Do renal access coordinators make a difference? What is the evidence?

Background
Since the introduction of the renal access coordinator (RAC) role into Australia there have been only anecdotal examples of associated improvements in patient outcome and service delivery and scant published quantitative extant evidence exists.

Aim
To review the literature related to the impact of RACs on dialysis patient outcomes and associated service delivery, gauge the level of evidence available and identify gaps in the literature.

Method
A three stage Joanna Briggs Institute (JBI) systematic review process was used to collect and synthesise data. The review considered studies that explored and measured the RAC role in the adult haemodialysis context. All quantitative study designs were considered. Due to lack of homogeneity a narrative synthesis was undertaken.

Results
Five studies met the inclusion criteria for the review. All studies included multidisciplinary teams with variable emphasis on the RAC role. Four pre post intervention cohort studies measured incident and/or prevalent AVF, AVG and CVC rates in the haemodialysis population and the quality assurance report measured differences in patency rates between AVF and AVG and associated hospital length of stay. All discussed the role of central coordination as a contributor to the success of vascular access care.

Conclusion
The available reports do suggest an association between RACs and improved patient outcomes. These improved patient outcomes were apparent in an increase in incident and prevalent AVFs, and a decrease in the incidence and prevalence of CVCs. Both associations are correlated with a reduction in infection rates, length of hospital stay and healthcare costs
 

Developing an analytical framework to assess the uncertainty and flexibility mismatches across the supply chain

Purpose: The purpose of this paper is to discuss how decisions regarding organisational flexibility can be improved through targeted resource allocation, by focusing on the supply chain's level of uncertainty exposure. Specifically, the issue of where and in what ways flexibility has been incorporated across the organisation's supply chain is addressed. Design/methodology/approach: A two-phase methodology design based on literature review and case study was used. Using 83 journal articles in the areas of uncertainty and flexibility an analytical process for assessing uncertainty-flexibility mismatches was developed. Furthermore, results from ten interviews with senior/middle managers within the Australian manufacturing sector were used to provide preliminary insights on the usefulness and importance of the analytical process and its relationship with organisational practice. Findings: The paper emphasises the importance of having a systematic and encompassing view of uncertainty-flexibility mismatches across the supply chain, as well as the significance of socio-technical engagement. The paper both conceptually and empirically illustrates how, using a structured analytical process, flexibility requirements across the supply, process, control and demand segments of a supply chain might be assessed. A four-step analytical process was accordingly developed and, its application, usefulness and importance discussed using empirical data. Practical implications: The analytical process presented in this paper can assist managers to obtain a comprehensive overview of supply chain flexibility when dealing with situations involving uncertainty. This can facilitate and improve their decision-making with respect to prioritising attention on identified flexibility gaps in order to ensure stability of their performance. Originality/value: The paper presents a supply chain-wide discussion on the difficulties that uncertainty brings to organisations, and how organisational flexibility might serve to moderate those challenges for supply chain management. It discusses how to identify the flexibility gap and proposes an original analytical process for systematic assessment of uncertainty-flexibility mismatches. © Emerald Group Publishing Limited.

Exercise as an intervention to improve metabolic outcomes after intrauterine growth restriction

Individuals born after intrauterine growth restriction (IUGR) are at an increased risk of developing diabetes in their adult life. IUGR impairs β-cell function and reduces β-cell mass, thereby diminishing insulin secretion. IUGR also induces insulin resistance, with impaired insulin signaling in muscle in adult humans who were small for gestational age (SGA) and in rodent models of IUGR. There is epidemiological evidence in humans that exercise in adults can reduce the risk of metabolic disease following IUGR. However, it is not clear whether adult IUGR individuals benefit to the same extent from exercise as do normal-birth-weight individuals, as our rat studies suggest less of a benefit in those born IUGR. Importantly, however, there is some evidence from studies in rats that exercise in early life might be able to reverse or reprogram the long-term metabolic effects of IUGR. Studies are needed to address gaps in current knowledge, including determining the mechanisms involved in the reprogramming effects of early exercise in rats, whether exercise early in life or in adulthood has similar beneficial metabolic effects in larger animal models in which insulin resistance develops after IUGR. Human studies are also needed to determine whether exercise training improves insulin secretion and insulin sensitivity to the same extent in IUGR adults as in control populations. Such investigations will have implications for customizing the recommended level and timing of exercise to improve metabolic health after IUGR.

The effects of mechanical stress, environment and cathodic protection on the degradation and failure of coatings: An overview

Organic coatings have been used in conjunction with cathodic protection as the most economical method of corrosion protection by the oil and gas pipeline industry. In a bid to prolong the life of the pipelines, the degradation and failure of pipeline coatings under the effects of major influencing factors including mechanical stress, the environmental corrosivity and cathodic protection have been extensively investigated over the past decades. This paper provides an overview of recent research for understanding coating degradation under the effect of these factors, either individually or in combination. Electrochemical impedance spectroscopy remains the primary and the most commonly used technique of studying the degradation of organic coatings, although there have been attempts to use other techniques such as electrochemical polarization (both dynamic and static), electrochemical noise, Scanning Kelvin Probe, Fourier Transform Infrared Spectroscopy, Differential Scanning Calorimetry and Dynamic Mechanical Analyser. Major knowledge and technological gaps in the investigation of the combined effects of mechanical stress, environmental corrosivity and cathodic protection on coating degradation have been identified.

Current levels of salt knowledge: a review of the literature

 High salt intake increases the risk of hypertension and cardiovascular diseases. Given the role of knowledge as a determinant of food intake, this paper aims to review the current levels of salt knowledge and the association between salt knowledge and dietary salt intake and salt-related dietary practices in the general population. Twenty two studies were included in the review. In general, the studies showed consumers were able to identify the health risks associated with high salt intake. However, knowledge of recommended daily intakes, understanding of the relationships between salt and sodium and foods that contribute most salt to the diet were poor. Four of the five studies which examined the relationships between salt knowledge and salt-related dietary practices reported significant associations. Two important gaps in the current literature were identified. First, there is a need for a robustly validated tool to examine salt knowledge and its impact on salt intake. Second, a comprehensive salt knowledge assessment should include assessment of procedural, as well as declarative, knowledge. © 2014, by the authors; licensee MDPI, Basel, Switzerland.

Shining the light on sunshine: a systematic review of the influence of sun exposure on type 2 diabetes mellitus-related outcomes

Prospective observational studies uniformly link vitamin D deficiency with the incidence of type 2 diabetes mellitus (T2DM), yet trials supplementing participants at risk of T2DM with vitamin D to reduce progression to T2DM have yielded inconsistent results. Inconsistencies between supplementation trials may be due to insufficient dosing or small sample sizes. Observational studies may also have reported spurious associations due to uncontrolled confounding by lifestyle or genetic factors. Alternatively, observational and intervention studies may not be entirely comparable. Observational studies show an association between higher vitamin D status, which is predominantly derived from sun exposure, and decreased incidence of T2DM. Trials intervene with vitamin D supplementation, and therefore may be missing alternate causes of the effect of sun exposure, as seen in observational studies. We propose that sun exposure may be the driving force behind the associations seen in observational studies; sun exposure may have additional benefits beyond increasing serum 25-hydroxyvitamin D (25OHD) levels. We performed an electronic literature search to identify articles that examined associations between sun exposure and T2DM and/or glucose metabolism. A best evidence synthesis was then conducted using outcomes from analyses deemed to have high methodological quality. Ten eligible full-text articles were identified, yielding 19 T2DM-related outcomes. The best evidence analysis considered 11 outcomes which were grouped into six outcome types: T2DM, fasting glucose, glucose tolerance, fasting insulin, insulin secretion and insulin sensitivity. There was moderate evidence to support a role of recreational sun exposure in reducing odds of T2DM incidence. High-level evidence was lacking; evidence presented for other outcomes was of low or insufficient level. This review highlights significant gaps in research pertaining to sun exposure and T2DM-related outcomes. Further research is encouraged as we aim to identify novel preventative strategies for T2DM.

A global gap analysis of sea turtle protection coverage

 Although the number and extent of protected areas (PAs) are continuously increasing, their coverage of global biodiversity, as well as criteria and targets that underline their selection, warrants scrutiny. As a case study, we use a global dataset of sea turtle nesting sites (. n=. 2991) to determine the extent to which the existing global PA network encompasses nesting habitats (beaches) that are vital for the persistence of the seven sea turtle species. The majority of nesting sites (87%) are in the tropics, and are mainly hosted by developing countries. Developing countries contain 82% nesting sites, which provide lower protection coverage compared to developed countries. PAs encompass 25% of all nesting sites, of which 78% are in marine PAs. At present, most nesting sites in PAs with IUCN ratification receive high protection. We identified the countries that provide the highest and lowest nesting site protection coverage, and detected gaps in species-level protection effort within countries. No clear trend in protection coverage was found in relation to gross domestic product, the Global Peace Index or sea turtle regional management units; however, countries in crisis (civil unrest, war or natural catastrophes) provided slightly higher protection coverage of all countries. We conclude that global sea turtle resilience against threats spanning temperate to tropical regions require representative PA coverage at the species level within countries. This work is anticipated to function as a first step towards identifying specific countries or regions that should receive higher conservation interest by national and international bodies. © 2014 Elsevier Ltd.

Determining criteria to assess patient readiness for discharge from postanaesthetic care: An international Delphi study

Aims and objectives: To obtain expert consensus on essential criteria required to assess patient readiness for discharge from the postanaesthetic care unit. Background: A patient's condition can deteriorate after surgery, and the immediate postoperative period is recognised internationally as a time of increased risk to patient safety. A recent systematic review identified evidence-based assessment criteria for the safe discharge of patients from the postanaesthetic care unit and identified gaps in the evidence. Design: Descriptive consensus study using the Delphi method. Methods: Members of international clinical specialist groups with expertise in anaesthesia or postanaesthetic care participated in three consultation rounds. Online surveys were used to determine expert consensus with regard to aspects of postanaesthetic care and specific criteria for assessing patient readiness for discharge. Three rounds of surveys were conducted from May 2011-September 2012. Results: Twenty-three experts contributed to the panel. Consensus, that is, at least 75% agreement, was reached in regard to 24 criteria considered essential (e.g. respiratory rate 100%; pain 100%; heart rate 95%; temperature 91%). Consensus was also reached for 15 criteria not considered essential (e.g. appetite 96%; headache 76%). Consensus was not obtained for a further 10 criteria. Participants (95%) agreed that a discharge tool was important to ensure safe patient discharge. Conclusion: Consensus was achieved by a panel of international experts on the use of a tool to assess patient readiness for discharge from postanaesthesia care unit and specific variables to be included or excluded from the tool. Further work is required to develop a tool and test its reliability and validity. Relevance to clinical practice: The findings of this study have informed the development of an evidence-based tool to be piloted in a subsequent funded study of nursing assessment of patient readiness for discharge from the postanaesthetic care unit.

Actor-Network Theory (ANT) based visualisation of socio-technical facets of RFID technology translation: an Australian hospital scenario

In the early 2000s, Information Systems researchers in Australia had begun to emphasise socio-technical approaches in innovation adoption of technologies. The ‘essentialist' approaches to adoption (for example, Innovation Diffusion or TAM), suggest an essence is largely responsible for rate of adoption (Tatnall, 2011) or a new technology introduced may spark innovation. The socio-technical factors in implementing an innovation are largely flouted by researchers and hospitals. Innovation Translation is an approach that purports that any innovation needs to be customised and translated in to context before it can be adopted. Equally, Actor-Network Theory (ANT) is an approach that embraces the differences in technical and human factors and socio-professional aspects in a non-deterministic manner. The research reported in this paper is an attempt to combined the two approaches in an effective manner, to visualise the socio-technical factors in RFID technology adoption in an Australian hospital. This research investigation demonstrates RFID technology translation in an Australian hospital using a case approach (Yin, 2009). Data was collected using a process of focus groups and interviews, analysed with document analysis and concept mapping techniques. The data was then reconstructed in a ‘movie script' format, with Acts and Scenes funnelled to ANT informed abstraction at the end of each Act. The information visualisation at the end of each Act using ANT informed Lens reveal the re-negotiation and improvement of network relationships between the people (factors) involved including nurses, patient care orderlies, management staff and non-human participants such as equipment and technology. The paper augments the current gaps in literature regarding socio-technical approaches in technology adoption within Australian healthcare context, which is transitioning from non-integrated nearly technophobic hospitals in the last decade to a tech-savvy integrated era. More importantly, the ANT visualisation addresses one of the criticisms of ANT i.e. its insufficiency to explain relationship formations between participants and over changes of events in relationship networks (Greenhalgh & Stones, 2010).

Computational chemistry for graphene-based energy applications: progress and challenges.

Research in graphene-based energy materials is a rapidly growing area. Many graphene-based energy applications involve interfacial processes. To enable advances in the design of these energy materials, such that their operation, economy, efficiency and durability is at least comparable with fossil-fuel based alternatives, connections between the molecular-scale structure and function of these interfaces are needed. While it is experimentally challenging to resolve this interfacial structure, molecular simulation and computational chemistry can help bridge these gaps. In this Review, we summarise recent progress in the application of computational chemistry to graphene-based materials for fuel cells, batteries, photovoltaics and supercapacitors. We also outline both the bright prospects and emerging challenges these techniques face for application to graphene-based energy materials in future.

Working with people who have killed: The experience and attitudes of forensic mental health clinicians working with forensic patients

Forensic mental health (FMH) clinicians sometimes feel unsupported and unprepared for their work. This article explores their experiences of working in a FMH setting in Australia. The research examined the clinical context of clinicians working with forensic patients (FP), particularly those individuals who have killed while experiencing a mental illness. A qualitative, exploratory design was selected. Data were collected through focus groups and individual interviews with hospital and community-based forensic clinicians from all professional groups: psychiatric medicine, social work, psychology, mental health nursing, occupational therapy, and psychiatric service officers. The main themes identified were orientation and adjustment to FMH, training in FMH, vicarious traumatization, clinical debriefing and clinical supervision, and therapeutic relationships. Participants described being frustrated and unsupported in making the transition to working with FP and felt conflicted by the emotional response that was generated when developing therapeutic relationships. Recommendations include the development of programmes that might assist clinicians and address gaps in service delivery, such as clinical governance, targeted orientation programmes, and clinical supervision.

"I tell ya who needs educatin’”: non-Indigenous cultural self-awareness and prisoner education.

Glen says, “current education is colonial; it ain’t ours. I tell ya who needs educatin’, wadjellas”. Glen is a Noongar man who, along with several other Aboriginal adults living in Western Australia, teaches me in a PhD research project about prisoner education from their perspective. His words pose a question for wadjellas like myself who are raised, taught and work in a white neo-colonial society. We have been raised in, taught in and work in a colonial system. As non-Aboriginal people we have unearned privileges which are often invisible and unacknowledged. How then to address the outcomes of this in a way that might lead to working co-operatively alongside Aboriginal people? What kind of ‘educatin’ could teach us about our own unacknowledged privilege and the disadvantage this can lead to for others? Is the standard cross-cultural awareness training enough?This paper shares some of the teachings of Glen and other participants in this research. It expresses the view that, ultimately, the usually unacknowledged legacy of colonisation and associated issue of denied Aboriginal sovereignty lies at the heart of much of the disadvantage experienced by Aboriginal people today when considering education and the prison system. Addressing gaps in non-Indigenous cultural self-awareness by learning from Aboriginal people is an important factor in improving their experiences of education.

Interprofessional interactions influence nurses' adoption of handover improvement

Aim: The purpose of this study was to explore clinician experiences of adopting quality improvement tools to standardise interprofessional (anaesthetist-to-nurse) handover communication when patients arrive in the post-anaesthetic care unit (PACU). Method: In this study, factors that impacted PACU nurses' adoption of the quality improvement tools were explored using pre- and postimplementation, semi-structured focus group interviews. Interview data was analysed using the PARiHS¹ (context, evidence and facilitation) framework as a deductive analysis tool. Results: PACU nurses recognised that PACU handover from anaesthetists to PACU nurses was suboptimal and described the tools as useful for their practice. However, PACU nurses frequently cited fear of anaesthetists' reactions as reasons not to insist on the use of the handover improvement tools. PACU nurses at Hospital 2 identified lacking "authority" (Hospital 2 FG 2) in the OR as hindering their willingness to use the tools against these behaviours. In comparison, visible support from leadership at Hospital 1 was described as encouraging nurses to be "assertive" (Hospital 1 FG 2) and take charge of their patients' care. Conclusion: PACU nurses perceived the handover tools were useful and helped them identify gaps in handover practice; however, PACU nurses described difficult relationships as hindering communication effectiveness and discouraging their adoption of the tools. However, strong leadership and organisational support of change emerged as essential to mitigate the effects of these difficult relationships.

Geo-identity, urban school choice and education campaigns for public schools

Educational campaigning has received little attention in the literature. This study investigates long-term and organised urban campaigns that are collectively lobbying the Victorian State Government in Australia, for a new public high school to be constructed in their suburb. A public high school is also known as a state school, government school, or an ordinary comprehensive school. It receives the majority of its funding from the State and Federal Australian Government, and is generally regarded as ‘free’ education, in comparison to a private school. Whilst the campaigners frame their requests as for a ‘public school’, their primary appeal is for a local school in their community. This study questions how collective campaigning for a locale-specific public school is influenced by geography, class and identity. In order to explore these campaigns, I draw on formative studies of middle-class school choice from an Australian and United Kingdom perspective (Campbell, Proctor, & Sherington, 2009; Reay, Crozier, & James, 2011). To think about the role of geography and space in these processes of choice, I look to apply Harvey’s (1973) theory of absolute, relational and relative space. I use Bourdieu (1999b) as a sociological lens that is attentive to “site effects” and it is through this lens that I think about class as a “collection of properties” (Bourdieu, 1984, p. 106), actualised via mechanisms of identity and representation (Hall, 1996; Rose, 1996a, 1996b). This study redresses three distinct gaps in the literature: first, I focus attention on a contemporary middle-class choice strategy—that is, collective campaigning for a public school. Research within this field is significantly under-developed, despite this choice strategy being on the rise. Second, previous research argues that certain middle-class choosers regard the local public school as “inferior” in some way (Reay, et al., 2011, p. 111), merely acting as a “safety net” (Campbell, et al., 2009, p. 5) and connected to the working-class chooser (Reay & Ball, 1997). The campaigners are characteristic of the middle-class school chooser, but they are purposefully and strategically seeking out the local public school. Therefore, this study looks to build on work by Reay, et al. (2011) in thinking about “against-the-grain school choice”, specifically within the Australian context. Third, this study uses visual and graphic methods in order to examine the influence of geography in the education market (Taylor, 2001). I see the visualisation of space and schooling that I offer in this dissertation as a key theoretical contribution of this study. I draw on a number of data sets, both qualitative and quantitative, to explore the research questions. I interviewed campaigners and attended campaign meetings as participant observer; I collected statistical data from fifteen different suburbs and schools, and conducted comparative analyses of each. These analyses are displayed by using visual graphs. This study uses maps created by a professional graphic designer and photographs by a professional photographer; I draw on publications by the campaigners themselves, such as surveys, reports and social media; but also, interviews with campaigners that are published in local or state newspapers. The multiple data sets enable an immersive and rich graphic ethnography. This study contributes by building on understandings of how particular sociological cohorts of choosers are engaging with, and choosing, the urban public school in Australia. It is relevant for policy making, in that it comes at a time of increasing privatisation and a move toward independent public schools. This study identifies cohorts of choosers that are employing individual and collective political strategies to obtain a specific school, and it identifies this cohort via explicit class-based characteristics and their school choice behaviours. I look to use fresh theoretical and methodological approaches that emphasise space and geography, theorising geo-identity and the pseudo-private school

Optimizing safety, fidelity and usability of an Intelligent Clinical Support Tool (ICST) for acute hospital care: an Australian case study using a multi-method Delphi Process

This research focuses on a major health priority for Australia by addressing existing gaps in the implementation of nursing informatics solutions in healthcare. It serves to inform the successful deployment of IT solutions designed to support patient-centered, frontline acute healthcare delivery by multidisciplinary care teams. The outcomes can guide future evaluations of the contribution of IT solutions to the efficiency, safety and quality of care delivery in acute hospital settings.