Validity of the Waterlow screening tool and risks for pressure injury in acute care

Objectives: To assess the validity of the Waterlow screening tool in a cohort of internal medicine patients and to identify factors contributing to pressure injury. Design: Longitudinal cohort study Setting: A tertiary hospital in Brisbane, Australia Participants: 274 patients admitted through the Emergency Department or outpatient clinics and expected to remain in hospital for at least three days were included in the study. The mean age was 65.3 years. Interventions: Patients were screened on admission using the Waterlow screening tool. Every second day, their pressure ulcer status was monitored and recorded. Main outcome measures: Pressure ulcer incidence Results: Fifteen participants (5.5%) had an existing pressure ulcer and a further 12 (4.4%) developed a pressure ulcer during their hospital stay. Sensitivity of the Waterlow scale was 0.67, (95% CI: 0.35 to 0.88); specificity 0.79, (95% CI: 0.73 to 0.85); PPV 0.13, (95% CI: 0.07 to 0.24); NPV 0.98, (95% CI: 0.94 to 0.99). Conclusion: This study provides further evidence of the poor predictive validity of the Waterlow scale. A suitably powered randomised controlled trial is urgently needed to provide definitive evidence about the usefulness of the Waterlow scale compared with other screening tools and with clinical judgement.

Identity fraud and torrens - minimising the risks and allocating the loss to achieve a sustainable system

Immediate indefeasibility is the cornerstone of the Torrens system of land registration. However, when combined with the apparent ease in which forged mortgages become registered, the operation of this doctrine can come into question. This article seeks to argue that, rather than question indefeasibility, the focus should be on the verification of identity of parties to land transactions. Whilst no system can ever be infallible, it is suggested that by correctly imposing the responsibility for identity verification on the appropriate individual, the Torrens system can retain immediate indefeasibility as its paramount principle, yet achieve the optimum level of fairness in terms of allocation of responsibility and loss. With the dawn of a new era of electronic conveyancing about to begin, the framework suggested here provides a model for minimising the risks of forged mortgages and appropriately allocating the loss.

Creating an effective prevention curriculum to reduce transport risks and injuries

Adolescent injury is a significant health concern and can be a result of the adolescents engagement in transport-related behaviours. There is however significant planning and formative research needed to inform prevention programme design. This presentation reports on the development and evaluation of a curriculum programme that was shown to be effective in reducing transport-related risks and injuries. Early adolescents report injuries resulting from a number of transport-related behaviours including those associated with riding a bicycle, a motorcycle, and as a passenger (survey of 209 Year 9 students). In focus groups, students (n=30) were able to describe the context of transport risks and injuries. Such information provided evidence of the need for an intervention and ecologically valid data on which to base programme design including insights into the language, culture and development of adolescents and their experiences with transport risks. Additional information about teaching practices and implementation issues were explored in interviews with 13 teachers. A psychological theory was selected to operationalise the design of the programmes that drew on such preparatory data. The programme, Skills for Preventing Injury in Youth was evaluated with 197 participating and 137 control students (13–14 year olds). Results showed a significant difference between the intervention and control groups from baseline to 6-month follow-up in a number of transport-related risk behaviours and transport-related injuries. The programme thus demonstrated potential in reduce early adolescents transport risk behaviours and associated harm. Discussion will involve the implications of the development research process in designing road safety interventions.

Work-related road risks and legal liabilities : report for the Redland City Council

Workplace serious injuries and deaths due to unsafe work practices are a substantial health and socioeconomic burden to the community, particularly in industries such as construction, agriculture and fishing, and transport and storage. Some 2000 individuals die each year from work-related causes and tens of thousands of individuals incur permanent disabling work-related injuries and the direct (e.g., medical & legal) and indirect (e.g., lost productivity) cost to the Australian economy has been estimated between $32 billion and $57 billion annually. A common cause of workplace injuries and deaths is occupational driving and work-related fatal road crashes comprise between 23 and 32% of work-related fatalities each year. A major safety concern across the various industry groups therefore involve deaths and injuries associated with work-related driving. However, while organisations emphasise safety practices in most spheres of the workplace they often neglect work-related driving and lack appropriate policies to enhance safe driving practices.

The risks and returns of new public management : political business

Purpose – This article aims to consider success in terms of the financial returns and risks of new public management (NPM) in state-owned enterprises (SOEs). Design/methodology/approach – Financial returns of New Zealand SOEs were examined through a review of their annual reports over a five-year period. Dimensions of risk were examined through interviews conducted in two phases over a two-year period with senior executives from 12 of the (then) 17 SOEs operating in New Zealand. Findings – Findings indicate the potential for SOEs to operate as profitable government investments, with clear support for positive financial returns under NPM. However, variations noted within individual SOEs also indicate that profitable and commercial operations may not be possible in all cases. An examination of the risks associated with SOEs’ operations reveals a number of dimensions of risk, encompassing financial, political (including regulatory), reputational, and public accountability aspects. Practical implications – There is a need for an enhanced awareness on the part of internal and external stakeholders (such as the government and general public) of the risks SOEs face in pursuing higher levels of profitability. Also required, is a more acute understanding on the part of internal and external stakeholders (e.g. government and the public) of the need for SOEs to manage the range of risks identified, given the potentially delicate balance between risk and return. Originality/value – While previous studies have considered the financial returns of SOEs, or the risks faced by the public sector in terms of accountability, few have addressed the two issues collectively in a single context.

An innovative approach to reducing risks associated with infant feeding : the use of technology

Infant feeding is a complex behavior enacted in a risk adverse society. Despite ongoing communication and education strategies, breastfeeding rates in countries like Australia, the US, and the UK remain static, thus increasing the risk of short and long-term health problems. Health professionals and non-profit organizations recognize social marketing as an appropriate strategy for increasing breastfeeding duration since it addresses the shortfalls of education-only campaigns. Technology as an innovative alternative to mass media and education has the potential to reduce the social price of breastfeeding by assisting women to manage the identity and health risks associated with infant feeding. This paper reports findings from six focus groups that explored the risks associated with breastfeeding and the potential role of technology in ameliorating these risks. A key finding of this research was that technology has the potential to negate the impact of perceived uncertainty and lack of control associated with breastfeeding. The results indicated that future breastfeeding campaigns that are innovative in their approach and use technology may be more effective in changing breastfeeding behavior.

The role of gender and framing in shaping community activists' perceptions of environmental risks

campaign to oppose projects proposed in their local community. The social constructionist perspective advocates that these motivations are driven by activists’ interpretation of reality, such that activists will assign multiple meanings to and frame environmental issues in a way that reflects their view of reality. Past research suggest that these are also influenced by patterns of shared meaning and interpretation that develop over time in protest movements that shape activists’ perceptions of the environmental risks and impacts associated with construction activity. This paper explores the role of gender distinctions in shaping perceptions of environmental risk and how this affects their framing of the environmental, social, cultural/ historical impacts associated with a construction project. Using Snow and Benford’s (1988) 3-prong analytical tool for framing: diagnostic framing, prognostic framing and motivational framing, this paper presents findings from the content analysis of in-depth interviews of 24 activists protesting against a highly controversial housing project in the greater Sydney metropolitan area. The research adopts a single case study approach, and is particularly significant as it investigates an extensive and on-going community-based protest campaign (dating back almost 20 years) that has generated the longest standing 24-hour community picket in Australia.

Community protest groups' perceptions of environmental risks using social contagion theory

Local communities are vulnerable to the potential environmental risks associated with construction activity. Currently, little is understood about how perceptions of environmental risks are shaped and spread within a community. A better understanding of this process can help bridge the gap between developers and communities and bring about more sustainable development practices. This paper reports a research methodology which uses social contagion theory to investigate this process. The research adopts a single case study approach of a highly controversial housing project in the greater Sydney metropolitan area. The case study is particularly significant as it investigates an extensive and on-going community-based protest campaign (dating back almost 20 years) that has generated the longest standing 24 hour community picket in the New South Wales.

Bariatric patients and the use of mobile hoists : user experiences from three hospitals in South Australia

Nursing personnel are consistently identified as one of the occupational groups most at risk of work-related musculoskeletal disorders. During the moving and handling of bariatric patients, the weight of the patient combined with atypical body mass contributes to a significant risk of injury to the care provider and patient. This is further compounded by the shape, mobility and co-operation of the patient. The aim of this study was determine user experiences and design requirements for mobile hoists with bariatric patients. Structured interviews were conducted with six experienced injury management staff from the Manual Task Services department of three hospitals in Adelaide, South Australia. All staff had experience in patient handling, the use of patient handling equipment and the provision of patient handling training. A series of open-ended questions were structured around five main themes: 1) patient factors; 2) building/vehicle space and design; 3) equipment and furniture; 4) communication; and 5) staff issues. Questions focussed on the use of mobile hoists for lifting and transferring bariatric patients. Interviews were supplemented with a walk-through of the hospital to view the types of mobile hoists used, and the location and storage of equipment. Across the three hospitals there were differing classification systems to define bariatric patients. Ensuring patient dignity, respect and privacy were viewed as important in the management and rehabilitation of bariatric patients. Storage and space constraints were considered factors restricting the use of mobile floor hoists, with ceiling hoists being the preferred method for patient transfers. When using mobile floor hoists, the forces required to push, pull and manoeuvre, as well as sudden unstable movements of the hoist were considered important risks factors giving rise to a risk of injury to the care provider. Record keeping and purchasing policies appeared to inhibit the effective use of patient handling equipment. The moving and handling of bariatric patients presents complex and challenging issues. A co-ordinated and collaborative approach for moving and handling bariatric patients is needed across the range of care providers. Designers must consider both user and patient requirements.

Advanced musculoskeletal simulation as an ergonomic design method

In recent years, the advent of new tools for musculoskeletal simulation has increased the potential for significantly improving the ergonomic design process and ergonomic assessment of design. In this paper we investigate the use of one such tool, ‘The AnyBody Modeling System’, applied to solve a one-parameter and yet, complex ergonomic design problem. The aim of this paper is to investigate the potential of computer-aided musculoskeletal modelling in the ergonomic design process, in the same way as CAE technology has been applied to engineering design.