Clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : A modified Delphi study

Aim To develop clinical practice guidelines for nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Background Numerous studies have reported that nurse-administered procedural sedation and analgesia is safe. However, the broad scope of existing guidelines for the administration and monitoring of patients who receive sedation during medical procedures without an anaesthetist presents means there is a lack of specific guidance regarding optimal nursing practices for the unique circumstances in which nurse-administered procedural sedation and analgesia is used in the cardiac catheterisation laboratory. Methods A sequential mixed methods design was utilised. Initial recommendations were produced from three studies conducted by the authors: an integrative review; a qualitative study; and a cross-sectional survey. The recommendations were revised in accordance with responses from a modified Delphi study. The first Delphi round was completed by nine senior cardiac catheterisation laboratory nurses. All but one of the draft recommendations met the pre-determined cut-off point for inclusion. There were a total of 59 responses to the second round. Consensus was reached on all recommendations. Implications for nursing The guidelines that were derived from the Delphi study offer twenty four recommendations within six domains of nursing practice: Pre-procedural assessment; Pre-procedural patient and family education; Pre-procedural patient comfort; Intra-procedural patient comfort; Intra-procedural patient assessment and monitoring; and Post-procedural patient assessment and monitoring. Conclusion These guidelines provide an important foundation towards the delivery of safe, consistent and evidence-based nursing care for the many patients who receive sedation in the cardiac catheterisation laboratory setting.

Supportive and palliative care for lung cancer patients

Lung cancer patients face poor survival and experience co-occurring chronic physical and psychological symptoms. These symptoms can result in significant burden, impaired physical and social function and poor quality of life. This paper provides a review of evidence based interventions that support best practice supportive and palliative care for patients with lung cancer. Specifically, interventions to manage dyspnoea, one of the most common symptoms experienced by this group, are discussed to illustrate the emerging evidence base in the field. The evidence base for the pharmacological management of dyspnoea report systemic opioids have the best available evidence to support their use. In particular, the evidence strongly supports systemic morphine preferably initiated and continued as a once daily sustained release preparation. Evidence supporting the use of a range of other adjunctive non-pharmacological interventions in managing the symptom is also emerging. Interventions to improve breathing efficiency that have been reported to be effective include pursed lip breathing, diaphragmatic breathing, positioning and pacing techniques. Psychosocial interventions seeking to reduce anxiety and distress can also improve the management of breathlessness although further studies are needed. In addition, evidence reviews have concluded that case management approaches and nurse led follow-up programs are effective in reducing breathlessness and psychological distress, providing a useful model for supporting implementation of evidence based symptom management strategies. Optimal outcomes from supportive and palliative care interventions thus require a multilevel approach, involving interventions at the patient, health professional and health service level.

Swimmer localization from a moving camera

At the highest level of competitive sport, nearly all performances of athletes (both training and competitive) are chronicled using video. Video is then often viewed by expert coaches/analysts who then manually label important performance indicators to gauge performance. Stroke-rate and pacing are important performance measures in swimming, and these are previously digitised manually by a human. This is problematic as annotating large volumes of video can be costly, and time-consuming. Further, since it is difficult to accurately estimate the position of the swimmer at each frame, measures such as stroke rate are generally aggregated over an entire swimming lap. Vision-based techniques which can automatically, objectively and reliably track the swimmer and their location can potentially solve these issues and allow for large-scale analysis of a swimmer across many videos. However, the aquatic environment is challenging due to fluctuations in scene from splashes, reflections and because swimmers are frequently submerged at different points in a race. In this paper, we temporally segment races into distinct and sequential states, and propose a multimodal approach which employs individual detectors tuned to each race state. Our approach allows the swimmer to be located and tracked smoothly in each frame despite a diverse range of constraints. We test our approach on a video dataset compiled at the 2012 Australian Short Course Swimming Championships.

Ray's Night Out

Research Background: The proliferation of technologically-based interventions and mHealth in particular have led to a need for innovative, relevant and engaging ways of presenting health messages to young people using technology. ‘Ray’s Night Out’ is a mobile health application co-designed with young people by an interdisciplinary team of researchers at Queensland University of Technology. Research Questions: The design, research, development and evaluation of ‘Ray’s Night Out’ addressed a number of research questions from across the fields of Psychology and Interactive and Visual Design. The specific design research questions addressed were: How can a mobile intervention be best designed to promote young people’s safety and wellbeing and minimise harm when consuming alcohol on a typical night out? Specifically, how can principles of interactive and visual design be effectively applied to develop innovative digital health communication solutions that empower young people as active participants in improving their health and wellbeing? Research Contribution: Innovation The mobile app, as a digital artifact, represents a new way of engaging young people in the issue of alcohol consumption and the pacing and self-care behaviours through unique interaction, visual and interface designs which resulted from the participant-led and iterative design research process. The design of the specific interactive and visual features of the app informed by participatory design data and by health research present a novel approach to preventing young people in crossing the ‘stupid line’ on a typical night out. Research Significance: The significance of the design research component within the larger interdisciplinary practices that have informed ‘Ray’s Night Out’ (e.g. field of psychology, reported through journal articles and other related outcomes), is the unique visual and interactive presentation of participant data and health concepts within the app interface and interaction design which improves and increases young people’s engagement with the health messages it contains. The global quality standard is further demonstrated by the launch on Apple iTunes: https://itunes.apple.com/us/app/rays-night-out/id978589497?mt=8 This demonstrates the application meets the high professional requirements for global release and international standards set by Apple AppStore.

Current management of transitional feeding issues in preterm neonates born in Queensland, Australia

Background: Many preterm neonates display difficulty establishing suck-feeding competence in the weeks following birth. Ineffective management of transitional feeding issues may cause patient complications, and can contribute to increased length of stay. Aims: Given that many neonatal nurseries appear to vary in their neonatal feeding management practices, the aim of this study was to investigate and document the routine level of support and intervention currently provided for preterm neonates with transitional feeding issues across the various level II (special care) nurseries (SCNs) in Queensland, Australia. Methods: A questionnaire was mailed to all Queensland SCNs in 2005 (n = 36). The questionnaire contained a series of closed-choice and short-answer questions designed to obtain information from each SCN regarding their current practices for managing transitional feeding issues in preterm neonates. Results were confirmed during a follow-up phone call. Results: Responses were obtained from 29 SCNs (80.6%). None of these nurseries reported having any formal, written policies regarding the management of transitional feeding issues in preterm neonates. Wide variations were reported in relation to the suck-feeding assessments and interventions used by staff within the various SCNs. Of the 29 nurseries, 4 (13.8%) reported using checklists or assessments to judge readiness for suck-feeds, and 5 (17.2%) reported using pulse oximetry to judge tolerance of suck-feeding attempts. Eighteen SCNs (62.1%) reported offering some form of active intervention to assist neonates with transitional feeding issues, with the most common intervention techniques reported being non-nutritive sucking during tube feeds, pre-feeding oral stimulation, and actively pacing suck-feeds. Twenty-two SCNs (75.4%) reported having access to a lactation consultant to assist mothers with breastfeeding issues. Conclusions: Differences were reported in the routine management of transitional feeding issues in preterm neonates across the various SCNs in Queensland. It is suggested that evidence based guidelines need to be developed, and that, in order to do this, further research studies are required to determine current best practice, as well as to answer remaining questions. © 2008 Elsevier Ireland Ltd. All rights reserved.

Low-frequency electrical stimulation combined with a cooling vest improves recovery of elite kayakers following a simulated 1000-m race in a hot environment

This study compared the effects of a low-frequency electrical stimulation (LFES; Veinoplus® Sport, Ad Rem Technology, Paris, France), a low-frequency electrical stimulation combined with a cooling vest (LFESCR) and an active recovery combined with a cooling vest (ACTCR) as recovery strategies on performance (racing time and pacing strategies), physiologic and perceptual responses between two sprint kayak simulated races, in a hot environment (∼32 wet-bulb-globe temperature). Eight elite male kayakers performed two successive 1000-m kayak time trials (TT1 and TT2), separated by a short-term recovery period, including a 30-min of the respective recovery intervention protocol, in a randomized crossover design. Racing time, power output, and stroke rate were recorded for each time trial. Blood lactate concentration, pH, core, skin and body temperatures were measured before and after both TT1 and TT2 and at mid- and post-recovery intervention. Perceptual ratings of thermal sensation were also collected. LFESCR was associated with a very likely effect in performance restoration compared with ACTCR (99/0/1%) and LFES conditions (98/0/2%). LFESCR induced a significant decrease in body temperature and thermal sensation at post-recovery intervention, which is not observed in ACTCR condition. In conclusion, the combination of LFES and wearing a cooling vest (LFESCR) improves performance restoration between two 1000-m kayak time trials achieved by elite athletes, in the heat.