated instrument at baseline and each time a PSC was identified at any of the reviews.
Results
Nineteen ostomates were recruited however, two withdrew leaving 17 who were followed through to 12 weeks or reversal of their stoma if prior to 12 weeks. One hundred percent of ostomates presented with one or more PSCs, 74%(n=14) were attributed to irritant dermatitis, which was directly related to a leaking appliance. Fifty three percent (n=10) of ostomates had PSCs which were classified as ‘bruising’. Ostomates were more likely to have a PSC with stomas less than 20mm in height, none were classified as severe with many ostomates not recognising that they had a PSC. The greatest effect on QoL was the ostomates fearing that their PSCs would get worse.
Discussion
The results from this study align to the PSCs reported in the international literature and highlight the importance of regular postoperative STN follow-up especially in the early post-operative period. The study has identified the main contributing factors for PSCs which can be used to identify ostomates at high risk of developing PSCs and guide prevention strategies
Validation of psychometric properties of partners in health scale for heart failure
No full textBackground: Congestive heart failure (CHF) is a complex chronic disease, and it is associated with a second comorbid condition in more than half of cases. Self-management programs can be specific to CHF or generic for chronic diseases. Several tools have been validated for CHF. Presently, there are no established generic instruments that are validated for measuring self-management in CHF.
Objective: This study aims to evaluate the internal reliability and construct validity (psychometric properties) of the Partners in Health (PIH) scale for patients with congestive heart failure, a generic chronic disease self-management tool.
Methods: The study included 210 adult CHF patients [120 with heart failure with reduced ejection fraction (HfrEF), 90 with preserved ejection fraction (HfpEF)], from Community Cardiology Outpatients in West Melbourne, Australia, who were treated in community cardiology and were included between May 2022 and Jan 2024. The screened patient population were diagnosed with CHF and were eligible for an SGLT-2 inhibitor. Cohort analysis used the Bayesian confirmatory factor analysis to evaluate the a priori four-factor structure. Omega coefficients and 95% credible intervals (CI) were used to assess internal reliability.
Results: In the CHF (HFrEF) and preserved ejection fraction (HFpEF) cohorts, participants’ mean [standard deviation (SD)] age was 66.8 (13.5) and 71.3 (9.76) years. Description of study sociodemographics highlighted that 88% and 52% of patients were male, there was a BMI \u3e 50% in both cohorts, eGFR \u3e 60 mL/min were 59% and 74%, and LVEF \u3c 40% and \u3e 50% were 99% and 100%, respectively. Model fit for the hypothesised model was adequate (posterior predictive p = 0.073) and all hypothesised factor loadings were substantial (\u3e0.6) and significant (p \u3c 0.001). Omega coefficients (95% CI) for the PIH subscales of Knowledge, Partnership, Management and Coping were 0.84 (0.79–0.88), 0.79 (0.73–0.84), 0.89 (0.85–0.91) and 0.84 (0.79–0.88), respectively. Conclusion: This study is original in confirming the dimensionality, known-group validity, and reliability of the PIH scale for measuring generic self-management in outpatients with CHF syndrome
A Paradox Theory Approach to Investigating Individual Level Responses to Corporate Social Responsibility in Small to Medium Enterprises
Get PDFIn Australia, small and medium-sized enterprises (SMEs) occupy important positions within their communities, contributing to employment and national economic growth. Despite their significance, it remains unclear how SME owners, as individuals, navigate and respond to the tensions arising from their unique business characteristics and the adoption of social and environmental activities. This research aims to bridge this knowledge gap by investigating how SME owners manage and respond to paradoxical tensions in implementing social and environmental responsibility practices within the SME context. The conventional definition of corporate social responsibility (CSR) does not integrate with the lexicon or landscape of SMEs. This research uses pluralistic logic theory to unpack and analyse the competing demands that confront SME owners and influence their cognitive, emotional, and behavioural responses to paradoxical tensions. This study adopts phenomenology as the methodological framework and theoretical perspective to produce insight into the participants\u27 experiences. In this thesis, a total of thirty (30) in-depth interviews were conducted as the primary data collection tool to best capture, in the participants\u27 own words, their thoughts, feelings, emotions, and perceptions about their experiences.
The findings of this research highlight that SME owners exhibit ethical perspectives towards social and environmental responsibility, shaped by their religious values, personal morals, and childhood upbringing. However, despite their commitment to social and environmental practices, SME owners lack the paradoxical mindset to effectively manage the tensions between their values and ethical decision-making. Instead, they resort to defensive measures such as temporal separation, prioritising short-term survival and profitability over long-term social and environmental commitments. Resource constraints and a lack of strategic thinking skills further exacerbate this short-term mindset, which hinders the systematic integration of values logic into business operations. Furthermore, the informal nature of SMEs and the ingrained personal values of owners contribute to the challenge of formally embedding social and environmental values logic into the business. While personal values drive positive engagement in CSR, the absence of formal structures and processes impedes their systematic integration. Finally, the short-term orientation of SMEs poses barriers to the long-term adoption of social and environmental practices. SME owners prioritise immediate business concerns such as cash flow and survival, often at the expense of longer-term and more strategic considerations.
This research makes two contributions. Firstly, it demonstrates the misalignment between SME features (such as informality, short-term orientation, and ethical values of owners) and traditional CSR concepts. Secondly, this study enriches the theoretical discourse on CSR and SMEs by using the paradoxical approach to investigate how SME owners cognitively, emotionally, and behaviourally respond to social and environmental responsibility paradoxes. Whilst previous research explores tensions in SMEs arising from innovation, family governance, R&D, and autonomy versus control, this study uniquely focuses on social and environmental responsibility paradoxes in SMEs from an individual perspective.
This research has practical implications, offering insights into social and environmental responsibility within SMEs, considering SME owners\u27 cognitive, emotional, and behavioural responses. Through a reconceptualisation of CSR that more closely aligns with the distinctive business model of SMEs, policymakers can benefit from a more nuanced understanding of how SMEs manage paradoxical tensions between their unique firms and conventional CSR requirements, enabling more accurate policymaking decisions. Future research avenues can examine relationships between paradoxes or the consequences of these tensions. This research can encompass various SME sizes, sectors, and geographical locations. One of the main limitations of this study is that it primarily draws on responses from SMEs located in NSW, Australia, and therefore limits sample heterogeneity by excluding data from other states around the country. Another limitation is the potentially small sample size, mainly due to the lack of accessibility to SME owners, primarily owing to the researcher’s time and resource constraints
Feasibility and acceptability of implementing an evidence-based ESCALATION system for paediatric clinical deterioration
No full textBackground: The ESCALATION system is a novel paediatric Early Warning System that incorporates family involvement and sepsis recognition. This study aimed to assess the feasibility and iteratively refine the ESCALATION system in a variety of hospital settings in preparation for full-service implementation.
Methods: A series of four multi-methods studies using an Implementation Science and co-design approach were conducted. We examined concepts of implementation, context, and mechanisms of action across a variety of hospitals. Data collected included practice and chart audits, surveys (health professionals), interviews (families) and focus groups (health professionals). Quantitative data were analysed descriptively with qualitative findings assessed by content analysis or thematic analysis.
Results: There were 650 audits (Study I–IV), 205 health professional survey responses (Study I), 154 health professionals participated in focus groups (Study II–IV), 13 parents of hospitalised children interviewed (Study I), and 107 parents reported their involvement in the ESCALATION system (Study III–IV). Each of the studies further refined and confirmed the feasibility, specifically the components of family involvement and the sepsis recognition pathway.
Conclusion: The Implementation Science evaluation of the ESCALATION system resulted in a uniform approach that was feasible and acceptable to users and appropriate for full-service implementatio
Pandemic Paradox: A Mixed Methods Study Unmasking the Impact of Covid-19 on Australia\u27s Nursing and Midwifery Workforce Job Satisfaction and Retention
Get PDFBackground: The COVID-19 pandemic has seen an outpouring of attention focusing on the global nursing and midwifery shortage and its damaging impact on healthcare systems worldwide. However, there is limited research, both globally and in Australia, on its impact on nurses’ and midwives’ job satisfaction and their associated intentions to stay or leave their job and/or profession, as a result. The lack of extensive research in this area highlights the importance of this Doctoral thesis. My research aimed to fill this gap by conducting a detailed study of the personal experiences of nurses and midwives who worked during the pandemic in Australia and examined how COVID-19 affected their job satisfaction.
Aim: The aim of my research study was to investigate Australian Registered Nurses and Registered Midwives’ lived experiences of working through the COVID-19 pandemic, whilst examining how the pandemic has affected their intention to stay, or leave, their job or profession.
Methods: In this convergent parallel mix method research study, 306 Registered Nurses, 42 Dual Practicing Registered Nurses and Midwives, and 16 Registered Midwives from across Australia completed an online validated quantitative questionnaire named the Nursing Workplace Satisfaction Questionnaire (developed by Fairbrother and Jones and used with permission). This tool measures three key domains of job satisfaction: intrinsic job satisfaction, extrinsic job satisfaction and relational job satisfaction. Concurrently, further in-depth qualitative data was obtained via 11 semi-structured, online interviews with six Registered Nurses and five Registered Midwives who worked in various facilities across four states and territories, using an Interpretive Phenomenological approach. Furthermore, my study was underpinned by the Postpositivist Theoretical Framework.
Results: Participants experienced significant isolation from the community, family, and friends, feeling like ‘lepers in the eyes of the public’. Participants also reported being bullied and labelled ‘troublemakers’ for questioning unsafe policy changes. Nurses and midwives felt undervalued and expendable, due to the rationing of personal protective equipment that favoured physicians. It was revealed that nurses and midwives working in both public and private sectors reported lower levels of extrinsic and relational job satisfaction compared to those employed in just one sector. This variation was confirmed as statistically significant. Midwives showed higher relational job satisfaction, yet lower extrinsic job satisfaction compared their nursing
counterparts. While participants dual practicing as nurses and midwives reported higher job satisfaction in all categories. Specifically, their relational job satisfaction was statistically significant. The study’s midwifery participants likened pandemic healthcare protocol changes, such as limited pain relief and birthing partner restrictions, to a loss of women’s rights. Participants relied on personal resilience to cope with organisational failures and shortcomings. Poor organisational resilience led to participants having feelings of helplessness and anxiety. Nurses and midwives in Western Australia had job satisfaction levels remarkably similar to those in other states and territories, with only a 0.01% difference. Profound emotional distress was evident among participants regarding redeployment. In some cases, redeployment anxiety surpassed the fear of the pandemic itself. The participants reported severe mental health deterioration during the pandemic, including burnout, anxiety, depression, post-traumatic stress disorders, suicidal ideation, and disrupted sleep patterns with nightmares akin to wartime experiences.
Conclusion and Implications: In my study it was found that challenges like isolation, workplace bullying, and societal perceptions negatively impacted nurses and midwives intrinsic job satisfaction, with individual resilience being crucial in mitigating these effects. Extrinsic job satisfaction was severely affected by hierarchical bullying, often forcing nurses and midwives to choose between unsafe practices and professional repercussions. Relational job satisfaction varied, with midwives generally having higher relational job satisfaction, but were more adversely affected by strict pandemic guidelines that affected the relational aspect of their profession. Despite being calculated independently, each individual job satisfaction (intrinsic, extrinsic, and relational) score was found to be statistically correlated.
Regardless of the case numbers or mortality rates, nurses and midwives are inherently prone to psychological distress due to the inherent nature and demands of their professional role, identity, and sense of duty. Involvement in pre-pandemic preparedness and informed awareness about potential redeployment may reduce the shock of sudden redeployment during a pandemic. My study highlights the need for organisational adaptability and proactive risk management, shifting the focus from individual resilience to organisational responsibility
Loss in Light of the Last Things: Christianity, eschatology, and grief in inside out
No full textWith reference to the film Inside Out, we show how Christian eschatology helps us understand the personal experience of grieving loss, generated by capital’s demands for labor hypermobility and its resultant disjunctures in a person’s biography. Inside Out cinematically portrays, in seemingly unremarkable moments, an inbreaking of a redemptive eschatological moment. We organize our case around two eschatological themes, those of judgement and death. The first section links a person’s affective experience, the structures that generate those experiences, and the last things; we make our case using Merleau-Ponty’s account of the intervolved body and Affect Theory’s relationship to Foucauldian power. The second section investigates what becomes of loss and restoration when they are refracted eschatologically, using Guardini’s idea of biographical death, Critical Theory’s conception of the Messianic, and Bonaventure’s conception of the convergence of opposites. We ultimately propose that, seen in the light of the last things, grieving over loss and its opposite, the restoration of what was lost, converge into one and the same thing. A third section will circle back to Inside Out and highlight the contours of the restoration of that which was lost in light of the two eschatological themes above
Clinician\u27s perspectives on the feasibility of patient controlled analgesia in emergency departments: A qualitative descriptive study
No full textBackground: Despite pain being the most common reason for patients to visit the emergency department (ED), conventional pain management methods are often inadequate. Patient controlled analgesia (PCA), which allows patients to self-administer intravenous analgesia, is widely used across many hospital wards, however, is not routinely used in ED. We aimed to identify clinicians’ perceptions of PCA use in the ED setting.
Methods: A qualitative descriptive approach was employed using semi-structured individual interviews conducted with ED clinicians from two hospitals in Western Australia. Interviews were recorded and transcribed. Data was analysed using qualitative content analysis.
Results: Data saturation was achieved after 20 participant interviews. Five themes emerged from the interview data: sustainability and choosing the right patient; time; safety concerns and side effects; anticipating the patient’s perspective (staff perception); facilitating PCA use in ED.
Conclusion: Most participants perceived that patients would experience several benefits from PCA use in ED. Several perceived barriers and facilitators were also identified. To facilitate the use of PCA in ED, there is a need for staff education on PCA use, patient selection guidelines and effective change management strategies. Further research about the time it takes to administer analgesia via PCA compared with conventional methods is needed