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Perceptions of nurses working with psychiatric consumers regarding the elimination of seclusion and restraint in psychiatric inpatient settings and emergency departments: An Australian survey
Get PDFCopyright © 2018 Australian College of Mental Health Nurses Inc.
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.Seclusion and restraint continue to be used across psychiatric inpatient and emergency settings, despite calls for elimination and demonstrated efficacy of reduction initiatives. This study investigated nurses’ perceptions regarding reducing and eliminating the use of these containment methods with psychiatric consumers. Nurses (n = 512) across Australia completed an online survey examining their views on the possibility of elimination of seclusion, physical restraint, and mechanical restraint as well as perceptions of these practices and factors influencing their use. Nurses reported working in units where physical restraint, seclusion, and, to a lesser extent, mechanical restraint were used. These were viewed as necessary last resort methods to maintain staff and consumer safety, and nurses tended to disagree that containment methods could be eliminated from practice. Seclusion was considered significantly more favourably than mechanical restraint with the elimination of mechanical restraint seen as more of a possibility than seclusion or physical restraint. Respondents accepted that use of these methods was deleterious to relationships with consumers. They also felt that containment use was a function of a lack of resources. Factors perceived to reduce the likelihood of seclusion/restraint included empathy and rapport between staff and consumers and utilizing trauma‐informed care principles. Nurses were faced with threatening situations and felt only moderately safe at work, but believed they were able to use their clinical skills to maintain safety. The study suggests that initiatives at multiple levels are needed to help nurses to maintain safety and move towards realizing directives to reduce and, where possible, eliminate restraint use
The effectiveness of a stage-based lifestyle modification intervention for obese children
Get PDFThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background
Interventions that encompass behavioural modifications of dietary intake and physical activity are essential for the management of obesity in children. This study assessed the effectiveness of a stage-based lifestyle modification intervention for obese children.
Methods
A total of 50 obese children (7–11 years old) were randomized to the intervention group (IG, n = 25) or the control group (CG, n = 25). Data were collected at baseline, at follow-up (every month) and at six months after the end of the intervention. IG received stage-based lifestyle modification intervention based on the Nutrition Practice Guideline for the Management of Childhood Obesity, while CG received standard treatment. Changes in body composition, physical activity and dietary intake were examined in both the intervention and control groups.
Results
Both groups had significant increases in weight (IG: 1.5 ± 0.5 kg; CG: 3.9 ± 0.6 kg) (p < 0.01) and waist circumference (IG: 0.1 ± 0.5 cm; CG: 2.2 ± 0.7 cm) (p < 0.05), but the increases were significantly higher in CG than IG. Body Mass Index (BMI)-for-age z scores decreased significantly in IG (− 0.2 ± 0.0, p < 0.01) but not in CG. The physical activity of the IG significantly increased (0.44 ± 0.13) compared with that of CG (− 0.28 ± 0.18), and the difference in mean change between groups was statistically significant (p < 0.05). Dietary intake was not significantly different between the two groups. However, calorie and carbohydrate intake decreased significantly in both groups.
Conclusions
A stage-based intervention that modified dietary and physical activity behaviour may be effective in weight management for obese children.
Trial registration
NCT03429699 retrospectively registered 9 February 2018
"They're not the flavour of the month": regional primary health care organisations and primary health care for migrants and people from refugee backgrounds in Australia
No full text© The Author(s) 2018. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.Introduction:
Globally, new migrants and refugees face barriers accessing Primary Health Care (PHC) and experience inequitable health outcomes. Many nations have regional PHC organisations (RPHCOs) to coordinate PHC. This paper describes a project examining PHC in Australia in two incarnations of RPHCOs – Medicare Locals (MLs) and Primary Health Networks (PHNs). We consider the extent to which they facilitated the PHC needs of migrants and refugees, and how RPHCOs in Australia and internationally might be improved.
Methods:
We undertook analysis of ML and PHN reports, a survey of senior staff and board members (N = 121 ML and N = 66 PHN), individual interviews with senior staff in MLs (N = 50) and PHNs (N = 55) and 8 focus groups with migrant/refugee organisations across Australia (N = 62). Documents and interviews were analysed thematically and survey data using frequencies.
Results:
Multiple barriers to PHC access were identified. Migrant/refugee health was reported as a low priority for RPHCOs, though some with larger migrant/refugee populations had specific initiatives. In the surveys 117 (56%) ML and 27 (41%) PHN staff reported somewhat/very effective relationships with migrant health organisations. However, in focus groups with migrant/refugee organisations low levels of RPHCO engagement were reported and there was little migrant/refugee health representation on RPHCO boards. A lack of policy and political support and limited resources were reported as key barriers. Facilitators included migrant/refugee health being a priority, ‘champions’ within RPHCOs, dedicated funding, long-term relationships with migrant/refugee organisations, and social health approaches.
Conclusions:
Comprehensive PHC delivery for migrants and refugees RPHCOs requires strong collaborations with migrant/refugee organisations, relevant policy frameworks, flexible funding, and social health approaches.
Main messages:
Despite comprehensive PHC being crucial for new migrants and refugees, they face many access barriers.
RPHCOs have the potential to facilitate PHC access but require strong policy frameworks, adequate funding and effective collaboration with migrant and refugee organisations
A framework for regional primary health care to organise actions to address health inequities
Get PDF“This is a post-peer-review, pre-copyedit version of an article published in International Journal of Public Health. The final authenticated version is available online at: http://dx.doi.org/10.1007/s00038-018-1083-9”.
© Swiss School of Public Health (SSPH+) 2018Objectives
Regional primary health-care organisations plan, co-ordinate, and fund some primary health-care services in a designated region. This article presents a framework for examining the equity performance of regional primary health-care organisations, and applies it to Australian Medicare Locals (funded from 2011 to 2015).
Methods
The framework was developed based on theory, literature, and researcher deliberation. Data were drawn from Medicare Local documents, an online survey of 210 senior Medicare Local staff, and interviews with 50 survey respondents.
Results
The framework encompassed equity in planning, collection of equity data, community engagement, and strategies to address equity in access, health outcomes, and social determinants of health. When the framework was applied to Medicare Locals, their inclusion of equity as a goal, collection of equity data, community engagement, and actions improving equity of access were strong, but there were gaps in broader advocacy, and strategies to address social determinants of health, and equity in quality of care.
Conclusions
The equity framework allows a platform for advancing knowledge and international comparison of the health equity efforts of regional primary health-care organisations
Outcome predictability biases cued search
Get PDF"©American Psychological Association, 2018. This paper is not the copy of record and may not exactly replicate the authoritative document published in the APA journal. Please do not copy or cite without author's permission. The final article is available, upon publication, at: https://doi.org/10.1037/xlm0000529"Within the domain of associative learning, there is substantial evidence that people (and other animals) select among environmental cues on the basis of their reinforcement history. Specifically, people preferentially attend to, and learn about, cueing stimuli that have previously predicted events of consequence (a predictiveness bias). By contrast, relatively little is known about whether people prioritize some (to-be-predicted) outcome events over others on the basis of their past experience with those outcomes (a predictability bias). The present experiments assessed whether the prior predictability of a stimulus results in a learning bias in a contingency learning task, as such effects are not anticipated by formal models of associative learning. Previously unpredictable stimuli were less readily learned about than previously predictable stimuli. This pattern is unlikely to reflect the use of strategic search processes or blocking of learning by the context. Instead we argue that our findings are most consistent with the operation of a biased learning mechanism. (PsycINFO Database Record (c) 2018 APA, all rights reserved
Cross-ancestry genome-wide association analysis of corneal thickness strengthens link between complex and Mendelian eye diseases
Get PDFOpen Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/.
This article has been corrected, correction published 14 May 2018Central corneal thickness (CCT) is a highly heritable trait associated with complex eye diseases such as keratoconus and glaucoma. We perform a genome-wide association meta-analysis of CCT and identify 19 novel regions. In addition to adding support for known connective tissue-related pathways, pathway analyses uncover previously unreported gene sets. Remarkably, >20% of the CCT-loci are near or within Mendelian disorder genes. These included FBN1, ADAMTS2 and TGFB2 which associate with connective tissue disorders (Marfan, Ehlers-Danlos and Loeys-Dietz syndromes), and the LUM-DCN-KERA gene complex involved in myopia, corneal dystrophies and cornea plana. Using index CCT-increasing variants, we find a significant inverse correlation in effect sizes between CCT and keratoconus (r = −0.62, P = 5.30 × 10−5) but not between CCT and primary open-angle glaucoma (r = −0.17, P = 0.2). Our findings provide evidence for shared genetic influences between CCT and keratoconus, and implicate candidate genes acting in collagen and extracellular matrix regulation
Forskolin reduces fat accumulation in Nile tilapia (Oreochromis niloticus) through stimulating lipolysis and beta-oxidation
Get PDF© 2018 Published by Elsevier Ltd. This manuscript version is made available under the CC-BY-NC-ND 4.0 license: http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (December 2018) in accordance with the publisher’s archiving policyHigh fat diets are commonly used in aquaculture to reduce feed cost in Nile tilapia, but impair its lipid homeostasis. This study evaluated the role of forskolin on reducing fat accumulation in Nile tilapia (Oreochromis niloticus) by using in vitro and in vivo experiments. The use of 50 μM forskolin in vitro increased free fatty acid and glycerol release, but decreased triglyceride in adipocytes and hepatocytes. The adipose triglyceride lipase (ATGL), protein kinase cAMP-dependent type I regulatory subunit alpha (PKAR I) and other genes related to β-oxidation (peroxisome proliferator activated receptor alpha, PPARα and carnitine O-palmitoyltransferase 1, CPT1) were significantly up-regulated. After feeding a high-fat diet for six weeks, O. niloticus were fed with 0 (control), 0.5 and 1.5 mg/kg forskolin for two weeks to determine whether forskolin could reduce fat accumulation in vivo. Fish fed the two levels of forskolin decreased significantly the hepatosomatic and mesenteric fat indices. The total lipid in the whole fish and liver together with the serum glycerol content were lower in fish fed on forskolin than in the control. The fish fed on forskolin diets exhibited smaller areas of lipid droplets in adipose and liver tissues. Lipolysis related genes (ATGL, hormone-sensitive lipase, HSL; monoacylglycerol lipase, MGL; and protein kinase cAMP-activated catalytic subunit, PKAC) and β-oxidation genes (PPARα; fatty acid binding protein 1, FABP1; and CPT1) in the adipose were up-regulated. Similarly, in the liver lipolysis genes such as ATGL and PKAR I and β-oxidation genes (PPARα, FABP1, CPT1 and acyl-CoA oxidase, ACO) showed an increasing trend with the increase of forskolin doses. This study indicates that forskolin can reduce fat accumulation in the adipose and liver by stimulating lipolysis and β-oxidation in O. niloticus
Oxygen titration after resuscitation from out-of-hospital cardiac arrest: A multi-centre, randomised controlled pilot study (the EXACT pilot trial)
Get PDF© 2018 Elsevier. This manuscript version is made available under the CC-BY-NC-ND 4.0 license:http://creativecommons.org/licenses/by-nc-nd/4.0/
This author accepted manuscript is made available following 12 month embargo from date of publication (April 2018) in accordance with the publisher’s archiving policyIntroduction
Recent studies suggest the administration of 100% oxygen to hyperoxic levels following return-of-spontaneous-circulation (ROSC) post-cardiac arrest may be harmful. However, the feasibility and safety of oxygen titration in the prehospital setting is unknown. We conducted a multi-centre, phase-2 study testing whether prehospital titration of oxygen results in an equivalent number of patients arriving at hospital with oxygen saturations SpO2 ≥ 94%.
Methods
We enrolled unconscious adults with: sustained ROSC; initial shockable rhythm; an advanced airway; and an SpO2 ≥ 95%. Initially (Sept 2015–March 2016) patients were randomised 1:1 to either 2 L/minute (L/min) oxygen (titrated) or >10 L/min oxygen (control) via a bag-valve reservoir. However, one site experienced a high number of desaturations (SpO2 < 94%) in the titrated arm and this arm was changed (April 2016) to an initial reduction of oxygen to 4 L/min then, if tolerated, to 2 L/min, and the desaturation limit was decreased to <90%.
Results
We randomised 61 patients to titrated (n = 37: 2L/min = 20 and 2–4 L/min = 17) oxygen or control (n = 24). Patients allocated to titrated oxygen were more likely to desaturate compared to controls ((SpO2 < 94%: 43% vs. 4%, p = 0.001; SpO2 < 90%: 19% vs. 4%, p = 0.09). The majority of desaturations (81%) occurred at 2L/min. On arrival at hospital the majority of patients had a SpO2 ≥ 94% (titrated: 90% vs. control: 100%) and all patients had a SpO2 ≥ 90%. One patient (control) re-arrested. Survival to hospital discharge was similar.
Conclusion
Oxygen titration post-ROSC is feasible in the prehospital environment, but incremental titration commencing at 4L/min oxygen flow may be needed to maintain an oxygen saturation >90% (NCT02499042)