Child health nursing in the Solomon Islands: A qualitative evaluation of the impact of the 'Bachelor of nursing - Child health'

AIM

To explore graduates' perceptions of the impact on nursing practice of a new postgraduate course in child health, developed and implemented in the Solomon Islands in 2016.

BACKGROUND

The Bachelor of Nursing - Child Health was implemented in 2016 to develop nurses' knowledge and skills in child health and paediatric care with the intent to improve national child health outcomes.

DESIGN

A qualitative exploratory, descriptive design was used to evaluate the impact of the Bachelor of Nursing - Child Health on graduates' nursing practice.

METHODS

Fourteen nurses who graduated from the first cohort of students enrolled in the child health course were purposively selected to participate. Participants engaged in individual semi-structured interviews, conducted between August and December 2018. A thematic analysis was undertaken following Braun and Clarke's six-phase process.

RESULTS

Findings from the study demonstrate positive impacts of the course on graduates' nursing practice. These include a perceived enhanced quality of care through their commitment to evidence-based practice, the ability to contribute to capacity building of colleagues, the reinforcement of provincial public health programmes and expanded participation in managerial activities. Following graduation, most alumni took on senior roles and greater responsibilities, felt more confident in managing unwell children, felt there was better access to and quality of child health care at the community and broader country levels and felt recognised by colleagues and communities. Some graduates faced resistance from colleagues to change practice and felt that despite being given greater responsibilities, nursing levels and salaries remained unchanged. This reflected a potential lack of recognition from hospital or provincial managers, the Nursing Council as the regulatory body for the nursing profession, and the Ministry of Health and Medical Services. A lack of human and material resources also impacted quality of care.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

Findings from this study underline the need for the Solomon Islands National University, the Nursing Council, the Public Service and the Ministry of Health and Medical Services to concord and delineate formal accreditation standards for child health nurses. Overall, collaborative efforts and commitments at local, regional and global levels are required to support child health nurses in their ability and ambition to improve national child health outcomes.

CONCLUSIONS

Findings from this study demonstrate positive impacts of the course on graduates' nursing practice. The impact of increasing nurses' knowledge and skills on national child health outcomes could be significant. Ongoing implementation and recognition of this course in the Solomon Islands, as well as more broadly across the Pacific region, are recommended.

Audit tools for culturally safe and responsive healthcare practices with Aboriginal and Torres Strait Islander people: a scoping review

Aboriginal and Torres Strait Islander people in Australia face disparities in accessing culturally safe and appropriate health services. While current cultural safety and responsiveness frameworks set standards for improving healthcare practices, ensuring accountability and sustainability of changes, necessitates robust mechanisms for auditing and monitoring progress. This study examined existing cultural safety audit tools, and facilitators and barriers to implementation, in the context of providing culturally safe and responsive healthcare services with Aboriginal and Torres Strait Islander people. This will assist organisations, interested in developing tools, to assess culturally responsive practice. A scoping review was undertaken using Medline, Scopus, CINAHL, Informit and PsychInfo databases. Articles were included if they described an audit tool used for healthcare practices with Aboriginal and Torres Strait Islander people. Selected tools were evaluated based on alignment with the six capabilities of the Indigenous Allied Health Australia (IAHA) Cultural Responsiveness in Action Framework. Implementation barriers and facilitators were identified. 15 papers were included. Audit tools varied in length, terminology, domains assessed and whether they had been validated or evaluated. Seven papers reported strong reliability and validity of the tools, and one reported tool evaluation. Implementation facilitators included: tool comprehensiveness and structure; effective communication; clear organisational responsibility for implementation; commitment to prioritising cultural competence; and established accountability mechanisms. Barriers included: the tool being time-consuming and inflexible; responsibility for implementation falling on a small team or single staff member; deprioritising tool use; and lack of accountability for implementation. Two of the six IAHA capabilities (respect for the centrality of cultures and inclusive engagement) were strongly reflected in the tools. The limited tool evaluation highlights the need for further research to determine implementation effectiveness and sustainability. Action-oriented tools, which comprehensively reflect all cultural responsiveness capabilities, are lacking and further research is needed to progress meaningful change within the healthcare system.

"Hospitals respond to demand. Public health needs to respond to risk": health system lessons from a case study of northern Queensland's COVID-19 surveillance and response

BACKGROUND

The vast region of northern Queensland (NQ) in Australia experiences poorer health outcomes and a disproportionate burden of communicable diseases compared with urban populations in Australia. This study examined the governance of COVID-19 surveillance and response in NQ to identify strengths and opportunities for improvement.

METHODS

The manuscript presents an analysis of one case-unit within a broader case study project examining systems for surveillance and response for COVID-19 in NQ. Data were collected between October 2020-December 2021 comprising 47 interviews with clinical and public health staff, document review, and observation in organisational settings. Thematic analysis produced five key themes.

RESULTS

Study findings highlight key strengths of the COVID-19 response, including rapid implementation of response measures, and the relative autonomy of NQ's Public Health Units to lead logistical decision-making. However, findings also highlight limitations and fragility of the public health system more generally, including unclear accountabilities, constraints on local community engagement, and workforce and other resourcing shortfalls. These were framed by state-wide regulatory and organisational incentives that prioritise clinical health care rather than disease prevention, health protection, and health promotion. Although NQ mobilised an effective COVID-19 response, findings suggest that NQ public health systems are marked by fragility, calling into question the region's preparedness for future pandemic events and other public health crises.

CONCLUSIONS

Study findings highlight an urgent need to improve governance, resourcing, and political priority of public health in NQ to address unmet needs and ongoing threats.

Feasibility study of the Utstein Style For Drowning to aid data collection on the resuscitation of drowning victims

Aim

The revised Utstein Style For Drowning (USFD) was published in 2015. Core data were considered feasible to be reported in most health systems worldwide. We aimed to determine the suitability of the USFD as a template for reporting data from drowning research.

Method

Clinical records of 437 consecutive drowning presentations to the Sunshine Coast Hospital and Health Service Emergency Departments (ED) between 1/1/2015 and 31/12/2021 were examined for data availability to complete the USFD. The proportions of patients with each variable documented is reported. Time taken to record core and supplementary variables was recorded for 120 consecutive patients with severity of drowning Grade 1 or higher.

Results

There were 437 patients, including 227 (51.9%) aged less than 16 years. There were 253 (57.9%) males and 184 (42.1%) females. Sixty-one patients (13.9%) received cardiopulmonary resuscitation (CPR). There were nine (2.1%) deaths after presentation to the ED. Median time for data entry was 17 minutes for core variables and 6 min for supplementary. This increased to 29 + 6 minutes for patients in cardiac arrest. Sixteen (32.7%) of 49 core variables and four (13.3%) of 30 supplementary variables were documented 100% of the time. One (2.0%) core and seven (23.3%) supplementary variables were never documented. Duration of submersion was documented in 100 (22.9%) patients.

Conclusion

USFD is time consuming to complete. Data availability to enable completion of the USFD varies widely, even in a resource rich health system. These results should be considered in future revisions of the USFD.

Measuring occupational stress in emergency departments

OBJECTIVE

EDs are highly demanding workplaces generating considerable potential for occupational stress experiences. Previous research has been limited by a focus on specific aspects of the working environment and studies focussing on a range of variables are needed. The aim of the present study was to describe the perceptions of occupational stress and coping strategies of ED nurses and doctors and the differences between these two groups.

METHODS

This cross-sectional study was conducted at a public metropolitan hospital ED in Queensland, Australia. All ED nurses and doctors were invited to participate in an electronic survey containing 13 survey measures and one qualitative question assessing occupational stress and coping experiences. Descriptive statistics were employed to report stressors. Responses to open-ended questions were thematically analysed.

RESULTS

Overall, 104 nurses and 35 doctors responded (55.6% response rate). Nurses reported higher levels of both stress and burnout than doctors. They also reported lower work satisfaction, work engagement, and leadership support than doctors. Compared with doctors, nurses reported significantly higher stress from heavy workload/poor skill mix, high acuity patients, environmental concerns, and inability to provide optimal care. Thematic analysis identified high workload and limited leadership and management support as factors contributing to stress. Coping mechanisms, such as building personal resilience, were most frequently reported.

CONCLUSIONS

The present study found organisational stressors adversely impact the well-being of ED nurses and doctors. Organisational-focused interventions including leadership development, strategic recruitment, adequate staffing and resources may mitigate occupational stress and complement individual coping strategies. Expanding this research to understand broader perspectives and especially the impact of COVID-19 upon ED workers is recommended.

Addressing gaps in our understanding of the drowning patient: a protocol for the retrospective development of an Utstein style database and multicentre collaboration

INTRODUCTION

This retrospective observational study aims to create a comprehensive database of the circumstances of drowning (including care provided and outcomes of care) to report against the Utstein style for drowning (USFD) for patients presenting to the emergency department (ED). Four areas will be examined: a feasibility study of the USFD; a comparison of classification and prognostication systems; examination of indications and efficacy of different ventilation strategies; and differences in the circumstances, severity, treatment and outcomes of drowning by sex and gender.

METHODS AND ANALYSIS

This protocol outlines retrospective data collection for all patients presenting to EDs of the Sunshine Coast Hospital and Health Service in Queensland, Australia with the presenting problem or discharge diagnosis of drowning or immersion between 2015 and 2022. Patients computerised health records (emergency medical service record, pathology, radiology results, medical and nursing notes for ED, inpatient units and intensive care units) will be used to extract data for entry into an USFD database. Descriptive (eg, median, IQR) and inferential statistical analyses (eg, analysis of variance) will be used to answer the separate research questions. Development of an International Drowning Registry using the USFD dataset and the Research Electronic Data Capture (REDCap) web application is discussed.

ETHICS AND DISSEMINATION

This study has been approved by Metro North Human Research and Ethics Committee (Project No: 49754) and James Cook University Human Research Ethics Committee (H8014). It has been endorsed by national drowning prevention organisations Royal Life Saving Society Australia (RLSSA) and Surf Life Saving Australia (SLSA). Study findings will provide data to better inform clinical management of drowning patients and provide an evidence base on sex and gender differences in drowning. Results will be disseminated through peer review publications, conference presentations and media releases. Results will also be disseminated through RLSSA and SLSA membership of the Australian and New Zealand Resuscitation Council and the Australian Water Safety Council.

Cervical spine immobilisation is only required in drowning patients at high risk of axial loading of the spine

OBJECTIVES

Wave forced impacts are known to result in cervical spine injuries (CSI) and approximately 20% of drownings in Australia occur at the beach. The most common mechanism of injury in studies examining the frequency of CSI in drowning patients is shallow water diving. The aim of the present study was to determine what proportion of CSIs occurring in bodies of water experienced a concomitant drowning injury in a location where wave forced impacts are likely to be an additional risk factor.

METHODS

Electronic medical records at the Sunshine Coast Hospital and Health Service EDs, Queensland Ambulance Service case records and Surf Life Saving Queensland data between 1 January 2015 and 21 April 2021 were manually linked. Outcomes recorded included victim demographics, scene information, hospital course and patient disposition.

RESULTS

Ninety-one of 574 (15.9%) CSIs occurred in a body of water with risk of drowning. However, only 4 (4.3%) had a simultaneous drowning injury, representing 0.8% (4/483) of drowning presentations. Ten (10.9%) patients reported loss of consciousness, including the four with drowning. The principal mechanism of CSI was a wave forced impact (71/91, 78%). Most injuries occurred at the beach (79/91, 86.8%). Delayed presentation was common (28/91, 31%). A history of axial loading was 100% sensitive when indicating imaging.

CONCLUSIONS

The combination of CSI and drowning is uncommon. Cervical spine precautions are only required in drowning patients with signs or a history, or at high risk of, axial loading of the spine. This paper supports the move away from routine cervical spine precautions even in a high-risk population.

Exploring the nursing student experience at a remote Australian university campus: a qualitative study

Background

Nurses constitute most of the rural and remote Australian health workforce, however staff shortages in these regions are common. Rural exposure, association, and undertaking rural clinical placements can influence health students’ decision to work rurally after graduation, however attending university in rural and remote regions has been shown to be a great contributor. An improved understanding of these nursing students’ experiences may inform changes to teaching and support strategies for these students, which in turn could improve their retention and completion rates, contributing to a more sustainable rural and remote Australian nursing workforce. This study aimed to explore and describe students’ experiences of studying nursing in the context of a satellite university campus located in a remote town, with a focus on education delivery methods, staff, support, student services, and barriers and enablers to successful study.

Methodology

Nine students participated in this qualitative descriptive study. Semi-structured interviews were undertaken, allowing participants to reflect on their experiences as nursing students in the context of a geographically remote satellite university campus. The resulting data were grouped into common themes and summarised.

Results

Students were generally positive regarding lectures delivered by videoconference or recorded lectures, as they allowed for greater flexibility which accommodated their busy personal lives. Face-to-face teaching was especially valuable, and students were particularly positive about their small cohort size, which enabled the creation of strong, supportive relationships between students, their cohort, and teaching and support staff. However, barriers related to student demographics and some difficulties with course engagement and campus staffing were experienced.

Conclusions

The experiences of nursing students at remote university campuses are different from those experienced by traditional, metropolitan university students. Although these nursing students face additional barriers unique to the remote campus context, they benefit from a range of enabling factors, including their close relationships with other students, staff, family, and their local community.

Treatment of the lung injury of drowning: a systematic review

Background

Drowning is a cause of significant global mortality. The mechanism of injury involves inhalation of water, lung injury and hypoxia. This systematic review addressed the following question: In drowning patients with lung injury, what is the evidence from primary studies regarding treatment strategies and subsequent patient outcomes?

Methods

The search strategy utilised PRISMA guidelines. Databases searched were MEDLINE, EMBASE, CINAHL, Web of Science and SCOPUS. There were no restrictions on publication date or age of participants. Quality of evidence was evaluated using GRADE methodology.

Results

Forty-one papers were included. The quality of evidence was very low. Seventeen papers addressed the lung injury of drowning in their research question and 24 had less specific research questions, however included relevant outcome data. There were 21 studies regarding extra-corporeal life support, 14 papers covering the theme of ventilation strategies, 14 addressed antibiotic use, seven papers addressed steroid use and five studies investigating diuretic use. There were no clinical trials. One retrospective comparison of therapeutic strategies was found. There was insufficient evidence to make recommendations as to best practice when supplemental oxygen alone is insufficient. Mechanical ventilation is associated with barotrauma in drowning patients, but the evidence predates the practice of lung protective ventilation. There was insufficient evidence to make recommendations regarding adjuvant therapies.

Conclusions

Treating the lung injury of drowning has a limited evidentiary basis. There is an urgent need for comparative studies of therapeutic strategies in drowning.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13054-021-03687-2.

A scoping review of female drowning: an underexplored issue in five high-income countries

BACKGROUND

Drowning is a significant public health issue, with females accounting for one third of global drowning deaths. The rate of female drowning has not decreased within high-income countries and presentations to hospital have increased. This scoping review aimed to explore adult female unintentional drowning, including risk factors, clinical treatment and outcomes of females hospitalised for drowning.

METHODS

A systematic search of the literature following the PRISMA-ScR framework was undertaken. The databases OVID MEDLINE, Embase, CINAHL, OVID Emcare, Web of Science, Informit and Scopus were accessed. Study locations of focus were Australia, Canada, New Zealand, the United Kingdom, and the United States. Studies from January 2003 to April 2019 were included. The quality of evidence of included studies was assessed using GRADE guidelines.

RESULTS

The final search results included 14 studies from Australia (n = 4), Canada (n = 1), New Zealand (n = 1), United States (n = 6), United Kingdom (n = 1), and one study reporting data from both Australia and United States. Nine studies reported risk factors for female drowning including age, with the proportion of female drowning incidence increasing with age. Although females are now engaging in risk-taking behaviours associated with drowning that are similar to males, such as consuming alcohol and swimming in unsafe locations, their exposure to risky situations and ways they assess risk, differ. Females are more likely to drown from accidental entry into water, such as in a vehicle during a flood or fall into water. This review found no evidence on the clinical treatment provided to females in hospital after a drowning incident, and only a small number of studies reported the clinical outcomes of females, with inconsistent results (some studies reported better and some no difference in clinical outcomes among females).

CONCLUSION

Adult females are a group vulnerable to drowning, that have lacked attention. There was no single study found which focused solely on female drowning. There is a need for further research to explore female risk factors, the clinical treatment and outcomes of females hospitalised for drowning. This will not only save the lives of females, but also contribute to an overall reduction in drowning.

Epidemiology of unintentional fatal drowning among migrants in Australia

OBJECTIVE

This study aimed to describe the epidemiology and risk factors contributing to drowning among migrants in Australia.

METHODS

A total population retrospective epidemiological study of unintentional drowning deaths in Australia between 1 July 2009 and 30 June 2019 of people born outside Australia (migrants). Cases were extracted from the National Coronial Information System. Descriptive statistics, chi-square and relative risk were calculated. Crude drowning rates were based on country of birth and population in Australia.

RESULTS

There were 572 migrant deaths over the study period, 28.9% of total drowning deaths, 82.9% were male. Twenty-one per cent were aged 25-34 years and 40.8% had lived in Australia for 20+ years. Migrants at highest risk of drowning were from: South Korea (2.63/100,000 95%CI: 0.85-8.25), Taiwan (2.29/100,000 95%CI: 0.27-13.44), and Nepal (2.15/100,000 95%CI: 0.23-11.55). Migrants were more likely to drown when around rocks (p<0.001) compared with Australian-born people, who most frequently drowned in rivers (p<0.001).

CONCLUSIONS

Migrants are not over-represented in drowning statistics. However, unique trends were found for drowning among migrants based on country of birth and length of time in Australia. Implications for public health: Holistic drowning prevention strategies and policies are required to effectively lower drowning risk among migrant communities.

Studying nursing at Australian satellite university campuses: A review of teaching, learning and support

Distribution of the Australian health workforce is uneven, with the majority of health professionals favouring metropolitan areas over rural and remote regions. Although nurses account for the largest proportion of the Australian rural and remote health workforce, difficulties with staff recruitment and retention can impact the health care outcomes of these vulnerable populations. Satellite university campuses that offer undergraduate nursing programs might therefore contribute to a more sustainable rural and remote nursing workforce. This narrative literature review aimed at investigating the barriers and enablers that affect students enrolled at satellite nursing campuses, education delivery methods and academic and non-academic strategies employed to enhance the student learning experience. The literature was reviewed across 6 health and education databases. After screening, 12 articles met the inclusion criteria and were analysed, and the data were synthesised using a thematic approach. Three themes arose from the review: student characteristics and associated barriers and enablers to studying nursing at a satellite campus; teaching strategies and learning experiences; and academic and pastoral support. Students studying at satellite campuses were found to have different education experiences and faced challenges unique to their context; however, home support networks and small class sizes were seen as enabling factors. Education delivery methods and support strategies varied depending on remoteness and resources available. Consideration of the factors that affect satellite campus nursing students has the potential to increase student satisfaction and retention, which could result in a more sustainable rural and remote nursing workforce.

Beyond multimorbidity: primary care and the older person with complex needs

The aim of this study was to present the health and social characteristics of community-dwelling older people within the Cairns region who were identified by their GP as having complex care needs. This paper reports the subanalysis of baseline data from the Older Persons Enablement and Rehabilitation (OPEN ARCH) stepped wedge randomised controlled trial of an integrated model of care for community-dwelling older people. Data were analysed at the level of the participant and the level of the participant cluster (group of participants from the one GP). Median quality of life, as assessed by the EQ-5D, was higher for females than males (80 vs 70 respectively; P=0.05) and for people living alone than living with family (80 vs 60 respectively; P=0.0940). There was greater functional independence among non-Indigenous than Indigenous participants (median Functional Independence Measure scores of 122 vs 115 respectively; P=0.0937) and the incidence rate (95% confidence intervals) of presentation to the emergency department was sevenfold higher for Indigenous than non-Indigenous participants (11.47 (5.93-20.03) vs 1.65 (0.79-3.04) per 1000 person days respectively). Finally, 61.3% of participants required support to remain living in the community and 44% accessed allied health, with podiatry the most common intervention. The findings indicate that previous hospital utilisation is not a consistent indicator of complexity. Multimorbidity, cultural context and the living and caring situation are considered as matters of complexity, yet variation exists at the participant level.

FRI0235 PHASE 1 CLINICAL STUDY OF MGTA-145 IN COMBINATION WITH PLERIXAFOR SHOWS RAPID SINGLE-DAY MOBILISATION AND COLLECTION OF CD34+ HAEMATOPOIETIC STEM CELLS WITHOUT G-CSF

Background:

Autologous haematopoietic stem cell (HSC) transplantation is a recommended therapeutic option for selected patients with autoimmune diseases. G-CSF mobilisation of HSCs requires 4-7 days of injections that are associated with significant side effects and potential for severe complications including disease flares (e.g., scleroderma and multiple sclerosis). MGTA-145 is a biologic that activates CXCR2 on neutrophils, and with plerixafor rapidly mobilises HSCs in mice and non-human primates. The combination promises to be a same-day, G-CSF-free mobilisation regimen.

Objectives:

To evaluate the safety, tolerability, and mobilisation efficacy of MGTA-145 monotherapy and combination therapy with plerixafor in healthy volunteers.

Methods:

This healthy volunteer phase 1 study consisted of 4 parts- Part A: single-agent MGTA-145 or placebo; Part B: MGTA-145 or placebo given immediately or 2 hours after plerixafor; Part C: MGTA-145 or placebo given 2 hours after plerixafor on 2 consecutive days; Part D: MGTA-145 given 2 hours after plerixafor, just prior to apheresis cell collection.

Results:

Monotherapy of MGTA-145 mobilised CD34+ cells within minutes and peaked within 1 hour post MGTA-145 (median 11 CD34+ cells/µL, a 7-fold increase vs baseline). White blood cells and neutrophils followed a similar pattern. Importantly, markers of neutrophil activation were relatively unchanged (≤2-fold vs baseline).

MGTA-145 combined with plerixafor increased CD34+ cell mobilisation, whether given simultaneously or 2h after plerixafor (Fig. 1A). Mobilisation was highly enriched for CD34+CD90+CD45RA- HSCs, which tracked closely with the total CD34 count. At the 0.03 mg/kg dose with 2h stagger, median peak CD34+ peripheral blood mobilisation was ≥40 cells/µL in Part B. On a second consecutive day of dosing, MGTA-145 + plerixafor mobilises HSCs to levels comparable to day 1. Initial data from the ongoing Part D show that sufficient numbers of cells (median 4.3 x 10^6 CD34+ cells/kg) for transplant were collected in a single day.. Preliminary data from NSG mouse transplant studies of those mobilised HSCs in part D show higher engraftment rates of MGTA-145 + plerixafor mobilised HSCs, compared to G-CSF-mobilised HSCs.

Figure.

Peripheral blood mobilisation after plerixafor + 0.03 mg/kg MGTA-145 in healthy subjects with simultaneous and 2h stagger dosing after plerixafor. Dotted line: previously reported CD34+ counts with plerixafor alone mobilisation (Chenet al,Blood Advances. 2018).

MGTA-145 monotherapy was well tolerated with no significant adverse events (AEs). Grade 1, transient lower back pain that dissipated within minutes was reported. The combination of MGTA-145 with plerixafor was well tolerated, with some subjects experiencing grade 1/2 gastrointestinal AEs commonly observed with plerixafor and one grade 2 back pain with MGTA-145 at 0.075 mg/kg that resolved within minutes.

Conclusion:

MGTA-145 monotherapy was well-tolerated and induced rapid mobilisation of significant numbers of HSCs. CD34+ cell mobilisation with MGTA-145 + plerixafor was immediate and superior to plerixafor alone. These data suggest that the combination can enable the collection of sufficient HSCs for transplant in one day without the need for G-CSF. Further development as a first line mobilisation product is warranted in autoimmune diseases, gene therapy and haematologic malignancies.

Table.

Single-day Mobilisation and Apheresis Cell Yields in Part D

SubjectTotal CD34+ Yield (x106 cells)CD34+/kg (x106 cells)CD90+ (%)8013194.139%8073224.441%8175005.326%821 (*completed only 13L of planned 20L collection)2392.719%Median3214.333%

Disclosure of Interests:

John Dipersio Shareholder of: Magenta, Consultant of: Cellworks, Tioma, Rivervest, Bioline, Asterias, Amphivena and Bluebird, Celgene, Incyte, NeoImuneTech, Macrogenics, Steven Devine: None declared, Jonathan Hoggatt Shareholder of: Magenta, Grant/research support from: Magenta, Consultant of: Magenta, David Scadden Shareholder of: Magenta, Consultant of: Magenta, Haley Howell Shareholder of: Magenta, Employee of: Magenta, Veit Schmelmer Shareholder of: Magenta, Employee of: Magenta, Jason Neale Shareholder of: Magenta, Employee of: Magenta, Tony Boitano Shareholder of: Magenta, Employee of: Magenta, Michael Cooke Shareholder of: Magenta, Employee of: Magenta, Dwight Morrow Shareholder of: Magenta, Employee of: Magenta, Glen Raffel Shareholder of: Magenta, Employee of: Magenta, Will Savage Shareholder of: Magenta, Employee of: Magenta, Kevin Goncalves Shareholder of: Magenta, Employee of: Magenta, Pat Falahee Shareholder of: Magenta, Employee of: Magenta, John Davis Shareholder of: Magenta, Employee of: Magenta

Reorientation of health services: enablers and barriers faced by organisations when increasing health promotion capacity

Issue addressed Primary healthcare settings are important providers of health promotion approaches. However, organisational challenges can affect their capacity to deliver these approaches. This review identified the common enablers and barriers health organisations faced and it aimed to explore the experiences health organisations, in particular Aboriginal organisations, had when increasing their health promotion capacity. Methods A systematic search of peer-reviewed literature was conducted. Articles published between 1990-2014 that focused on a health care-settings approach and discussed factors that facilitated or hindered an organisation's ability to increase health promotion capacity were included. Results Twenty-five articles met the inclusion criteria. Qualitative (n=18) and quantitative (n=7) study designs were included. Only one article described the experiences of an Aboriginal health organisation. Enablers included: management support, skilled staff, provision of external support to the organisation, committed staffing and financial resources, leadership and the availability of external partners to work with. Barriers included: lack of management support, lack of dedicated health promotion staff, staff lacking skills or confidence, competing priorities and a lack of time and resources allocated to health promotion activities. Conclusions While the literature highlighted the importance of health promotion work, barriers can limit the delivery of health promotion approaches within primary healthcare organisations. A gap in the literature exists about how Aboriginal health organisations face these challenges. So what? Primary healthcare organisations wanting to increase their health promotion capacity can pre-empt the common barriers and strengthen identified enablers through the shared learnings outlined in this review.

The Clinical Research Associate Retention Study: A Report From the Children's Oncology Group

Pediatric medicine often struggles to receive adequate research funding for its small, yet vulnerable population of patients. Remarkable discovery in pediatric oncology is credited in large part to the collaborative structure of its research community. The Children's Oncology Group conducts studies supported by the National Cancer Institute. The clinical research associate (CRA) discipline comprises professionals who support administrative duties, regulatory duties, subject management, and data collection at individual research sites. The purpose of this study was to identify factors associated with CRA retention, as the group continues to have high turnover and position vacancy. A cross-sectional survey design was used to characterize the most frequently cited reasons CRAs gave when considering leaving or staying within their position. Results suggest that low salary, unmanageable workload, lack of career advancement and professional development, and lack of research commitment from the medical team were associated with intent to leave CRA positions. The most frequently cited reasons for staying at their job were the meaningfulness and interest in the work, a supportive principal investigator, and enjoyment working with colleagues. CRAs reported serious but eminently solvable issues that can be addressed using practical and low-cost solutions to improve job satisfaction and retention.

Comorbid substance use diagnoses and partner violence among offenders receiving pharmacotherapy for opioid dependence

While previous studies find mixed evidence of an association between opioid use and intimate partner violence perpetration among community samples, initial evidence has detected increased rates of partner violence among individuals receiving pharmacological intervention for opioid dependence. The current study evaluated the role of current comorbid substance use diagnoses, a robust risk factor for violent behavior, on the likelihood of perpetrating partner violence among a high risk sample of offenders receiving pharmacological intervention for opioid dependence. The authors analyzed self-report data provided by 81 (55 male) opioid dependent offenders during a court-ordered substance use interview. Approximately one-third of the sample evidenced the recent use of intimate partner violence. Findings indicated that cocaine and benzodiazepine use were independently associated with an increased likelihood of reporting physical partner violence. Alcohol and cannabis use were not associated with partner violence. The current results offer further support for the ongoing need to conduct routine partner violence screenings among substance involved offenders and highlight the importance of developing individualized treatment plans that address comorbid substance use and partner-violent behaviors among individuals in treatment for opioid dependence.

Substance Use Disorders and Intimate Partner Violence Perpetration among Male and Female Offenders

OBJECTIVE

The current investigation sought to examine the direct associations and interactions among individual and concurrent alcohol, cocaine, cannabis, and opioid use diagnoses with the perpetration of intimate partner violence as well as to assess gender differences across these associations within a large forensic sample of male and female offenders.

METHOD

Participants (1,290 male and 294 female) completed a court-mandated substance abuse evaluation during which they completed a clinical interview, either endorsing or denying recent physical partner violence perpetration. Specific substance use disorders were diagnosed based primarily upon responses to the clinical interview and were used to predict partner violence perpetration using logistic regression.

RESULTS

Alcohol and cocaine use disorders were significantly associated with IPV perpetration over the past year. Cannabis and opioid use disorders were not directly associated with IPV. A comorbid alcohol use diagnosis increased the likelihood of IPV perpetration among participants with either a cannabis or a cocaine use disorder while participants with an alcohol use disorder were less likely to be violent if they had also met criteria for a cannabis use disorder. These relationships held across males and females.

CONCLUSIONS

The current findings emphasize the importance of assessing associations between specific substances of abuse in researching and predicting partner violence and suggest that future efforts focus on the development of integrated treatments for co-occurring partner violence and substance use disorders.

The association between phencyclidine use and partner violence: an initial examination

The association between phencyclidine (PCP) use and violent behavior is unclear. The current investigation evaluated the association between PCP addiction and intimate partner violence, a specific violent behavior, using the substance abuse evaluations of 109 PCP, 81 cannabis, and 97 polysubstance (alcohol and cannabis) abusing offenders. Relative to both comparison groups, PCP users were more likely to receive inpatient referrals, have a significant legal history, and have perpetrated past-year general and intimate partner violence. Data suggest that PCP use may be associated with greater violence perpetration than cannabis use alone or in conjunction with problematic alcohol use.

An intervention to discourage Australian mothers from unnecessarily exposing their babies to the sun for therapeutic reasons

Parents play a key role in children's sun-protective behaviour, with good sun-protective habits established early tending to be sustained. We designed a maternity hospital-based educational intervention to reduce myths that could result in mothers intentionally sunning their babies. Interviews were conducted with two cross-sections of healthy post-partum inpatients in the maternity ward of a large regional public hospital. The first group (n = 106) was recruited before the commencement of educational in-services for maternity nursing staff; the second group (n = 203) was interviewed after the last staff in-service session. More pre-intervention than post-intervention women reported they would expose their baby to sunlight to: treat suspected jaundice (28.8% vs. 13.3%; p < 0.001) or help their baby's skin adapt to sunlight (10.5% vs. 2.5%; p = 0.003). Fewer post-intervention women indicated they would sun themselves to treat breastfeeding-associated sore/cracked nipples (7.6% vs. 2%; p = 0.026). This educational intervention should be used to educate parents, health professionals and students.

The clinical research team

Developing and maintaining an exemplary research team is essential to the success of a quality clinical research program.

Axis I psychopathology and the perpetration of intimate partner violence

OBJECTIVES

Initial evidence suggests that individuals with specific psychiatric conditions may perpetrate intimate partner violence (IPV) at greater frequency than nondiagnosed comparison samples. The present investigation examined the relationship between IPV and specific clinical diagnoses.

METHOD

The current investigation utilized data provided by 190 (34% female) adult offenders during court-mandated substance use evaluations to investigate the incidence of past-year IPV among samples of dually diagnosed (bipolar, posttraumatic stress disorder [PTSD], and attention deficit-hyperactivity disorder [ADHD]) clients relative to 3 comparison samples matched on substance use and sociodemographic variables.

RESULTS

Bipolar and PTSD diagnosed participants were more likely to perpetrate IPV than matched comparison and ADHD participants. Bipolar and PTSD diagnosed participants were equally likely to perpetrate IPV, as were ADHD and matched comparison samples.

CONCLUSIONS

The frequency of IPV perpetration among bipolar and PTSD diagnosed clients may complicate interpersonal and relationship functioning. The development of integrated treatments for IPV and underlying psychopathology is recommended.

Basic steps to building a research program

Establishing a clinical trial infrastructure is an important step when developing a successful research program. Two areas required for success include financial oversight and a qualified research team.

Clinical investigator responsibilities

When conducting a clinical trial, it is important that clinical investigators successfully meet all research expectations, including regulatory requirements and the Guidelines for Good Clinical Practice.

Differences in legal characteristics between Caucasian and African-American women diverted into substance abuse treatment

In this exploratory study, we examined differences in the legal characteristics of Caucasian and African-American female offenders (n = 122) who were diverted into substance abuse treatment, to identify any racial disparities. We also examined the differences between groups in demographics and in substance abuse, family, and violence histories. In terms of legal characteristics, the results showed that African-American female offenders were significantly more likely to have been incarcerated at the time of their substance dependency evaluation than were Caucasian female offenders. Also, African-American women were more likely to have served 13 months for the current legal charge in comparison to the 4 months served by Caucasian women, although no differences were found between groups in the severity of the current legal charge. Comparison of demographics and substance abuse, family, and violence histories indicated that African-American women were more likely to be undereducated, crack cocaine dependent, and overly exposed to violence. Overall, the sample of female offenders evidenced severe substance dependency problems, a strong need for inpatient substance abuse treatment, and chronic legal and social difficulties. Implications of these findings are discussed in relation to unbalanced sentencing policies and increasing awareness of the treatment needs of this unique population.

Violence and substance use among female partners of men in treatment for intimate-partner violence

To improve understanding of the complex dynamics in intimate partner violence (IPV) in heterosexual relationships, we explored violence and substance use among the female partners of men entering treatment for both IPV and substance-related problems. All male participants (n = 75) were alcohol dependent and had at least one domestic-violence arrest. Results showed that female partners were as likely as men to engage in substance use the week before treatment; however, according to reports by the men, the female partners were more likely than men to use substances during the last week of treatment, due to a reported increase in use during the men's treatment. Regarding violence, 59 percent of female IPV victims reported engaging in some form of mild violence against their male partners, and 55 percent reported engaging in some form of severe violence. By contrast, only 23 percent of male batterers reported that their female partners had engaged in mild violence, and only 19 percent reported that their partners had engaged in severe violence. Regardless of whether the violence was defensive in nature, the data suggest that women in relationships involving substance abuse and IPV are in need of treatment. Implications of these findings are discussed.

Good clinical practice and the conduct of clinical studies in pediatric oncology

This article discusses the principles that guide good clinical practice standards, with particular emphasis on how they to relate to pediatric oncology research and recent efforts at harmonization. The authors review the clinical trials process and the roles of the participants, highlighting the pivotal role of the clinical investigator and the research team, and briefly review the historical aspects of drug development regulations in the United States and the current regulatory paths for pediatric oncology drug development. Where relevant, historical events that underlie many of the regulations and their current applications are described, and practical examples are provided.

Commentary: implications for assessment and treatment of addictive and mentally disordered offenders entering prisons

In this commentary, we discuss the main findings of the research study by Gunter et al., "The Frequency of Mental Health and Addictive Disorders Among 320 Men and Women Entering the Iowa Prison System: Use of the MINI-PLUS." This commentary provides an overview on the use of standardized assessments with prison populations; prevalence rates of mental and addictive disorders within prisons; substance use disorders, as opposed to substance-induced psychiatric disorders, among prison populations; and research on diversion treatment programs within the community for nonviolent mentally ill and substance-using offenders.

Pharmacokinetic and maximum tolerated dose study of micafungin in combination with fluconazole versus fluconazole alone for prophylaxis of fungal infections in adult patients undergoing a bone marrow or peripheral stem cell transplant

In this dose escalation study, 74 adult cancer patients undergoing bone marrow or peripheral blood stem cell transplantation received fluconazole (400 mg/day) and either normal saline (control) (12 subjects) or micafungin (12.5 to 200 mg/day) (62 subjects) for up to 4 weeks. The maximum tolerated dose (MTD) of micafungin was not reached, based on the development of Southwest Oncology Group criteria for grade 3 toxicity; drug-related toxicities were rare. Commonly occurring adverse events considered related to micafungin were headache (6.8%), arthralgia (6.8%), hypophosphatemia (4.1%), insomnia (4.1%), maculopapular rash (4.1%), and rash (4.1%). Pharmacokinetic profiles for micafungin on days 1 and 7 were similar. The mean half-life was approximately 13 h, with little variance after repeated or increasing doses. Mean maximum concentrations of the drug in serum and areas under the concentration-time curve from 0 to 24 h were approximately proportional to dose. There was no clinical or kinetic evidence of interaction between micafungin and fluconazole. Five of 12 patients (42%) in the control group and 14 of 62 (23%) in the micafungin-plus-fluconazole groups had a suspected fungal infection during treatment which resulted in empirical treatment with amphotericin B. The combination of micafungin and fluconazole was found to be safe in this high-risk patient population. The MTD of micafungin was not reached even at doses up to 200 mg/day for 4 weeks. The pharmacokinetic profile of micafungin in adult cancer patients with blood or marrow transplants is consistent with the profile in healthy volunteers, and the area under the curve is proportional to dose.

Pilot study of 13cis-retinoic acid+dexamethasone+alpha interferon as maintenance therapy following high-dose chemotherapy and autologous stem cell transplant for multiple myeloma

Interleukin 6 (IL-6) is a major growth factor for myeloma cells and retinoids have been shown to inhibit expression of the interleukin 6 receptor (IL-6R). We performed a pilot study to assess the efficacy and tolerability of 13cis retinoic acid (13cRA) and dexamethasone (Dex), when added to interferon alpha (IFNalpha) as maintenance therapy post autologous stem cell transplantation. Between 90 and 120 days post stem cell transplantation, 33 patients were started on 13cRA 1 mg/kg p.o. daily for 14 days and Dex 40 mg p.o daily for 5 days every month. 13cRA was dose escalated by 0.5 mg/kg/month to 2 mg/kg. Seventeen patients had a persistent paraprotein post transplant. Overall, a response to therapy was observed in 11/17 (64%), with a complete response in 4/17 (23.5%) and a partial response (>/=50% paraprotein decline) in 7/17 (41%). With a median follow-up of 34.8 months, 22/33 (66%) demonstrated disease progression and 11/33 (33%) died. The median progression-free survival from diagnosis was 34.7 months. Although a decline in paraprotein was frequently observed on triple therapy, many patients discontinued therapy due to the side-effects of the IFNalpha. Future trials should be designed using 13cRA and Dex alone.

Supraventricular tachyarrhythmias after hematopoietic stem cell transplantation: incidence, risk factors and outcomes

Recent studies suggest that cancer patients may be at increased risk for supraventricular tachyarrhythmias (SVTA). We have observed clinically significant SVTA in patients undergoing hematopoietic stem cell transplantation occurring at a median of 6 days post transplant, manifesting as atrial fibrillation/flutter or regular narrow-complex tachycardia and persisting for a median of 3 days (range, 0-8). All patients received aggressive medical therapy and/or electrical cardioversion to restore sinus rhythm and to re-establish hemodynamic stability. Non-Hodgkin's lymphoma (NHL) was the most common diagnosis (53%), and a case control analysis in those patients demonstrated that SVTA occurred in 12% of patients and was associated with older age and pre-existing cardiac conditions. In conclusion, patients undergoing HSCT are at moderate risk for developing SVTA, particularly older patients with a diagnosis of NHL. These arrhythmias are clinically significant, and are a marker for increased mortality and prolonged hospital stay. Additional studies are needed to identify high-risk patients who may benefit from prophylactic anti-arrhythmic therapy.

Outcomes of adults with acute myelogenous leukemia in remission given 550 cGy of single-exposure total body irradiation, cyclophosphamide, and unrelated donor bone marrow transplants

On the basis of observations from dog models and human studies, we hypothesized that a low-dose (550 cGy), single-exposure total body irradiation (TBI)-based regimen would result in improved survival when given to adult patients with acute myelogenous leukemia (AML) who were undergoing unrelated donor bone marrow transplantation in complete remission (CR). The regimen consisted of single exposure (550 cGy) of TBI given at a high dose rate (30 cGy/min) and cyclophosphamide. Graft-versus-host disease prophylaxis consisted of cyclosporine, methotrexate, and corticosteroids. Thirty-two consecutive adult patients (median age, 47 years) with AML in CR (15 in CR 1 and 17 in CR > or =2) were treated. Sixteen patients (50%) were alive and in remission at last follow-up (median, 2.2 years; range, 0.6-4.0 years). Kaplan-Meier estimates of overall and leukemia-free survival at 3 years were 55% +/- 14% (mean +/- SE) and 57% +/- 14% in CR 1 patients and were both 39% +/- 12% in CR > or =2 patients. Transplant-related mortality was 13% for patients in CR 1 and 41% for those in CR > or =2. Only 1 patient (3%) experienced fatal regimen-related organ toxicity, and only 1 had grade III or IV acute graft-versus-host disease. Graft failure was not observed. Relapse occurred in 22% of patients. This low-dose (550 cGy), single-exposure TBI-based regimen resulted in good survival and a low risk of fatal regimen-related organ toxicity in adult patients with AML who underwent unrelated donor bone marrow transplantation in CR.