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A South African experience in applying the Adopt–Contextualise–Adapt framework to stroke rehabilitation clinical practice guidelines
Full text link© The Author(s). 2019 This 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: Clinical practice guideline (CPG) activity has escalated internationally in the last 20 years, leading to increasingly sophisticated methods for CPG developers and implementers. Despite this, there remains a lack of practical support for end-users in terms of effectively and efficiently implementing CPG recommendations into local practice. This paper describes South African experiences in implementing international CPG recommendations for best practice stroke rehabilitation into local contexts, using a purpose-build approach. METHODS: Composite recommendations were synthesised from 16 international CPGs to address end-user questions about best practice rehabilitation for South African stroke survivors. End-user representatives on the project team included methodologists, policy-makers, clinicians, managers, educators, researchers and stroke survivors. The Adopt–Contextualise–Adapt model was applied as a decision-guide to streamline discussions on endorsement and development of implementation strategies. Where recommendations required contextualisation to address local barriers before they could be effectively implemented, prompts were provided to identify barriers and possible solutions. Where recommendations could not be implemented without additional local evidence (adaptation), options were identified to establish new evidence. FINDINGS: The structured implementation process was efficient in terms of time, effort, resources and problem solving. The process empowered the project team to make practical decisions about local uptake of international recommendations, develop local implementation strategies, and determine who was responsible, for what and when. Different implementation strategies for the same recommendation were identified for different settings, to address different barriers. CONCLUSION: The South African evidence translation experience could be useful for evidence implementers in other countries, when translating CPG recommendations developed elsewhere, into local practice
The association between nutritional adequacy and 28-day mortality in the critically ill is not modified by their baseline nutritional status and disease severity
Full text link© The Author(s). 2019 This 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: During the initial phase of critical illness, the association between the dose of nutrition support and mortality risk may vary among patients in the intensive care unit (ICU) because the prevalence of malnutrition varies widely (28 to 78%), and not all ICU patients are severely ill. Therefore, we hypothesized that a prognostic model that integrates nutritional status and disease severity could accurately predict mortality risk and classify critically ill patients into low- and high-risk groups. Additionally, in critically ill patients placed on exclusive nutritional support (ENS), we hypothesized that their risk categories could modify the association between dose of nutrition support and mortality risk. METHODS: A prognostic model that predicts 28-day mortality was built from a prospective cohort study of 440 patients. The association between dose of nutrition support and mortality risk was evaluated in a subgroup of 252 mechanically ventilated patients via logistic regressions, stratified by low- and high-risk groups, and days of exclusive nutritional support (ENS) [short-term (≤ 6 days) vs. longer-term (≥ 7 days)]. Only the first 6 days of ENS was evaluated for a fair comparison. RESULTS: The prognostic model demonstrated good discrimination [AUC 0.78 (95% CI 0.73–0.82), and a bias-corrected calibration curve suggested fair accuracy. In high-risk patients with short-term ENS (≤ 6 days), each 10% increase in goal energy and protein intake was associated with an increased adjusted odds (95% CI) of 28-day mortality [1.60 (1.19–2.15) and 1.47 (1.12–1.86), respectively]. In contrast, each 10% increase in goal protein intake during the first 6 days of ENS in high-risk patients with longer-term ENS (≥ 7 days) was associated with a lower adjusted odds of 28-day mortality [0.75 (0.57–0.99)]. Despite the opposing associations, the mean predicted mortality risks and prevalence of malnutrition between short- and longer-term ENS patients were similar. CONCLUSIONS: Combining baseline nutritional status and disease severity in a prognostic model could accurately predict 28-day mortality. However, the association between the dose of nutrition support during the first 6 days of ENS and 28-day mortality was independent of baseline disease severity and nutritional status
Supplementary Materials. Modelling files for "Evaporation and salt accumulation effects on riparian freshwater lenses"
No full textDataset is 380 files (4.10Gb, compressed (zipped) to 424Mb).
© Flinders University. This dataset made available with CC BY 4.0: Attribution 4.0 International license.The files are input files for SUTRASET, the code used to simulate floodplain flow and transport for the manuscript: "Evaporation and salt accumulation effects on riparian freshwater lenses
Slavery and Slavery-like Practices in South Australia: a Report
No full text© Flinders University. Material in this report is provided under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).Slavery and slavery-like practices are a reality in South Australia (SA). These situations include cases of forced marriage; forced labour; and domestic, labour and sexual servitude in intimate partner violence cases linked to partner visas. These slavery practices are a gross violation of human rights as they reduce a person to a commodity to be exploited, and they are criminalised in the Commonwealth Criminal Code 1995 (divisions 270 and 271)
Consumers respond to a model for (re)building consumer trust in the food system
Full text link© 2019 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 (February 2019) in accordance with the publisher’s archiving policyResearchers and food system actors have developed a best practice model to assist with (re)building or maintaining consumer trust in the food system in the event of a food incident. The aim of the present study was to determine how well the model aligns with consumer views of the strategies required to maintain consumer trust during and following a food incident. This qualitative public deliberation study employed experimental, developmental vignettes during 2 full-day sessions in May 2018. Following general discussion of the food incident scenario presented in the vignettes, 15 South Australian adults (in two groups) developed a collated and ranked list of key strategies to be used by food system actors during a food incident to assist in maintaining consumer trust. Participants were then introduced to the existing model, and engaged in discussions about if and how their strategies aligned with those in the existing model. Findings demonstrate broad consistency between the two groups and the model in the strategies identified as key for (re)building and maintaining consumer trust during a food incident. For example, timely transparency was reported by consumers as the key strategy for maintaining consumer trust during and after a food incident. However, participants expressed pessimism regarding actors’ ability to implement strategies. Although minimal, differences were noted in strategy descriptions between the groups and the Model. This study suggests that overall the model is highly consistent with consumer views. If actors are to demonstrably apply the Model in the event of a food incident, our data suggest that the identified strategies will successfully assist them in (re)building and/or maintaining consumer trust in the food supply
Fresh living Arthrospira as dietary supplements: Current status and challenges
Full text link© 2019 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 (April 2019) in accordance with the publisher’s archiving policyBackground
Arthrospira (Spirulina) spp. has long been consumed as a dietary supplement that provides rich natural nutrients consisting of 60–70% proteins including essential amino acids, vitamins, and some minerals. The currently available Spirulina products in the market are mainly hot and spray-dried and their nutritional values are significantly compromised due to degradation of the heat-sensitive bioactive components.
Scope and approach
This commentary provides a critical view on the differences in main nutritional composition between dried and fresh living Arthrospira. In addition, the current R&D advances in the development of fresh living Arthrospira as a dietary supplement including the cultivation system, preservation and storage, product development, nutritional and functional properties and food safety were critically discussed.
Key findings and conclusions
Fresh living Arthrospira can better maintain their nutritional, functional, and health values, and therefore could be developed for a new range of Arthrospira derived products. However, the cultivation system that could ensure the food safety and long-term storage technologies to preserve the cell viability in different product formulations are still under development for expanding the commercial applications
Should we provide outreach rehabilitation to very old people living in Nursing Care Facilities after a hip fracture? A randomised controlled trial
Full text link© The Author(s) 2019. Published by Oxford University Press on behalf of the British Geriatrics Society.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited.To determine whether a 4-week postoperative rehabilitation program delivered in Nursing Care Facilities (NCFs) would improve quality of life and mobility compared with receiving usual care
Trust and Community Treatment Orders
Full text linkCopyright © 2019 McMillan, Lawn and Delany-Crowe. This 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.There are conflicting views about the benefits of community treatment orders (CTOs) for people with mental illness. While there is a significant literature on the coercive nature of CTOs, there is less on the impact that CTOs have upon trust. A recovery-oriented approach requires a trusting therapeutic relationship and the coercion inherent in the CTO process may make it difficult for trust to be built, nurtured, and sustained between workers and patients. Our aim was therefore to examine the role of trust within the CTO experience for mental health workers and patients on CTOs.
Methods: We conducted a thematic discourse analysis of 8 in-depth interviews with people who were currently on a CTO and 10 interviews with multi-disciplinary mental health workers in Adelaide, Australia (total N = 18 interviews). The interviews were coded and analyzed with the assistance of a patient representative. The findings reveal the challenges and opportunities for trust within the coercive relationship of a CTO.
Findings: We found that patients have diverse experiences of CTOs and that trust or mistrust played an import role in whether or not they found the CTO beneficial
How Can Activity Monitors Be Used in Palliative Care Patients?
Full text linkCopyright 2019, Mary Ann Liebert, Inc., publishers“Final publication is available from Mary Ann Liebert, Inc., publishers http://dx.doi.org/10.1089/jpm.2018.0414”
This author accepted manuscript is made available following 12 month embargo from date of publication (March 2019) in accordance with the publisher’s archiving policyBackground: Physical activity in palliative care patients is closely linked to independence, function, carer burden, prognosis, and quality of life. Changes in physical activity can also be related to service provision needs, including requirements for support and prognosis. However, the objective measurement of physical activity is challenging, with options, including self-report, invasive and intensive measures such as calorimetry, or newer options such as pedometers and accelerometers. This latter option is also becoming more viable with the advent of consumer technology driven by the health and exercise industry.
Objective: In this article, we highlight our experiences of activity monitoring in palliative care patients as part of telehealth trial. We also highlight the strengths and limitations of activity monitoring in the palliative care population and potential applications.
Conclusions: Although the advent of consumer technology for activity measurement makes their use seem attractive in clinical settings for palliative care patients, there are a number of issues that must be considered, in particular the reason for the activity monitoring and associated limitations in the technology
Macular GCIPL loss precedes peripapillary RNFL loss in glaucoma with lower intraocular pressure
Full text link© 2019 by the American Academy of Ophthalmology. 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 (March 2019) in accordance with the publisher’s archiving policyPurpose
To investigate which clinical measures influence whether an individual demonstrates earliest glaucomatous structural progression on peripapillary retinal nerve fibre layer (pRNFL) or macular ganglion cell-inner plexiform layer (mGCIPL).
Design
Prospective longitudinal cohort study.
Participants
271 eyes from 207 individuals with statistically significant evidence of glaucomatous progression on optical coherence tomography (OCT)-Guided Progression Analysis (GPA) software were drawn from a total of 1271 eyes from 686 individuals categorized as glaucoma suspect or having early manifest glaucoma undergoing glaucoma surveillance.
Methods
Individuals demonstrating earliest evidence of longitudinal progression on mGCIPL GPA event analysis were compared to individuals demonstrating evidence of earliest longitudinal progression on pRNFL GPA event analysis.
Outcome Measures
Correlation of OCT event change analysis with intraocular pressure (IOP), clinical variables, and baseline thickness of the pRNFL and mGCIPL.
Results
IOP, baseline pRNFL thickness, baseline mGCIPL thickness and systemic hypertension were associated with location of first progression. Eyes demonstrating earliest longitudinal progression on mGCIPL had significantly lower maximum-recorded pre-treatment IOP (mean difference: 3.90mmHg, 95%CI: 2.37-5.43; p<0.001). The time interval between progression on pRNFL and progression on mGCIPL increased by 12.4 months for every 5mmHg increase in IOP (95%CI: 10.32 -15.72). Eyes demonstrating earliest longitudinal progression on mGCIPL had significantly lower baseline average pRNFL thickness than eyes progressing on pRNFL first (mean difference: 7.07μm; 95%CI: 4-38-9.77; p<0.001). Eyes progressing first on mGCIPL parameters were 3.03 times more likely to develop a new paracentral field defect than cases progressing first on pRNFL parameters (OR: 3.03; 95%CI: 1.26-7.28; p=0.01).
Conclusion
Clinical features, particularly pre-treatment IOP, influence whether structural glaucoma progression is detected earlier with mGCIPL or pRNFL imaging. These data support the utility of mGCIPL imaging in addition to pRNFL analysis for detection of glaucoma progression, particularly in patients with normal IOP