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Pain self-management: easier said than done? Factors associated with early dropout from pain self-management in a rural primary care population
Get PDFThis manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (Sept 2018) in accordance with the publisher’s archiving policyObjective
To explore whether psychosocial or demographic factors are associated with early dropout from pain self-management in a rural, low–socioeconomic status population.
Design
Secondary analysis of retrospective data.
Setting
Multidisciplinary pain clinic located in an outer regional area of Australia.Subjects
One hundred eighty-six people attending a public community health center with chronic noncancer pain (mean age 54.9 years; 58.1% women; 81.7% in receipt of government benefit as their primary source of income).
Methods
Bivariate analysis and logistic regression, with early dropout as the dependent variable and a range of demographic and psychological independent variables.
Results
Following bivariate analysis, early dropout was significantly associated (P < 0.05) with male gender, younger age, history of substance use, being a past victim of assault/abuse, receiving unemployment or disability benefit, having literacy difficulties, higher pain catastrophizing score, higher daily opioid dose, and not holding a multifactorial belief about the cause of pain. Logistic regression analysis resulted in three significant predictors of dropout: substance use history (P = 0.002), past victim of assault or abuse (P = 0.029), high pain catastrophising score (P = 0.048); and one of engagement: holding a multifactorial belief about pain cause (P = 0.005).
Conclusions
In a rural, low–socioeconomic status population, addressing social stressors related to lifetime adversity may be important to increasing engagement in pain self-management. Lack of attention to these factors may increase health inequity among those most disabled by chronic pain. Further research into dropout and engagement, especially among disadvantaged populations, is recommended.No funding or financial aid was received for this research
Self-Reported Health Status of Donor Conceived Adults.
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorIntroduction: We previously conducted systematic reviews and meta-analyses of donor egg and sperm neonatal outcomes. Donor egg neonates were significantly more likely to be born of low birth weight (<2500g), very low birth weight (<1500g), and preterm (<37 weeks), compared to those conceived with autologous oocytes. Donor sperm neonates were significantly more likely to be born of low birth weight and with more birth defects than those conceived naturally. The Fetal Origins of Adult Disease hypothesis states that there are some instances of adult diseases that have their origins in-utero. Specifically, those people who have had a poor start in life and at birth, such as being small for gestational age or born prematurely, are more likely to suffer various conditions in adulthood. The systematic review also showed that there were no studies conducted to date looking at the long term health outcomes of donor conceived adults. We therefore conducted an exploratory online self-reported health survey comparing donor conceived adults to those conceived naturally. Methodology: Anonymous respondents from around the world were recruited via snowballing using social media. Various organizations that are involved in donor conception also advertised the survey to their members. Furthermore, some respondents were recruited via the survey website Prolific. Respondents completed a 185 question survey that was approved by Flinders SBREC. Results: The total number of respondents was 1159, with 282 respondents being donor conceived and 877 naturally conceived. Donor conceived adults reported significant differences in general health and some demographics, as well as differing levels of being diagnosed with various conditions in the areas of mental health, EENT, endocrinology, gastrointestinal, immunology, musculoskeletal, and respiratory systems. Conclusion: Donor conceived adults have poorer self-reported health outcomes than naturally conceived adults
Pupil dilation as a measure of listening effort in hearing science
No full textThis abstract was prepared for the inaugural 'HDR Student Conference', Flinders University, November 2018. Copyright © the authorListening effort' can be defined as the mental exertion required to attend to, and understand, an auditory message. The framework for effortful listening (FUEL) (developed in 2016) describes multiple factors that may affect the amount of listening effort that an individual must expend including: hearing status, motivation, level of fatigue and memory capacity. Recently, there has been a surge in interest around the concept, definition and measurement of listening effort. Excessive listening effortful is frequently reported in audiology clinics. Individuals with hearing impairments typically must expend more effort when listening than normal hearing individuals. This effort is further exacerbated in conditions that are acoustically adverse (e.g. those with background noise) and can result in stress and fatigue. In research settings, measurement of task-evoked pupil dilation provides a powerful tool to measure the listening effort that specific auditory tasks require. Presently, there is no objective measure of listening effort available for clinical use. However, task-evoked pupil dilation has the potential to fill this gap. This presentation will introduce the concept of listening effort, review the history of the measurement of task-evoked pupil dilation and its application to hearing sciences and discuss potential clinical applications
Outcomes of Patients Receiving Downstream Revascularization After Initial Medical Management for Non–ST-Segment Elevation Acute Coronary Syndromes (From the TRILOGY ACS Trial)
Get PDF© 2018 Elsevier Inc. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (July 2018) in accordance with the publisher’s archiving policyPatients with non–ST-segment elevation acute coronary syndromes (NSTE ACS) are sometimes treated with medical management alone rather than an invasive strategy. Among those medically managed without revascularization and discharged, a proportion will require revascularization later on, but little is known about this population. In TRILOGY ACS, 9,326 patients with NSTE ACS who were selected for medical management alone were randomized to treatment with prasugrel or clopidogrel and discharged without revascularization. Patient characteristics and ischemic and bleeding outcomes through 30 months were compared between patients who underwent downstream revascularization after the index hospitalization and those who did not. A total of 662 patients (7.1%) underwent later revascularization by percutaneous coronary intervention (73.1%), coronary artery bypass graft surgery (26.4%), or the two (0.5%). Median time to revascularization was 121 days (twenty-fifth, seventy-fifth percentiles: 41, 326). Revascularized patients were younger, more likely to be male, and had higher rates of hyperlipidemia, diabetes mellitus, prior myocardial infarction, and prior revascularization compared with those not revascularized. Europe and North America had the highest rates of revascularization. During the follow-up period, those who underwent revascularization had a higher rate of the composite outcome of cardiovascular death, myocardial infarction, or stroke occurring after revascularization compared with those not revascularized (hazard ratio [HR] 2.73 [95% confidence interval {CI} 2.21 to 3.38], p < 0.001) as well as a higher rate of each of the individual outcomes. Major bleeding was also higher in those who underwent revascularization (GUSTO severe or life-threatening: HR 2.61 [95% CI 1.02 to 6.67], p = 0.045; TIMI major: HR 2.24 [95% CI 1.12 to 4.48], p = 0.022). There was no evidence that bleeding and ischemic outcomes varied by treatment with clopidogrel versus prasugrel. In conclusion, among patients initially medically managed after NSTE ACS, a small proportion later require revascularization and have a high rate of ischemic and major bleeding outcomes compared with those not requiring downstream revascularization.See article under heading of Disclosures
The applicability of community of inquiry framework to online nursing education: A cross-sectional study
Get PDFThis manuscript version is made
available under the CC-BY-NC-ND 4.0 license:
http://creativecommons.org/licenses/by-nc-nd/4.0/ which permits use, distribution and reproduction in any medium, provided the original work is properly cited. This author accepted manuscript is made available following 12 month embargo from date of publication (October 2018) in accordance with the publisher’s archiving policyThe Community of Inquiry (CoI) framework has the potential to contribute to online education by addressing the nexus of pedagogy, technology, and learners’ needs. However, there has been limited investigation of the application of CoI to Australian online tertiary education, with the awareness of CoI amongst Australian nurse educators being unknown. This paper reports on a project which used an online survey to investigate the level of awareness of the CoI framework and its applicability to the design of online and blended courses in Australian higher education nursing schools.
Most respondents ranked the core concepts of the CoI framework as applicable for nursing education, but only 20% of the participants were familiar with the CoI framework before they participated in the survey. While nearly 90% of the participants viewed instructional design and a theoretical framework as essential for building an online course, 70% of respondents indicated that they did not use an explicit theoretical framework to guide the design or the evaluation of their nursing teaching and learning. These results provide the impetus for further investigation of factors influencing the development of online nurse education including the specific consideration of CoI frameworks.This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors
Reduced Excitability and Increased Neurite Complexity of Cortical Interneurons in a Familial Mouse Model of Amyotrophic Lateral Sclerosis
Get PDFThis is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.Cortical interneurons play a crucial role in regulating inhibitory-excitatory balance in brain circuits, filtering synaptic information and dictating the activity of pyramidal cells through the release of GABA. In the fatal motor neuron (MN) disease, amyotrophic lateral sclerosis (ALS), an imbalance between excitation and inhibition is an early event in the motor cortex, preceding the development of overt clinical symptoms. Patients with both sporadic and familial forms of the disease exhibit reduced cortical inhibition, including patients with mutations in the copper/zinc superoxide-dismutase-1 (SOD1) gene. In this study, we investigated the influence of the familial disease-causing hSOD1-G93A ALS mutation on cortical interneurons in neuronal networks. We performed whole-cell patch-clamp recordings and neurobiotin tracing from GFP positive interneurons in primary cortical cultures derived from Gad67-GFP::hSOD1G93A mouse embryos. Targeted recordings revealed no overt differences in the passive properties of Gad67-GFP::hSOD1G93A interneurons, however the peak outward current was significantly diminished and cells were less excitable compared to Gad67-GFP::WT controls. Post hoc neurite reconstruction identified a significantly increased morphological complexity of the Gad67-GFP::hSOD1G93A interneuron neurite arbor compared to Gad67-GFP::WT controls. Our results from the SOD1 model suggest that cortical interneurons have electrophysiological and morphological alterations that could contribute to attenuated inhibitory function in the disease. Determining if these phenomena are driven by the network or represent intrinsic alteration of the interneuron may help explain the emergence of inhibitory susceptibility and ultimately disrupted excitability, in ALS.This work was supported by the Stanford Family Motor Neuron Disease Collaboration Grant (#D0023678) and the Betty Laidlaw Motor Neuron Disease Research Grant (#BLP17), Motor Neuron Disease Research Institute of Australia; the Tasmanian Masonic Centenary Medical Research Foundation (#D0019780); Motor Neuron Disease Research Institute of Australia PhD Scholarship (C0021191); the Select Foundation Fellowship (#D0020742); Australian Research Council Discovery Early Career Research Award (#DE170101514) and the Broadreach Holdings Post-doctoral Medical Research Fellowship
Laser-Ablated Vortex Fluidic-Mediated Synthesis of Superparamagnetic Magnetite Nanoparticles in Water Under Flow
Get PDFACS AuthorChoice - This is an open access article published under an ACS AuthorChoice License, which permits copying and redistribution of the article or any adaptations for non-commercial purposesSelective formation of only one iron oxide phase is a major challenge in conventional laser ablation process, as is scaling up the process. Herein, superparamagnetic single-phase magnetite nanoparticles of hexagonal and spheroidal-shape, with an average size of ca. 15 nm, are generated by laser ablation of bulk iron metal at 1064 nm in a vortex fluidic device (VFD). This is a one-step continuous flow process, in air at ambient pressure, with in situ uptake of the nanoparticles in the dynamic thin film of water in the VFD. The process minimizes the generation of waste by avoiding the need for any chemicals or surfactants and avoids time-consuming purification steps in reducing any negative impact of the processing on the environment.The authors gratefully acknowledge the financial support from the Australia Research Council and the Government of South Australia; also the expertise, equipment, and support provided by the Australian Microscopy and Microanalysis Research Facility (AMMRF) and the Australian National Fabrication Facility (ANFF) at the South Australian nodes of the AMMRF and ANFF under the National Collaborative Research Infrastructure Strategy
Editorial: Journal of Orthopaedic Surgery: Past, present and future
Get PDFCreative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons
Attribution-NonCommercial 4.0 License (http://www.creativecommons.org/licenses/by-nc/4.0/) which permits non-commercial
use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open
Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sage).Asia Pacific Orthopaedic Association (APOA), with its current membership of over 24 countries and a membership base of over 60,000, has its humble beginning as the Western Pacific Orthopaedic Association (WPOA) in 1962. The purpose of WPOA was to foster an enduring professional and personal relationship between countries within the Pacific regions with the values of friendship, camaraderie, cooperation and a mutual sharing of experiences, expertise and up-to-date technologies.1 The first congress of WPOA was held in Unzen, near Nagasaki in Japan in 1965. The Journal of Western Orthopaedic Association (JOWPOA) was first published in June 1964 based in Manilla, Philippines. The first Editor-in-Chief was Dr Arthur Hodson and Catalino Jocson. This semi-annual publication gave a voice to WPOA surgeons, and the journal went from auspicious beginnings to being a well-respected regional journal
Assistants in nursing working with mental health consumers in the emergency department
Get PDFThis article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for self-archiving.
This author accepted manuscript is made available following 12 month embargo from date of publication (May 2018) in accordance with the publisher’s archiving policyNursing students, regardless of setting, require skills in working with people with mental health issues. One way to provide students with learning opportunities within the context of limited undergraduate mental health content and lack of mental health placements is through employment as assistants in nursing (AIN). The purpose of the study was to investigate the use of AINs employed in an emergency department in South Australia to supervise (continuous observation) mental health consumers on inpatient treatment orders. Twenty-four participants took part in the study, with AINs (n = 8, all studying in an undergraduate nursing programme), nurse managers (n = 5), and nurses (n = 11) participating in semi-structured interviews. Data were analysed using thematic analysis. Themes focused on (i) the AIN role, their practice, boundaries or restrictions of their role, and the image consumers have of AINs; (ii) learning through experience, where the AIN role was a practical opportunity to learn and apply knowledge obtained through university studies; and (iii) support, which focused on how AINs worked with nursing staff as part of the healthcare team. Overall, participants believed that AINs played an important role in the ED in supervising consumers on involuntary mental health treatment orders, where their unique role was seen to facilitate more positive consumer experiences. The AIN role is one way for nursing students to develop skills in working with people with mental health issues
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Get PDF'This story considers distance, remoteness and alienation in geographic and psychological terms. I hope the protagonist surfs to a safer shore.