Nurse-led clinic: Effective and efficient delivery of assessment and review of patients with Hepatitis B and C

Hepatology and gastroenterology services are increasingly utilising the skills and experience of nurse practitioners and nurse specialists to help meet the increasing demand for health care. A new nurse-led assessment clinic has been established in the liver clinic at Geelong Hospital to utilise the expertise of nurses to assess and triage new patients and streamline their pathway through the health care system. The aim of this study is to quantitatively assess the first two years of operation of the nurse assessment clinic at Geelong Hospital, and to assess advantages and disadvantages of the nurse-led clinic. Data was extracted retrospectively from clinical records of new patients at the liver clinic. Quarterly one-month periods were recorded over two-years. Patients were categorised according to the path via which they saw a physician, including missed and rescheduled appointments. The number of appointments, the waiting time from referral to appointments and the number of ‘did-not-attend’ occasions were analysed before and after the institution of the nurse-led assessment clinic. The Mann-Whitney rank sum test of ordinal data was used to generate median wait times. There was shown to be a statistically significant longer waiting time for physician appointment if seen by the nurse first. The difference in waiting time was 10 days. However, there was also a reduction in the number of missed appointments at the subsequent physician clinic. Other advantages have also been identified including effective triage of patients, and organisation of appropriate investigations from the initial nurse assessment.

Short communication: Influence of labeling on Australian and Chinese consumers' liking of milk with short (pasteurized) and long (UHT) shelf life

Sixty percent of milk consumed in China has a long shelf life (UHT), presumably because milk with a short shelf life (pasteurized) is comparatively expensive. This in contrast to Australia, where 10% of consumed milk is UHT and the price between UHT and pasteurized milk is equivalent. Whether UHT is actually more liked than pasteurized milk by Chinese consumers is unknown. However, the potential positive halo around the expensive pasteurized milk might result in Chinese consumers liking milk more when it is labeled as "short shelf-life milk." To test these hypotheses, Chinese (n=48, 20 males, 28 females, 23±7.2 yr) and Australian (n=93, 11 males, 82 females, 24±5.6 yr) consumers tasted and rated (9-point hedonic scale), in a randomized order, 3×30-mL samples of UHT milk (labeled as "long shelf-life milk," "short shelf-life milk," or "milk") and 3×30-mL samples of pasteurized milk (also labeled as "long shelf-life milk," "short shelf-life milk," or "milk"). Australian participants' liking of milk was not influenced by labeling. Regardless of what the label stated, they always preferred the taste of pasteurized milk over the taste of UHT milk. This was different for Chinese participants, who preferred the taste of UHT milk over the taste of pasteurized milk, but in general had a higher liking for any milk that was labeled "short shelf-life milk." Both Australian and Chinese were more positive about pasteurized than UHT milk. In conclusion, Chinese, but not Australian, consumers' liking of milk was guided by the positive expectations of pasteurized milk and the negative expectations of UHT milk. Further research is needed to investigate if the present findings can be extrapolated to a larger and more varied group of Chinese and Australian consumers.

Influence of the timing of cardiac surgery on the outcome of patients with infective endocarditis and stroke

BACKGROUND: The timing of cardiac surgery after stroke in infective endocarditis (IE) remains controversial. We examined the relationship between the timing of surgery after stroke and the incidence of in-hospital and 1-year mortalities. METHODS: Data were obtained from the International Collaboration on Endocarditis-Prospective Cohort Study of 4794 patients with definite IE who were admitted to 64 centers from June 2000 through December 2006. Multivariate logistic regression and Cox regression analyses were performed to estimate the impact of early surgery on hospital and 1-year mortality after adjustments for other significant covariates. RESULTS: Of the 857 patients with IE complicated by ischemic stroke syndromes, 198 who underwent valve replacement surgery poststroke were available for analysis. Overall, 58 (29.3%) patients underwent early surgical treatment vs 140 (70.7%) patients who underwent late surgical treatment. After adjustment for other risk factors, early surgery was not significantly associated with increased in-hospital mortality rates (odds ratio, 2.308; 95% confidence interval [CI], .942-5.652). Overall, probability of death after 1-year follow-up did not differ between 2 treatment groups (27.1% in early surgery and 19.2% in late surgery group, P = .328; adjusted hazard ratio, 1.138; 95% CI, .802-1.650). CONCLUSIONS: There is no apparent survival benefit in delaying surgery when indicated in IE patients after ischemic stroke. Further observational analyses that include detailed pre- and postoperative clinical neurologic findings and advanced imaging data (eg, ischemic stroke size), may allow for more refined recommendations on the optimal timing of valvular surgery in patients with IE and recent stroke syndromes.

What criteria do police officers use to measure the success of an interview with a child?

This study used a mixed-methods approach to explore the perceptions of a heterogeneous sample of 75 police interviewers regarding their performance in a mock interview with a 5-7-year-old child. Each officer recruited for this study was authorised to conduct investigative interviews with children. Specifically, we explored how the officers' perception of what makes a good interview differs depending on their background experience and their (perceived and actual) ability to adhere to best-practice interview guidelines. Overall, the officers' perceptions of what constitutes an effective interview were not entirely consistent with those held by experts in forensic interviewing. The majority of the interviewers perceived that the locus of control in the interview rested primarily with the child and/or the environmental setting. In contrast, experts tend to place the central onus of responsibility for the outcome of an interview on the skill of the interviewer in using open-ended questions. Several possible explanations for, and the implications of, these findings are discussed.

Police and prosecutors' perceptions of adult sexual assault evidence associated with case authorisation and conviction

This study examined the association between the quality of verbal evidence in cases of sexual assault reported by adults and professionals’ (police and prosecutor) ratings of the likelihood that the cases will result in a conviction at trial. Sixteen police detectives and 19 prosecutors (all specialists in sexual assault) each read two mock sexual offence briefs of evidence, one of a case involving rape of an adult and the other involving an adult reporting historical child sexual abuse. For each case type, two versions of the briefs were developed with regard to evidence quality, which varied according to the degree of elaboration in the responses by the witnesses and suspect, and contextual evidence. Participants rated the likelihood of proceeding with a case and conviction (on 10-point likert scales) and provided a rationale for their decisions. Almost all of the participants agreed that the cases would proceed to court. However, the likelihood of conviction was not associated with the likelihood of proceeding to court, or the evidence quality of the briefs. Differences were found in both the ratings of proceeding to court and conviction, and the factors underpinning the ratings across the two professional groups. The implications of the findings for police organisations are discussed.

Joint range of motion limitations in children and young adults with spinal muscular atrophy

Objectives
To elicit descriptive data about limited joint range of motion (ROM) in subjects with type II or III spinal muscular atrophy (SMA) and to examine the relation between the number of motions with limited range and both age and functional ability.
Design
Descriptive cross-sectional study.
Setting
Neurologic pediatric outpatient clinic at a hospital in Taiwan.
Participants
Twenty-seven subjects with SMA type II (mean age, 9.8±6.5y) and 17 with SMA type III (mean age, 12.2±8.7y).
Intervention
Measurement with transparent goniometers of joint ROM bilaterally of the shoulder, elbow, wrist, hip, knee, and ankle.
Main outcome measures
The proportion of participants with each ROM limitation compared with all participants with the same SMA type, age distribution of the participants with each ROM limitation, mean range loss of each motion limitation, and the contracture index (risk index of joint contracture).
Results
Eighty-nine percent of the participants with SMA type II experienced knee extension limitation. Approximately 50% of the participants with both types of SMA had ankle dorsiflexion limitation. The motions of knee and hip extension and ankle dorsiflexion also had a relatively high contracture index. The number of motions with limited range positively correlated (P<.001) with age and upper-extremity functional grade (the higher the functional grade, the poorer the functional ability) for SMA type II.
Conclusions
We found varying degrees of joint ROM limitation. Certain motions were noted to be high risks for the development of contractures. This risk was higher mostly in younger children.

Integration at Harryson Primary School : a study of aspects of a primary school's involvement in the integration of students with disabilities into its programs

The integration of students with disabilities, impairments and problems in schooling has been stated government policy in the Victorian education system since 1984. Many schools have become involved in programs whereby students with varying disabilities have participated in the educational and social lives of their local school. This research details one primary school's experiences with the integration program. The involvement of teachers, parents, students, integration aide and principal in mutually supportive roles is described. The role of the Integration Support Group is highlighted. The participation of the students being integrated and their non-disabled peers is described in detail. The roles of the principal, the integration aide and the Integration Support Group are found to be crucial in this school's program.

The analysis of café espresso using two-dimensional reversed phase–reversed phase high performance liquid chromatography with UV-absorbance and chemiluminescence detection

In this study, an activity based screening technique combining two-dimensional liquid chromatography (2DHPLC) with UV-absorbance and chemiluminescence detection was applied to study “Ristretto”, "Decaffeinatto” and “Volluto” espresso coffees. This technique, which coupled the separation power of 2DHPLC with the sensitivity and selectivity of the chemiluminescence detection, offers great potential for screening complex samples for antioxidant compounds. Detailed information regarding the complexity of the sample, and the variation between these three coffees could be obtained using this multidimensional-hyphenated method of analysis.

Faecal microbiota of individuals with autism spectrum disorder

Many children with autistic spectrum disorders (ASDs) suffer from gastrointestinal problems such as diarrhoea, constipation and abdominal pain. Such symptoms may be due to a disruption of the indigenous gut microbiota promoting the overgrowth of potentially pathogenic micro-organisms. These observations have stimulated investigations into possible abnormalities of intestinal microbiota in autistic patients. The purpose of the present study was to determine if a relationship exists between ASD severity (mild – severe) and GI microbial populations. The faecal microbiota of 22 male and 6 female participants with ASDs (aged 7 ± 6 years) were analyzed by standard microbial culture methods and compared within-group (based on ASD severity) and with a standard laboratory reference range. Comparisons between children with mild ASD and those with moderate to severe ASD, as well as comparisons to a neurotypical control group previously reported, revealed that no significant differences appear to exist in the composition of the gut microbiota. Nevertheless, examination of each individual’s gut microbial composition showed 10 cases of unusual findings witch means 1out of 3 cases have unusual microbiota. Our data do not support consistent GI microbial abnormalities in ASD children, but the findings do suggest that aberrations may be found in a minority subset of ASD children. Further studies are required to determine the possible association between the microbiota and gastrointestinal dysfunctions in a subset of children with both ASD and gastro-intestinal problems.