Risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory : a matched case-control study

Background: Side effects of the medications used for procedural sedation and analgesia in the cardiac catheterisation laboratory are known to cause impaired respiratory function. Impaired respiratory function poses considerable risk to patient safety as it can lead to inadequate oxygenation. Having knowledge about the conditions that predict impaired respiratory function prior to the procedure would enable nurses to identify at-risk patients and selectively implement intensive respiratory monitoring. This would reduce the possibility of inadequate oxygenation occurring. Aim: To identify pre-procedure risk factors for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory. Design: Retrospective matched case–control. Methods: 21 cases of impaired respiratory function were identified and matched to 113 controls from a consecutive cohort of patients over 18 years of age. Conditional logistic regression was used to identify risk factors for impaired respiratory function. Results: With each additional indicator of acute illness, case patients were nearly two times more likely than their controls to experience impaired respiratory function (OR 1.78; 95% CI 1.19–2.67; p = 0.005). Indicators of acute illness included emergency admission, being transferred from a critical care unit for the procedure or requiring respiratory or haemodynamic support in the lead up to the procedure. Conclusion: Several factors that predict the likelihood of impaired respiratory function were identified. The results from this study could be used to inform prospective studies investigating the effectiveness of interventions for impaired respiratory function during nurse-administered procedural sedation and analgesia in the cardiac catheterisation laboratory.

Exploring the ethical implications of the late discovery of adoptive and donor-insemination offspring status

Some children adopted under the now discredited period of closed adoption were never told of their adoptive status until it was revealed to them in adulthood. Yet to date, this ‘late-discovery’ experience has received little research attention. Now a new generation of ‘late discoverers’ is emerging as a result of (heterosexual couple) donor insemination (DI) practices. This study of 25 late-discovery participants of either adoptive or (heterosexual couple) DI offspring status reveals ethical concerns particular to the lateness of discovery. Most of the participants were Australian, with the remainder from the UK, USA and Canada. All were asked to give an ‘open’ account of their experience, with four themes or suggestions provided on request. These accounts were added to those available in relevant publications. The analysis employed a hermeneutic phenomenological methodology and all accounts were analysed using an ethical perspective developed by Walker (2006, 2007). The main themes that emerged were: disrupted personal autonomy, betrayal of deep levels of trust and feelings of injustice and diminished self-worth. The lack of recognition of concerns particular to late discovery has resulted in late discoverers (i) feeling unable to regain a sense of personal control, (ii) significantly disrupted relationships with those closest to them and others, including community and institutions, and (iii) feelings of diminished value and self-worth.

Alternative models of cardiac rehabilitation : a systematic review

The traditional hospital-based model of cardiac rehabilitation faces substantial challenges, such as cost and accessibility. These challenges have led to the development of alternative models of cardiac rehabilitation in recent years. The aim of this study was to identify and critique evidence for the effectiveness of these alternative models. A total of 22 databases were searched to identify quantitative studies or systematic reviews of quantitative studies regarding the effectiveness of alternative models of cardiac rehabilitation. Included studies were appraised using a Critical Appraisal Skills Programme tool and the National Health and Medical Research Council's designations for Level of Evidence. The 83 included articles described interventions in the following broad categories of alternative models of care: multifactorial individualized telehealth, internet based, telehealth focused on exercise, telehealth focused on recovery, community- or home-based, and complementary therapies. Multifactorial individualized telehealth and community- or home-based cardiac rehabilitation are effective alternative models of cardiac rehabilitation, as they have produced similar reductions in cardiovascular disease risk factors compared with hospital-based programmes. While further research is required to address the paucity of data available regarding the effectiveness of alternative models of cardiac rehabilitation in rural, remote, and culturally and linguistically diverse populations, our review indicates there is no need to rely on hospital-based strategies alone to deliver effective cardiac rehabilitation. Local healthcare systems should strive to integrate alternative models of cardiac rehabilitation, such as brief telehealth interventions tailored to individual's risk factor profiles as well as community- or home-based programmes, in order to ensure there are choices available for patients that best fit their needs, risk factor profile, and preferences.

Directing democracy : competing interests and contested terrain in the John Lewis Partnership

The John Lewis Partnership is one of Europe’s largest models of employee ownership and has been operating a form of employee involvement and participation since its formation in 1929. It is frequently held up as a model of best practice (Cathcart, 2013) and has been described as a ‘workers’ paradise’ (Stummer and Lacey, 2001). At the beginning of 2012, the Deputy Prime Minister of the UK unveiled plans to create a ‘John Lewis Economy’ (Wintour, 2012). As John Lewis is being positioned at the heart of political and media discussions in the UK about alternatives to the corporate capitalist model of enterprise, it is vital that more is known about the experience of employee involvement and participation within the organisation. This article explores the ways in which the practice of employee involvement and participation has changed in John Lewis as a result of competing employee and managerial interests. Its contribution is a contemporary exploration of participation in the John Lewis Partnership and an examination of the ways in which management and employees contested the meaning and practice of employee involvement and participation as part of a ‘democracy project’, which culminated in significant changes and degeneration of the democratic structures.

Vision-based place recognition : how low can you go?

In this paper we use the algorithm SeqSLAM to address the question, how little and what quality of visual information is needed to localize along a familiar route? We conduct a comprehensive investigation of place recognition performance on seven datasets while varying image resolution (primarily 1 to 512 pixel images), pixel bit depth, field of view, motion blur, image compression and matching sequence length. Results confirm that place recognition using single images or short image sequences is poor, but improves to match or exceed current benchmarks as the matching sequence length increases. We then present place recognition results from two experiments where low-quality imagery is directly caused by sensor limitations; in one, place recognition is achieved along an unlit mountain road by using noisy, long-exposure blurred images, and in the other, two single pixel light sensors are used to localize in an indoor environment. We also show failure modes caused by pose variance and sequence aliasing, and discuss ways in which they may be overcome. By showing how place recognition along a route is feasible even with severely degraded image sequences, we hope to provoke a re-examination of how we develop and test future localization and mapping systems.

PP39 Mental health outcomes of abortion for young women aged 18-23 years, findings from an Australian longitudinal birth cohort study

Background: Few longitudinal studies have examined the mental health outcomes of women after abortion and the results are controversial. Despite falling birth rates, teenage pregnancies remain high and over half (53%) of teenage and a third (36%) of young adult (20_24 years) pregnancies are aborted. Recent findings from a NewZealand longitudinal birth cohort linked abortion and subsequent psychiatric disorders in young women. Limited Australian data is available examining this association. Methods: Data were taken from the Mater-University Study of Pregnancy (MUSP). Running since 1981, this is a prospective birth cohort study of 7223 mothers and children. At the 21-year follow-up 3775 (52.3% of the original cohort) participants were surveyed, of these 1132 young women had complete data on pregnancy outcomes and psychiatric diagnoses from a structured interview. Binary logistic regression examined the association between five lifetime psychiatric disorders (nicotine, alcohol, cannabis, affective and anxiety disorders) and ever having an abortion or birth. Analyses adjusted for age, concurrent and maternal sociodemographic factors, and factors related to adolescent behaviour, previous mental health and family functioning. Results: A quarter of the young women (n_261) reported at least one pregnancy and 32.6% had an abortion. Abortion was significantly associated with age-adjusted OR for all the lifetime disorders. After full adjustment abortion remained significantly associated with nicotine (OR_2.1, 1.2_3.6) and alcohol disorders (OR_2.0, 1.3_3.3). Conclusion: The findings suggest that abortion in young women is independently associated with an increased risk of nicotine and alcohol disorders.

Letter : anxiety score as a risk factor for radial artery vasospasm during radial interventions : a pilot study

I read with interest the article in Angiology that determined the role of anxiety level on radial artery spasm during transradial coronary angiography.1 As the importance of conducting more randomised controlled trials using anxiolytics to define the relation between anxiety and vasospasm was noted by the authors, I offer the following insights for investigators to consider when conducting such research. While previous research has already identified that moderate procedural sedation and opioid analgesia reduces the incidence of vasospasm,2 the identification of risk factors in the present study is hypothesis generating as to how outcomes might be even further improved. It is possible that selectively applying either even more intensive sedation and analgesia or complementary non-pharmacological stress-reducing therapies, such as music therapy or visualisation and attentive behaviour, to patients ‘at-risk’ of vasospasm (women and those with high levels of anxiety prior to the procedure) might lead to even better patient outcomes...

Development of the palliative care needs assessment tool (PC-NAT) for use by multi-disciplinary health professionals

Needs assessment strategies can facilitate prioritisation of resources. To develop a needs assessment tool for use with advanced cancer patients and caregivers, to prompt early intervation. A convenience sample of 103 health professionals viewed three videotaped consultations involving a simulated patient, his/her caregiver and a health professional, completed the Palliative Care Needs Assessment Tool (PC-NAT) and provided feedback on clarity, content and acceptability of the PC-NAT. Face and content validity, acceptability and feasibility of the PC-NAT were confirmed. Kappa scores indicated adequate inter-rater reliability for the majority of domains; the patient spirituality domain and the caregiver physical and family and relationship domains had low reliability. The PC-NAT can be used by health professionals with a range of clinical expertise to identify individuals' needs, thereby enabling early intervention. Further psychometric testing and an evaluation to assess the impact of the systematic use of the PC-NAT on quality of life, unmet needs and service utilisation of patients and caregivers are underway.

Organized crime in Oceania

Oceania has a relatively low level of crime prevalence yet in the smaller and under-developed PICs we have shown that transnational crime has become increasingly common. A risk contained but potentially dangerous if state failure or fragility undermines law enforcement capacities. We predict that as the pace of globalization quickens and the demand for raw materials and resources grows some parts of the Pacific will be prone to criminal enterprises run by both indigenous and foreign crime groups. Australia and New Zealand will remain attractors of illicit goods notably ATS but will in turn be source countries for diminishing fish stock such as beche de mere and abalone as well forest timber. Finally the role of states such as Australia and New Zealand in helping to maintain law enforcement capacities throughout the region will be crucial if organized crime in Oceania is to be kept in check while demand for illicit resources grow.

Transnational organized crime in Oceania

Oceania has a relatively low level of crime prevalence yet in the smaller and under-developed PICs we have shown that transnational crime has become increasingly common. A risk contained but potentially dangerous if state failure or fragility undermines law enforcement capacities. We predict that as the pace of globalization quickens and the demand for raw materials and resources grows some parts of the Pacific will be prone to criminal enterprises run by both indigenous and foreign crime groups. Australia and New Zealand will remain attractors of illicit goods notably ATS but will in turn be source countries for diminishing fish stock such as beche de mere and abalone as well forest timber. Finally the role of states such as Australia and New Zealand in helping to maintain law enforcement capacities throughout the region will be crucial if organized crime in Oceania is to be kept in check while demand for illicit resources grow.

The micro-movie wave in a globalising China : adaptation, formalisation and commercialisation

While user-generated short online videos have existed since the emergence of video sharing sites in China, they have undergone a process of formalisation and commercialisation, culminating in the wave of micro-movies in recent years. By addressing the wider context of globalisation alongside relevant state policies and shifting viewing habits, this article analyses the local and global causes of this wave. It offers evidence that illustrates how online video service providers in China have adapted in a changing industry landscape as they negotiate state policies, advertiser interests and user preference. It then examines the production and distribution dynamics, where professional producers draw on social media, grassroots creativity and creative talents in regional markets. Finally, it discusses the cultural implications of this process in terms of both the nature and flow of creativity. Based on these analyses, the article also sheds light on the interplay between the state and the market in the context of globalisation and marketisation of media sectors, which becomes more complicated when the state-owned or controlled media enter the emerging market sectors.

Mothers' perceptions of introducing solids to their infant at six months of age : identifying critical belief-based targets to promote adherence to current infant feeding guidelines

We investigated critical belief-based targets for promoting the introduction of solid foods to infants at six months. First-time mothers (N = 375) completed a Theory of Planned Behaviour belief-based questionnaire and follow-up questionnaire assessing the age the infant was first introduced to solids. Normative beliefs about partner/spouse (β = 0.16) and doctor (β = 0.22), and control beliefs about commercial baby foods available for infants before six months (β = −0.20), predicted introduction of solids at six months. Intervention programs should target these critical beliefs to promote mothers’ adherence to current infant feeding guidelines to introduce solids at around six months.

Social influences and the physical activity intentions of parents of young-children families: An extended Theory of Planned Behavior Approach

Evidence within Australia and internationally suggests parenthood as a risk factor for inactivity; however, research into understanding parental physical activity is scarce. Given that active parents can create active families and social factors are important for parents’ decision making, the authors investigated a range of social influences on parents’ intentions to be physically active. Parents (N = 580; 288 mothers and 292 fathers) of children younger than 5 years completed an extended Theory of Planned Behavior questionnaire either online or paper based. For both genders, attitude, control factors, group norms, friend general support, and an active parent identity predicted intentions, with social pressure and family support further predicting mothers’ intentions and active others further predicting fathers’ intentions. Attention to these factors and those specific to the genders may improve parents’ intentions to be physically active, thus maximizing the benefits to their own health and the healthy lifestyle practices for other family members.