The cost-benefit of using soft silicone multilayered foam dressings to prevent sacral and heel pressure ulcers in trauma and critically ill patients: a within-trial analysis of the Border Trial.

Little is known about the cost-benefit of soft silicone foam dressings in pressure ulcer (PU) prevention among critically ill patients in the emergency department (ED) and intensive care unit (ICU). A randomised controlled trial to assess the efficacy of soft silicone foam dressings in preventing sacral and heel PUs was undertaken among 440 critically ill patients in an acute care hospital. Participants were randomly allocated either to an intervention group with prophylactic dressings applied to the sacrum and heels in the ED and changed every 3 days in the ICU or to a control group with standard PU prevention care provided during their ED and ICU stay. The results showed a significant reduction of PU incidence rates in the intervention group (P = 0·001). The intervention cost was estimated to be AU$36·61 per person based on an intention-to-treat analysis, but this was offset by lower downstream costs associated with PU treatment (AU$1103·52). Therefore, the average net cost of the intervention was lower than that of the control (AU$70·82 versus AU$144·56). We conclude that the use of soft silicone multilayered foam dressings to prevent sacral and heel PUs among critically ill patients results in cost savings in the acute care hospital.

Use of the Screening Tool of Older Persons' Prescriptions (STOPP) and the Screening Tool to Alert doctors to the Right Treatment (START) in hospitalised older people

To determine the prevalence and nature of potentially inappropriate medications (PIMs) and potential prescribing omissions (PPOs) in patients aged 65 years and over.

Consent as a Common Law Defence to Non-Sexual Assaults: The Effect of Neal v The Queen

The following discussion is an exposition of the recognised exceptions to the general rule that the law will not sanction the giving of a lawful consent to the application or threat of actual or grievous bodily harm. The discussion will also focus on a series of decisions in the UK and Australia, particularly Neal v The Queen, that have altered the law's approach to these exceptions and, more importantly, now permit a personto give an informed consent to the risk of contracting HIV or any other sexually transmitted diseases, provided there was no intention on the part of the accused to actually infect the other person. The underlying rationale for sanctioning an informed consent to such a risk is that consenting adults should be accorded the utmost autonomy in conductingtheir private affairs, and particularly so in the context of the choices they make regarding their private sexual activities. Whether one agrees or disagrees with the notion of allowing one to lawfully consent to such a risk, it raises an important question as to the current status of the general rule that one cannot generally give an informed consent to the applicationor threat of actual or grievous bodily harm. More succinctly stated, if the law is prepared to allow an informed consent to the risk of contracting a potentially fatal disease, then what remains of what had previously been a well-settled rule that, save for a few well-recognised exceptions, persons were generally prohibited from consenting to the application or threat of actual or grievous bodily harm?

Five ways to hack and cheat with bring-your-own-device electronic examinations

Bring-your-own-device electronic examinations (BYOD e-exams) are a relatively new type of assessment where students sit an in-person exam under invigilated conditions with their own laptop. Special software restricts student access to prohibited computer functions and files, and provides access to any resources or software the examiner approves. In this study, the decades-old computer security principle that ‘software security depends on hardware security’ is applied to a range of BYOD e-exam tools. Five potential hacks are examined, four of which are confirmed to work against at least one BYOD e-exam tool. The consequences of these hacks are significant, ranging from removal of the exam paper from the venue through to receiving live assistance from an outside expert. Potential mitigation strategies are proposed; however, these are unlikely to completely protect the integrity of BYOD e-exams. Educational institutions are urged to balance the additional affordances of BYOD e-exams for examiners against the potential affordances for cheaters.

Cancer patients' perceptions of the barriers and facilitators to patient participation in symptom management during an episode of admission

BACKGROUND:: Symptoms by definition are subjective, and patients' role in their assessment and management will impact on patient outcomes; thus, symptom management is an area of acute care practice where facilitation of patient participation is vital if quality outcomes are to be achieved. OBJECTIVE:: This study originated from a large multimethod research program exploring patient participation in symptom management in an acute oncology setting. The purpose of this article is to explore patients' perceptions of the barriers and facilitators to participating in their symptom management during an episode of admission to an acute oncology ward and the relationships between these perceptions and patients' preference for participation. METHODS:: One hundred seventy-one cancer inpatients consented and completed an interview-administered questionnaire. Patients' preference for participation was measured using the Control Preference Scale. Responses to open-ended survey questions were evaluated using content analysis. RESULTS:: Ten categories were identified in the analyses of patient perceptions of the barriers and facilitators to participating in care decisions relating to their symptoms. Patients, irrespective of their Control Preference, reported multiple barriers and facilitators to participating in their symptom management. CONCLUSIONS:: Patients overall perceived information as the most critical component of participation. Irrespective of patients' preference for participation, there were similarities in the barriers and facilitators to the operationalization of participation in the acute care setting reported. IMPLICATIONS FOR PRACTICE:: Understanding patient perceptions of barriers and facilitators of participating in symptom management has provided important insights into person and system factors in the acute care sector impacting quality patient symptom outcomes.

Development of key messages for adolescents on providing basic mental health first aid to peers: a Delphi consensus study.

AIM: Most young people fail to receive professional treatment for mental disorders; however, they do indicate a preference for sharing problems with peers. This article describes key messages about knowledge and actions to form the basis of a basic mental health first aid (MHFA) course for adolescents to increase recognition of and help seeking for mental health problems by teaching the best knowledge and helping actions a young person can undertake to support a peer with a mental health problem. METHODS: The Delphi method was used to achieve consensus among Australian and Canadian youth mental health experts regarding the importance of statements that describe helping actions a young person can take, and information they should have, to support a friend with a mental health problem. There were two expert panels, one consisting of 36 youth mental health consumer advocates and the other of 97 Youth MHFA instructors. Panellists rated each statement according to how appropriate it would be as a basic mental health first aid message for both a junior adolescent (12-15 years) and a senior adolescent (16-18 years). RESULTS: Out of 98 statements, 78 were endorsed as key basic MHFA messages for junior adolescents and 81 were endorsed for senior adolescents. CONCLUSION: The study has identified key messages for adolescents on how they can help a peer. These messages will form the basis of the curriculum for an MHFA course for adolescents, which will aim to facilitate early recognition of and help seeking for mental health problems in adolescents.

Development of mental health first aid guidelines on how a member of the public can support a person affected by a traumatic event: a Delphi study

BACKGROUND: People who experience traumatic events have an increased risk of developing a range of mental disorders. Appropriate early support from a member of the public, whether a friend, family member, co-worker or volunteer, may help to prevent the onset of a mental disorder or may minimise its severity. However, few people have the knowledge and skills required to assist. Simple guidelines may help members of the public to offer appropriate support when it is needed.

METHODS: Guidelines were developed using the Delphi method to reach consensus in a panel of experts. Experts recruited to the panels included 37 professionals writing, planning or working clinically in the trauma area, and 17 consumer or carer advocates who had been affected by traumatic events. As input for the panels to consider, statements about how to assist someone who has experienced a traumatic event were sourced through a systematic search of both professional and lay literature. These statements were used to develop separate questionnaires about possible ways to assist adults and to assist children, and panel members answered either one questionnaire or both, depending on experience and expertise. The guidelines were written using the items most consistently endorsed by the panels across the three Delphi rounds.

RESULTS: There were 180 items relating to helping adults, of which 65 were accepted, and 155 items relating to helping children, of which 71 were accepted. These statements were used to develop the two sets of guidelines appended to this paper.

CONCLUSIONS: There are a number of actions which may be useful for members of the public when they encounter someone who has experienced a traumatic event, and it is possible that these actions may help prevent the development of some mental health problems in the future. Positive social support, a strong theme in these guidelines, has some evidence for effectiveness in developing mental health problems in people who have experienced traumatic events, but the degree to which it helps has not yet been adequately demonstrated. An evaluation of the effectiveness of these guidelines would be useful in determining their value. These guidelines may be useful to organisations who wish to develop or revise curricula of mental health first aid and trauma intervention training programs and policies. They may also be useful for members of the public who want immediate information about how to assist someone who has experienced a potentially traumatic event.

Changing listening frequency to minimise white noise and hear indigenous voices

Listening… can involve the listener in an intense, efficacious, and complex set of communicative acts in which one is not speaking, discussing, or disclosing, but sitting quietly, watching, and feeling-the-place, through all the senses…. In the process, one becomes a part of the scene, hearing and feeling with it (Carbaugh 1999: 259).To listen this way involves much more than providing a chance for words to be spoken; it includes tuning in and getting the listening frequency clear. As a non-Indigenous person seeking to conduct qualitative research that listens to Aboriginal people, I need to ask how I can tune into the “active attentiveness” described by Carbaugh (1999) in order to listen in a manner that is appropriate, respectful and minimises my inherent white privilege. In addressing this question I draw on the work of Indigenous authors and academics, critical whiteness studies and my own experiences learning from Aboriginal people in a number of contexts over the past ten to fifteen years.History in Australia since colonization has created a situation where Aboriginal voices are white noise to the ears of many non-Indigenous people. This paper proposes that white privilege and the resulting white noise can be minimised and greater clarity given to Aboriginal voices by privileging Indigenous knowledge and ways of working when addressing Indigenous issues. To minimise the interference of white noise, non-Indigenous people would do well to adopt a position that recognises, acknowledges and utilises some of the strengths that can be learned from Aboriginal culture and Indigenous authors.This paper outlines a model of apprentice, allied listening for non-Indigenous researchers to adopt when preparing to conduct research alongside Indigenous people. Such an approach involves Re-learning of history, Reviewing of the researcher’s beliefs and placing Relating at the centre of the listening approach. Each of these aspects of listening is based on privileging of Indigenous voices.

First aid recommendations for psychosis: using the Delphi method to gain consensus between mental health consumers, carers, and clinicians.

BACKGROUND: Members of the general public often lack the knowledge and skills to intervene effectively to help someone who may be developing a psychotic illness before appropriate professional help is received. METHODS: We used the Delphi method to determine recommendations on first aid for psychosis. An international panel of 157 mental health consumers, carers, and clinicians completed a 146-item questionnaire about how a member of the public could help someone who may be experiencing psychosis. The panel members rated each questionnaire item according to whether they believed the statement should be included in the first aid recommendations. The results were analyzed by comparing consensus rates across the 3 groups. Three rounds of ratings were required to consolidate consensus levels. RESULTS: Eighty-nine items were endorsed by >or=80% of panel members from all 3 groups as essential or important for psychosis first aid. These items were grouped under the following 9 headings: how to know if someone is experiencing psychosis; how to approach someone who may be experiencing psychosis; how to be supportive; how to deal with delusions and hallucinations; how to deal with communication difficulties; whether to encourage the person to seek professional help; what to do if the person does not want help; what to do in a crisis situation when the person has become acutely unwell; what to do if the person becomes aggressive. CONCLUSIONS: These recommendations will improve the provision of first aid to individuals who are developing a psychotic disorder by informing the content of training courses.

In-reach nursing services improve older patient outcomes and access to emergency care

Aims: To identify the impact of in-reach services providing specialist nursing care on outcomes for older people presenting to the emergency department from residential aged care. Methods: Retrospective cohort study compared clinical outcomes of 2278 presentations from 2009 with 2051 presentations from 2011 before and after the implementation of in-reach services. Results: Median emergency department length of stay decreased by 24 minutes (7.0 vs 6.6 hours, P<0.001) and admission rates decreased by 23% (68 vs 45%, P<0.001). The proportion of people with repeat emergency department visits within six months decreased by 12% (27 vs 15%). The proportion of admitted patients who were discharged with an end of life palliative care plan increased by 13% (8 vs 21%, P=0.007). Conclusions: There was a significant reduction in the median length of stay, fewer hospital admissions and fewer repeat visits for people from residential aged care following implementation of in-reach services.

Dysglycaemia and other predictors for progression or regression from impaired fasting glucose to diabetes or normoglycaemia

Aims. Diabetes mellitus is a growing health problem worldwide. This study aimed to describe dysglycaemia and determine the impact of body composition and clinical and lifestyle factors on the risk of progression or regression from impaired fasting glucose (IFG) to diabetes or normoglycaemia in Australian women. Methods. This study included 1167 women, aged 20-94 years, enrolled in the Geelong Osteoporosis Study. Multivariable logistic regression was used to identify predictors for progression to diabetes or regression to normoglycaemia (from IFG), over 10 years of follow-up. Results. At baseline the proportion of women with IFG was 33.8% and 6.5% had diabetes. Those with fasting dysglycaemia had higher obesity-related factors, lower serum HDL cholesterol, and lower physical activity. Over a decade, the incidence of progression from IFG to diabetes was 18.1 per 1,000 person-years (95% CI, 10.7-28.2). Fasting plasma glucose and serum triglycerides were important factors in both progression to diabetes and regression to normoglycaemia. Conclusions. Our results show a transitional process; those with IFG had risk factors intermediate to normoglycaemics and those with diabetes. This investigation may help target interventions to those with IFG at high risk of progression to diabetes and thereby prevent cases of diabetes.

Rebound or resignation: developing a predictive model of return to subjective wellbeing set-point

Though subjective wellbeing (SWB) is generally stable and consistent over time, it can fall below its set-point in response to adverse life events. However, deviations from set-point levels are usually only temporary, as homeostatic processes operate to return SWB to its normal state. Given that income and close interpersonal relationships have been proposed as powerful external resources that are coincident with higher SWB, access to these resources may be an important predictor of whether or not a person is likely to recover their SWB following a departure from their set-point. Under the guiding framework of SWB Homeostasis Theory, this study considers whether access to a higher income and a committed partner can predict whether people who score lower than normal for SWB at baseline will return to normal set-point levels of SWB (rebound) or remain below the normal range (resigned) at follow-up. Participants were 733 people (53.3 % female) from the Australian Unity Longitudinal Wellbeing Study who ranged in age from 20 to 92 years (M = 59.65 years; SD = 13.15). Logistic regression analyses revealed that participants’ demographic characteristics were poor predictors of whether they rebounded or resigned. Consistent with homeostasis theory, the extent of departure from the proposed normal SWB set-point at baseline was significantly associated with rebound or resignation at time 2. These findings have implications for the way that SWB measures can be used in professional practice to identify people who are particularly vulnerable to depression and to guide the provision of appropriate and effective therapeutic interventions.

To the very ground of meaning, to vary the ground of meaning

Parody may be understood as the absorption of a revolutionary impulse into the everyday production of meaning as continuous variation and soft subversion. Considered in this way, parody is transformative because it operates on the components within a system of meaning and/or the context, logic or spatial perspective that grounds the possibility of meaning. It is the conditions under which shared meaning, sense and sensation depend that I aim to unpack in order to suggest the ways in which parody can alter a person’s relationship to the world. By approaching parody as a mode of lived abstraction and as an embodied approach to affective self-organisation, body-environment co-construction and a challenge to identity, it becomes possible to move from formal concerns that have characterised parody to a set of transformative practices. Thus parody indicates where the anchors of embodied, embedded, extended, enacted and affective are dug in and hold identity and the ground of meaning in a steady state. This paper will examine how parody moves from the impulse to overthrow and invert — ‘Beneath the street, The beach’—to a collective impulse that moves the ground of meaning into a reconfigurative process that is allows totalised systems of meaning to collide and intersect. What is left is not the rubble and ruins of meaning but revitalised fragments, stems cells of meaning ready-to-be-remade.A lineage of parodic works will be paraded and discussed that directly address the tacit relation of ground, horizon, orientation and position. This parody parade will form the basis of a critique and the analysis of the ontological orientations that for example, opposing systems of perspective insert as the very ground of meaning. The implication of this line of inquiry leads to the assertion that all descriptions of the world, universe and the cosmos are parodies in search of an origin. Totalised or unified images of the ground of meaning are already parodies of a/the set of conditions by which meaning operates that also produce a trajectory that as a lived-abstraction directs or hijacks subsequent productions of meaning

Extraordinary television time travel and the wonderful end to the working day

In this article I will present two arguments. First, the argument that the time travel television series historically provided viewers with a spectacular temporal and spatial alternative to the routine of everyday life, the regulation of television scheduling, and the small-world confines of domestic subjectivity. Taking the decades of the 1970s and 1980s, predominantly in a UK viewing environment, I will suggest that the special effect rendering of the time travel sequence expanded the viewer’s material universe, and affectively wrenched the television set free from the strictures of scheduling and realist programming. Further, the time travel series readily and regularly took the domestic space, the ordinary day and the everyman/ person into awesome environments and situations that suggested alternative lifestyles and behaviours, with a different existential tempo and rhythm. At a narrative, thematic, meta- textual, and aesthetically spectacular level, television time travel saw to the wonderful end of the working day. Case studies include Sapphire and Steal, Dr Who, and Quantum Leap. Second, the article will argue that rather than the contemporary time travel television series being an extraordinary alternative to ordinary life, they instead articulate convergence culture, deregulation, multiple channel viewing, and time-shift culture where there is no such thing as an ordinary working day or domestic viewing context.

Translating person-centered care into practice: a comparative analysis of motivational interviewing, illness-integration support, and guided self-determination

OBJECTIVE: Person-centred care [PCC] can engage people in living well with a chronic condition. However, translating PCC into practice is challenging. We aimed to compare the translational potentials of three approaches: motivational interviewing [MI], illness integration support [IIS] and guided self-determination [GSD]. METHODS: Comparative analysis included eight components: (1) philosophical origin; (2) development in original clinical setting; (3) theoretical underpinnings; (4) overarching goal and supportive processes; (5) general principles, strategies or tools for engaging peoples; (6) health care professionals' background and training; (7) fidelity assessment; (8) reported effects. RESULTS: Although all approaches promoted autonomous motivation, they differed in other ways. Their original settings explain why IIS and GSD strive for life-illness integration, whereas MI focuses on managing ambivalence. IIS and GSD were based on grounded theories, and MI was intuitively developed. All apply processes and strategies to advance professionals' communication skills and engagement; GSD includes context-specific reflection sheets. All offer training programs; MI and GSD include fidelity tools. CONCLUSION: Each approach has a primary application: MI, when ambivalence threatens positive change; IIS, when integrating newly diagnosed chronic conditions; and GSD, when problem solving is difficult, or deadlocked. PRACTICE IMPLICATIONS: Professionals must critically consider the context in their choice of approach.