Continence prevalence and management in an acute hospital

Learning Objective 1: describe the prevalence of incontinence within an Australian acute care hospital

Learning Objective 2: describe the current management practices for incontinence with regard to patients in an acute care hospital
Introduction: In 1998 the World Health Organisation recognised the international problem of incontinence. However, incontinence remains a major problem that affects more than 3.8 million Australians. Currently, there are no Australian guidelines governing the management of continence within the acute healthcare setting. Cabrini Health sought to identify the prevalence of incontinence in the acute inpatient setting and pilot a Continence Management Program to improve patient safety and patient outcomes.

Aim: The aim of this study was to determine the prevalence of and current management practices for incontinence with regard to Cabrini Health inpatients.

Method: The sample comprised 392 inpatients across three campuses of Cabrini Health (mean age= 68.3 years). Continence prevalence was assessed using a validated Continence Point Prevalence Tool.

Results: Urinary incontinence prevalence was 14%. The resulting overall faecal incontinence prevalence was 7.4%. There were 113 (52.3%) patients who were not incontinent and were using a continence product/device. Fifteen (25.9%) patients were incontinent and were not using any form of continence product/device. There were 43 (74.1%) patients who were incontinent and were using a continence product/device. For the large majority of patients, the admission notes contained documentation of their bladder and bowel function. Specifically, 46 (11.8%) patients had no form of admission documentation relating to bowel function and 45 (11.5%) patients had no form of admission documentation regarding to bladder function.

Conclusions: This study provided baseline continence prevalence for Cabrini Health. There is a need for evidence-based guidelines to support the management of incontinent patients. These interventions will assist staff to educate patients on appropriate choice of continence products and enable patients to maintain or regain continence. Thereby, leading to improved outcomes for patients and improved risk management.

Taking environmental water requirements and climate change into account in the designation and management of protected areas for floodplain ecosystems

In 2005, the Victorian government asked the Victorian Environmental Assessment Council (VEAC) to 1) identify and evaluate the extent, condition, values, management, resources and uses of riverine red gum forests and associated fauna, wetlands, floodplain ecosystems and vegetation communities in northern Victoria; and 2) make recommendations relating to the conservation, protection and ecological sustainable use of public land. The design of a comprehensive, adequate and representative (CAR) reserve system was a key part of the recommendations made by VEAC. In order to assist in the decision-making for environmental water allocation for protected areas and other public land, a process for identifying flood-dependent natural values on the Victorian floodplains of the River Murray and its tributaries was developed.

Although some areas such as the Barmah forest are very well known, there have been few comprehensive inventories of important natural values along the Murray floodplains. For this project, VEAC sought out and compiled data on flood requirements (natural flood frequency, critical interval between floods, minimum duration of floods) for all flood-dependent ecological vegetation classes (EVCs) and threatened species along the Goulburn, Ovens, King and Murray Rivers in Victoria. The project did not include the Kerang Lakes and floodplains of the Avoca, Loddon and Campaspe Rivers. 186 threatened species and 110 EVCs (covering 224,247 ha) were identified as flood-dependent and therefore at risk from insufficient flooding.

Past environmental water allocations have targeted a variety of different natural assets (e.g. stressed red gum trees, colonial nesting waterbirds, various fish species), but consideration of the water requirements of the full suite of floodplain ecosystems and significant species has been limited. By considering the water requirements of the full range of natural assets, the effectiveness of water delivery for biodiversity can be maximised. This approach highlights the species and ecosystems most in need of water and builds on the icon sites approach to view the Murray floodplains as an interconnected system. This project also identified for the first time the flood-frequency and duration requirements for the full suite of floodplain ecosystems and significant species.

This project is the most comprehensive identification of water requirements for natural values on the floodplain to date, and is able to be used immediately to guide prioritisation of environmental watering. As more information on floodplain EVCs and species becomes available, the water requirements and distribution of values can be refined by ecologists and land and water managers. That is, the project is intended as the start of an adaptive process allowing for the incorporation of monitoring and feedback over time. The project makes it possible to transparently and easily communicate the extent to which manipulated or natural flows benefit various natural values. Quantitative and visual outputs such as maps will enable environmental managers and the public to easily see which values do and do not receive water (see http://www.veac.vic.gov.au/riverredgumfinal.htm for further details).

The role of loneliness in prison suicide prevention and management

Suicide in prisons has been seen as a public health concern reaching crisis proportions around the world. In this study, data from 60 inmates in a South Australian remand facility were used to examine the relationship between loneliness and known predictors of self-harm, such as depression and hopelessness. As predicted, the results suggested that prisoners who scored higher on a measure of loneliness reported higher levels of depression, hopelessness and indicators of suicidal behaviour. The implications of these findings for suicide management are discussed. It is concluded that whilst specialist mental health services are needed to treat problems such as depression, loneliness is something that may be managed by correctional staff with no professional experience or training.

Prevalence, awareness, treatment, and control of hypertension in China data from the China National Nutrition and Health Survey 2002

Background— The present article aims to provide accurate estimates of the prevalence, awareness, treatment, and control of hypertension in adults in China.

Methods and Results— Data were obtained from sphygmomanometer measurements and an administered questionnaire from 141 892 Chinese adults 18 years of age who participated in the 2002 China National Nutrition and Health Survey. In 2002, 153 million Chinese adults were hypertensive. The prevalence was higher among men than women (20% versus 17%; P<0.001) and was higher in successive age groups. Overall, the prevalence of hypertension was higher in urban compared with rural areas in men (23% versus 18%; P<0.01) and women (18% versus 16%; P<0.001). Of the 24% affected individuals who were aware of their condition, 78% were treated and 19% were adequately controlled. Despite evidence to suggest improved levels of treatment in individuals with hypertension over the past decade, compared with estimates from 1991, the ratio of controlled to treated hypertension has remained largely unchanged at 1:4.

Conclusions— One in 6 Chinese adults is hypertensive, but only one quarter are aware of their condition. Despite increased rates of blood pressure–lowering treatment, few have their hypertension effectively controlled. National hypertension programs must focus on improving awareness in the wider community, as well as treatment and control, to prevent many tens of thousands of cardiovascular-related deaths.

Nutrients in Pirron Yallock Creek, southwestern Victoria : paleolimnological and management considerations

The concentrations of various forms of nitrogen and phosphorus in the main stream and selected tributaries of Pirron Yallock Creek, southwestern Victoria were examined over a two-year period. Exceedingly high levels of both nutrients were found within a particular tributary, while generally high nutrient levels were observed throughout the catchment. The speciation results indicated that dairy effluent was the primary source of nutrients to Pirron Yallock Creek. A palaeolimnological study was undertaken to determine the impact of European settlement upon waterway nutrient concentrations within the region. The palaeolimnological study focused primarily on the diatom flora preserved within the sediments of nearby Lakes Corangamite and Bullen Merri. Lack of preservation of diatoms within the sediments of Lake Corangamite resulted in no water quality inferences for this lake. The preserved diatoms within Lake Bullen Merri suggested an increase in trophic status of this lake during the last 500 years. While a change in the diatom flora of Lake Bullen Merri was evident, it was not possible to differentiate the impact of European settlement upon nutrient status of this waterway from long-term trophic status change. In light of the particularly high nutrient concentrations observed in Pirron Yallock Creek, improved nutrient management strategies are proposed for the catchment. These strategies, which consider current nutrient management activities, are predominantly focussed on the dairy industry, which occupies the majority of the catchment.

An integrated observation network for the Gippsland Lakes, Victoria, Australia : balancing the needs of science and management

The Gippsland Lakes region in eastern Victoria is a partially flushed coastal lake system within a diverse catchment of rural and urban communities. Pressure from lakeside developments, re-occurring blue-green algal blooms, declining fisheries, sedimentation and infilling of the ocean entrance, has borne several decades of focussed studies and routine monitoring programs, along with a variety of engineering and management solutions. A recent review recommended that these disparate studies should be enhanced to formulate a coordinated monitoring network that could improve both spatial and temporal coverage, develop a capacity to trigger responsive investigations and was able to serve the needs of system management. Through a series of partnerships an integrated network was developed that comprises event and baseline monitoring of catchment loads, local meteorological forcing and an array of water quality sampling sites within the lakes system. A majority of these sites are incorporated with real-time telemetry that provides up to the minute information to stakeholders via a web-based information management system and vital operational status to technical system management.

Exercise increases MEF2- and GEF DNA-binding activity in human skeletal muscle

Diabetes is quickly reaching epidemic proportions, with 216 million people worldwide predicted to be diagnosed with the disease by 2010. While it appears that the expression of the insulin responsive glucose transporter isoform 4 (GLUT4) is not reduced in diabetic populations, overexpression of GLUT4 exclusively in muscle enhances insulin action and improves glucose homeostasis. Consequently, understanding the regulation of GLUT4 expression is considered important in identifying potential therapeutic targets for the treatment and management of insulin resistance and related disorders such as type 2 diabetes. Using transgenic mice, we have identified two conserved regions on the GLUT4 gene promoter that are required for normal skeletal muscle GLUT4 expression. The first region contains a binding site for the myocyte enhancer factor 2 (MEF2) transcription factor, between –464 and –473 bp, and it appears that a MEF2A/D heterodimer binds this sequence. However, this site is not sufficient to support full GLUT4 expression, and another region between –712 and –742 bp, termed Domain 1, is also required. A novel transcription factor, named the GLUT4 enhancer factor (GEF), was found to bind to this region. It appears that MEF2 and GEF physically interact in order to induce GLUT4 expression. A single bout of exercise is sufficient to increase both GLUT4 transcription and mRNA abundance. However, the molecular mechanisms underpinning this response remain largely unexplored, particularly in human skeletal muscle. Therefore, the aim of this study was to determine whether a single, acute bout of exercise increases the DNA-binding activity of both MEF2 and GEF in human skeletal muscle.

Exercise and skeletal muscle glucose transporter 4 expression: molecular mechanisms

1.      Skeletal muscle is a highly plastic tissue that has a remarkable ability to adapt to external demands, such as exercise. Many of these adaptations can be explained by changes in skeletal muscle gene expression. A single bout of exercise is sufficient to induce the expression of some metabolic genes. We have focused our attention on the regulation of glucose transporter isoform 4 (GLUT-4) expression in human skeletal muscle.

2.      Glucose transporter isoform 4 gene expression is increased immediately following a single bout of exercise, and the GLUT-4 enhancer factor (GEF) and myocyte enhancer factor 2 (MEF2) transcription factors are required for this response. Glucose transporter isoform enhancer factor and MEF2 DNA binding activities are increased following exercise, and the molecular mechanisms regulating MEF2 in exercising human skeletal muscle have also been examined.

3.      These studies find possible roles for histone deacetylase 5 (HDAC5), adenosine monophosphate–activated protein kinase (AMPK), peroxisome proliferator-activated receptor gamma coactivator 1α (PGC-1α) and p38 mitogen-activated protein kinase (MAPK) in regulating MEF2 through a series of complex interactions potentially involving MEF2 repression, coactivation and phosphorylation.

4.      Given that MEF2 is a transcription factor required for many exercise responsive genes, it is possible that these mechanisms are responsible for regulating the expression of a variety of metabolic genes during exercise. These mechanisms could also provide targets for the treatment and management of metabolic disease states, such as obesity and type 2 diabetes, which are characterized by mitochondrial dysfunction and insulin resistance in skeletal muscle.

Knowledge sharing in professional accountancy firms : the effects of task complexity and management control system

Numerous empirical studies on knowledge management have focused on effectiveness of enablers such as organizational structure (Bennett and Gabriel, 1999; Gold et al., 2001), technology (Gold et al., 2001; O’Dell and Grayson, 1998), culture (DeLong and Fahey, 2000; Gupta and Govindarajan, 2000), managerial system (Nonaka, 1994; Sveiby, 1997) and strategy (Bierly and Chakrabarti, 1996; Holsapple and Joshi, 2001) on knowledge sharing. These enablers are organizational infrastructure or mechanism for facilitating the sharing of knowledge in a firm. In knowledge-intensive firms, task complexity and management control systems (MCS) can potentially affect the mode and effectiveness of knowledge sharing. However, these two factors have not been distinctly and explicitly investigated and discussed in literature relevant to the domain of knowledge sharing and management. This study proposes to examine how task complexity and the design of MCS could be the key determinants of the mode and effectiveness of knowledge sharing in professional accounting firms or practices.

Subtypes of psychopathy : proposed differences between narcissistic, borderline, sadistic and antisocial psychopaths

Atascadero State Hospital (ASH) is a maximum-security forensic hospital that houses male patients with a wide range of psychiatric diagnoses. Psychopaths at this institution appear to be a heterogeneous group of individuals who, while sharing core personality characteristics, manifest substantial variability in their behavior. Identifying subtypes within this clinical classification can have implications for patient treatment and management, as well as for the safety of the staff who work with them and for the communities to which they will eventually return. Several means of identifying subtypes have been proposed in the literature, and potential subgroups have been identified. Clinical observations at ASH have suggested 4 possible subtypes of psychopathy: narcissistic, borderline, sadistic, and antisocial. Issues related to the conceptualization of psychopathy are addressed, recognizing that additional data are needed to understand the observed variations in cases of psychopathy.

Development of a universal approach to estuarine planning and management, with special reference to Australia

The study develops a universal management framework for estuaries. Based on the identified problems, policy makers' inputs and characteristics of effective management models, the study proposes a universal planning and management framework, which consists of four elements. On the basis of the elements the study outlines a detailed planning and management framework for estuaries.