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Impact of the Neonatal Resuscitation Video Review program for neonatal staff: a qualitative analysis
No full textBACKGROUND: Neonatal resuscitation video review (NRVR) involves recording and reviewing resuscitations for education and quality assurance. Though NRVR has been shown to improve teamwork and skill retention, it is not widely used. We evaluated clinicians' experiences of NRVR to understand how NRVR impacts learning and can be improved. METHODS: Neonatal Intensive Care Unit (NICU) clinicians with previous NRVR experience were recruited for individual semi-structured interviews. Using a social constructivist viewpoint, five researchers used thematic analysis to analyze participant responses. RESULTS: Twenty-two clinicians (11 nurses, 11 doctors) were interviewed. All participants expressed positive attitudes towards NRVR. Four themes were identified: (1) Learning from reality-exposure to real-life resuscitations was highly clinically relevant. (2) Immersive self-regulation-watching videos aided recall and reflection. (3) Complexities in learner psychological safety-all participants acknowledged viewing NRVR videos could be confronting. Some expressed fear of judgment from colleagues, though the educational benefit of NRVR superseded this. (4) Accessing and learning from diverse vantage points-NRVR promoted group discussion, which prompted participant learning from colleagues' viewpoints. CONCLUSION: Neonatal clinicians reported NRVR to be an effective and safe method for learning and refining skills required during neonatal resuscitation, such as situational awareness and communication. IMPACT: Neonatal resuscitation video review is not known to be widely used in neonatal resuscitation teaching, and published research in this area is limited. Our study examined clinician attitudes towards an established neonatal resuscitation video review program. We found strong support for teaching using neonatal resuscitation video review among neonatal doctors and nurses, with key benefits including increased situational awareness and increased clinical exposure to resuscitations, while maintaining psychological safety for participants. The results of this study add evidence to support the addition of video review to neonatal resuscitation training
Rethinking Models of Chronic Kidney Disease Care: A Narrative Review
No full textBACKGROUND: Chronic kidney disease (CKD) affects over 850 million people worldwide and is associated with significant morbidity and mortality. There has been recent expansion in treatment options to reduce CKD progression and cardiovascular risk, and it is essential that this translates into clinical practice. SUMMARY: The primary objectives of this review were to outline current CKD care models and associated care gaps and review the literature for alternative care models, with a focus on the early detection and management of CKD. Several care models have been proposed to improve CKD management including nurse-led, pharmacy-led, integrated care models and digital interventions, with mixed results. KEY MESSAGES: There is a need for ongoing health systems and implementation research to improve translation of evidence into practice in the management of CKD
Hypothalamic excitatory input to AT1AR and TH expressing neurons of the nucleus of the solitary tract in mice
No full textAutonomic reflexes are modified during development or in response to specific physiological challenges and disease. One modulating region is the hypothalamic paraventricular nucleus (PVN), whose neurons project to the nucleus of the solitary tract (NTS) to modulate viscerosensory input. Yet the neural circuitry by which this is achieved remains ill-defined. Adeno-associated virus was injected into the hypothalamus of TH-GFP or angiotensin type 1A receptor (AT1AR)-GFP mice to drive channel rhodopsin 2 (ChR2) expression. Whole-cell recordings of NTS neurons in close proximity to labelled hypothalamic efferents were made in horizontal slices of the brainstem, allowing activation of both hypothalamic and viscerosensory inputs. Most neurons recorded did not exhibit ChR2-mediated responses, despite extensive hypothalamic axon/terminal labelling. In some NTS neurons, ChR2-mediated stimulation of hypothalamic efferents elicited glutamatergic, AMPA receptor mediated excitatory postsynaptic currents (ChR2-EPSCs). Responsive NTS neurons included both 2nd, and higher, order neurons and AT1AR and few TH expressing neurons. All ChR2-EPSCs tested were blocked by TTX. Some TTX blocked ChR2-EPSCs could be recovered with the co-application 4AP, confirming monosynaptic connection between hypothalamic and NTS neurons. Superimposition of convergent inputs from hypothalamic and viscerosensory efferents resulted in summated EPSCs that would likely increase throughput probability of the viscerosensory signals at NTS neurons. The neural link between the hypothalamus and NTS comprises discreet glutamatergic input, including to TH positive and AT1AR expressing NTS neurons
Cardiac arrest while using the toilet: not uncommon and associated with adverse resuscitation profile
No full textBackground: Out-of-hospital cardiac arrest (OHCA) on the toilet has been reported to be common and possibly driven by straining or vagal stimulus. Toilet-associated OHCA may also create a challenging resuscitation environment. Methods: The national Danish sudden death registry and state-wide Australian End Unexplained Cardiac Death (EndUCD) registry were examined. Persons with a fatal OHCA aged 5–50 years with autopsy-confirmed cardiac or unascertained aetiology were included. Resuscitation-related, aetiological and forensic factors were compared between persons experiencing fatal toilet-associated OHCA versus elsewhere. A composite variable of physiological conditions creating pressure-load or pressure-sensitivity was created, comprising hypertrophic cardiomyopathy, aortic stenosis/coarctation, and aortic aneurysm/dissection. Results: Of 2,463young persons, 75 (3.0 %) experienced toilet-associated fatal OHCA while 2,388 (97.0 %) experienced out-of-toilet OHCA. Australians experienced toilet-associated OHCA 1.7 times more frequently than Danes (4.1 % vs 2.4 %, p = 0.016). Toilet-associated OHCA was less frequently witnessed (13.3 % vs 32.1 %, p = 0.001), with lower rates of bystander cardiopulmonary resuscitation (32.0 % vs 55.7 %, p < 0.0001) and shockable rhythm (5.9 % vs 23.8 %, p = 0.003) compared to non-toilet OHCA. Toxicological results were more frequently positive for illicit substances in toilet-associated OHCA (32.8 % vs 16.3 %, p < 0.0001). No differences were identified in OHCA aetiology, including rates of the composite variable of aetiologies such as hypertrophic cardiomyopathy and aortic dissection. Conclusion: 3.0 % of young fatal OHCA of cardiac aetiology is toilet-associated, with almost double the rates of toilet-associated OHCA in Australia compared to Denmark. No differences in OHCA aetiology were identified in toilet-associated OHCA. Resuscitation-related factors were adverse in toilet-related OHCA, highlighting the need for innovative ways to recognise and respond to toilet-associated OHCA
Getting the full picture: what are the enablers and barriers to a rural pharmacy workforce for employers and employees? A critical review of literature from 2002–2022
No full textAbstract
Purpose of review
Geographical maldistribution of pharmacists to regional and rural areas in Australia is well documented in a similar fashion to other health professions. This narrative review aimed to identify the enablers and barriers to staff recruitment and retention and ascertain the extent of evidence in the literature from the perspective of prospective employers.
Sources of information
A comprehensive literature search was undertaken for peer reviewed, English language articles published from 2002–2022 using non‐Medical Subject Headings (MeSH) terms including ‘rural’, ‘remote’, ‘pharmacy’, ‘pharmacist’, ‘employer’, ‘manager’, ‘workforce’ and ‘practice’, with pharmacy‐specific filters applied using databases MEDLINE/EBSCOhost, PudMed, Scopus, ScienceDirect, and DOAJ (Directory of Open Access Journals). The themes identified were tabulated and analysed.
Key findings
A large number of themes were identified, and much of the literature focused on the perspectives of employees. The most commonly identified themes in the 12 studies included ‘rural origin or background/initial training’, ‘professional relationship with other health professionals’, and ‘lifestyle/lifestyle enabled by cost of housing and living’. Some previously highly regarded predictors such as ‘rural origin’ were less common.
Conclusion
Recent studies suggest that positive experiences during rural clinical placements and initial employment after undergraduate study are likely to be statistically impactful. Only few themes were shared between employees and employers. The existing literature is heavily skewed towards the views of prospective employees, while relatively little regarding the views of employers. Further, original research from an employer's point of view, especially with regards to the challenges they face and any incentives they offer in attracting a pharmacist workforce to rural and regional areas, is needed
Digital health technologies in the accelerating medicines Partnership® Schizophrenia Program
No full textAlthough meta-analytic studies have shown that 25-33% of those at Clinical High Risk (CHR) for psychosis transition to a first episode of psychosis within three years, less is known about estimating the risk of transition at an individual level. Digital phenotyping offers a novel approach to explore the nature of CHR and may help to improve personalized risk prediction. Specifically, digital data enable detailed mapping of experiences, moods and behaviors during longer periods of time (e.g., weeks, months) and offer more insight into patterns over time at the individual level across their routine daily life. However, while novel digital health technologies open up many new avenues of research, they also come with specific challenges, including replicability of results and the adherence of participants. This paper outlines the design of the digital component of the Accelerating Medicines Partnership® Schizophrenia Program (AMP SCZ) project, a large international collaborative project that follows individuals at CHR for psychosis over a period of two years. The digital component comprises one-year smartphone-based digital phenotyping and actigraphy. Smartphone-based digital phenotyping includes 30-item short daily self-report surveys and voice diaries as well as passive data capture (geolocation, on/off screen state, and accelerometer). Actigraphy data are collected via an Axivity wristwatch. The aim of this paper is to describe the design and the three goals of the digital measures used in AMP SCZ to: (i) better understand the symptoms, real-life experiences, and behaviors of those at CHR for psychosis, (ii) improve the prediction of transition to psychosis and other health outcomes in this population based on digital phenotyping and, (iii) serve as an example for replicable and ethical research across geographically diverse regions and cultures. Accordingly, we describe the rationale, protocol and implementation of these digital components of the AMP SCZ project. **Link to video interview: https://vimeo.com/1060935583 *.10.1038/s41537-025-00599-
Digital health to assist recovery after critical illness
No full text© 2025 Nina Elizabeth LeggettThere is a current disconnect between the profound, long-lasting effects of an intensive care unit (ICU) admission on survivors, and the availability of evidence-based recovery programs to support survivors. Evidence published during this PhD program provides novel evidence about the challenges of navigating transitions in care following an ICU admission, from the perspectives of healthcare users and providers. Further, this thesis provides new data related to the feasibility of digital health interventions to support this vulnerable population.
Two systematic reviews conducted during this PhD summarise the current post-ICU interventions for ICU survivors (Chapter 2) and the implementation factors for digital health interventions (Chapter 5). These reviews show that non-hospital-based models of follow-up care are more feasible to deliver than hospital-based models, and that digital health interventions are feasible for ICU survivors.
This thesis includes two qualitative studies (Chapters 3 and 4) of transitions from ICU to primary care, from the perspectives of ICU clinicians, general practitioners, patients and family members. These studies revealed new themes related to the fragmentation of care, and that poor communication between clinicians leads to poor outcomes. The thesis offers clinician and patient-derived solutions to improve communication and care delivery, including several digital health interventions, ready for future testing.
A prospective cohort study (Chapter 6) investigated access to next-generation technologies and the digital health literacy of minority ICU survivor groups. This study determined that it is appropriate to develop and test digital health interventions in ICU survivor groups due to sufficient access and digital health literacy in older adult, culturally and linguistically diverse, and rural ICU survivor populations.
Finally, a pilot feasibility randomised controlled trial (Chapter 7) tested a telehealth peer support program for ICU survivors. This trial demonstrated feasibility across all pre-specified targets and indicated trends towards improved patient-reported health outcomes.
This thesis and its included studies contribute to the development of the science of telehealth and tele-rehabilitation in a critical care cohort. They provide prototype digital health solutions, ready for further rigorous testing, which may improve outcomes for future ICU survivors
Towards an Integrative Account of Potential Mechanisms Mediating the Path From Sleep Dysfunction to Hallucinations
No full textBACKGROUND: Sleep dysfunction shares a bidirectional relationship with hallucinatory experiences, with the strongest path from sleep dysfunction to the occurrence of hallucinatory experiences. This review aimed to identify potential mechanisms through which sleep dysfunction leads to hallucinations. STUDY DESIGN: A narrative review was conducted across 4 levels of explanation: phenomenology (via lived-experience accounts), psychology, neural networks, and neurophysiology. STUDY RESULTS: Relatively few studies have directly tested underlying mechanisms linking sleep dysfunction to hallucinations, particularly at the levels of neural networks and neurophysiology. There is good support for stress as a mediator between sleep dysfunction and hallucinations. Stress was a plausible mechanism across levels of explanation and was supported by sleep manipulation studies in non-clinical populations. Inflammation of the nervous system is affected by sleep loss, which in turn impacts the brain connectivity underpinning hallucinatory experiences. Lived-experience accounts identified 3 novel mechanisms, all of which are meaningful to people with lived experience of hallucinations: source monitoring, mental resilience, and reasoning skills. Quantitative studies show these mechanisms are impacted by sleep loss, but the full causal path from sleep dysfunction to hallucinations via these mechanisms requires testing. CONCLUSIONS: Key priorities for future research are to (1) test stress as a mediator in clinical populations experiencing hallucinations, with stress assessed across the levels of explanation simultaneously; (2) carry out experimental tests of novel potential mediators identified in this review (eg, source monitoring, inflammation, prefrontal cortical networks); and (3) identify potential moderators that might explain individual differences in the lived-experience accounts of the effect of sleep dysfunction on hallucinations
Quantifying the effects of antibiotic resistance and within-host competition on strain fitness in Streptococcus pneumoniae
No full textCompetition plays a key role in shaping the structure and diversity of bacterial populations. In many clinically important bacterial species, strains compete at multiple scales: at the between-host scale for new hosts to colonise, and at the within-host scale during co-colonisation. Characterising these multiple facets of competition plays an important role in understanding bacterial ecology. This is particularly relevant for antibiotic resistance, where competition between antibiotic-susceptible and resistant strains determines resistance dynamics. In this work, we perform survival analyses on a large longitudinal dataset of Streptococcus pneumoniae carriage to quantify how within-host competition affects the rates of clearance and establishment of pneumococcal strains. We find that the presence of a within-host competitor is associated with a 33% increase in clearance and a 54% reduction in establishment. Priority effects and serotype differences partially predict the outcomes of this within-host competition. Further, we quantify the effects of antibiotic resistance on between- and within-host components of fitness. Antibiotic consumption is associated with increased clearance rate for both susceptible and resistant strains, albeit to a higher extent in susceptible strains. In the absence of antibiotics, we find some evidence that resistance is associated with increased susceptibility to within-host competition, suggesting a fitness cost of resistance. Overall, our work provides quantitative insights into pneumococcal competition across scales and the role of this competition in shaping pneumococcal epidemiology