Vein diameter for peripherally inserted cathether insertion: a scoping review

Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used forperipherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certainvein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veinsavailable to determine the most optimal vessel to introduce a catheter. It is important that clinicians have anunderstanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominanceon vein size to determine whether their clinical practice is appropriate.

Methods: A scoping review of published literature was performed to determine existing knowledge regarding thediameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality(left or right arm) on vein size.

Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at themidupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement toinform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant researchexamined the effect of laterality on vein diameter and 1 study was identified that reported the influence of handdominance or vein type on the diameter of veins used for PICC insertion.

Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion.Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins),although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Furtherresearch about the vasculature used for PICC insertion is needed to inform clinical practice.

A review of the literature exploring the occupation of contemporary pilgrimage

Contemporary pilgrimage is a multi-dimensional, diverse and evolving occupation, not limited to overtly religious intentions or practices, which has not been explored in the occupational science literature. The purpose of this paper is to present an overview of the scholarly discourse as an important initial step toward understanding the occupation of pilgrimage and its impact on well-being. The discovery process within the literature was strategically refined yielding occupational science's first view of this expanding field of enquiry. This paper introduces the scope of the topic, defines key terms and explores the range of participation in contemporary pilgrimage. International evidence of increased popular interest and participation in pilgrimage is discussed, and the interdisciplinary evidence of the benefits to health and well-being experienced by pilgrims is summarised. This paper argues that occupational science could take a leading role in investigating the relationship between participation in pilgrimage and the experience of well-being for a range of people and populations.

Addressing obesity in the management of knee and hip osteoarthritis - weighing in from an economic perspective

BACKGROUND: Obesity is one of the only modifiable risk factors for both incidence and progression of Osteoarthritis (OA). So there is increasing interest from a public health perspective in addressing obesity in the management of OA. While evidence of the efficacy of intereventions designed to address obesity in OA populations continues to grow, little is known about their economic credentials. The aim of this study is to conduct a scoping review of: (i) the published economic evidence assessing the economic impact of obesity in OA populations; (ii) economic evaluations of interventions designed to explicitly address obesity in the prevention and management of OA in order to determine which represent value for money. Besides describing the current state of the literature, the study highlights research gaps and identifies future research priorities.

METHODS: In July 2014, a search of the peer reviewed literature, published in English, was undertaken for the period January 1975 - July 2014 using Medline Complete (Ebscohost), Embase, Econlit, Global Health, Health Economics Evaluation Database (HEED), all Cochrane Library databases as well as the grey literature using Google and reference lists of relevant studies. A combination of key search terms was used to identify papers assessing the economic impact of obesity in OA or economic evaluations conducted to assess the efficiency of obesity interventions for the prevention or management of OA.

RESULTS: 14 studes were identified; 13 were cost burden studies assessing the impact of obesity as a predictor for higher costs in Total Joint Arthroplasty (TJA) patients and one a cost-effectiveness study of an intervention designed to address obesity in the managment of mild to moderate OA patients.

CONCLUSION: The majority of the economic studies conducted are cost burden studies. While there is some evidence of the association between severe obesity and excess hospital costs for TJA patients, heterogeneity in studies precludes definitive statements about the strength of the association. With only one economic evaluation to inform policy and practice, there is a need for future research into the cost-effectiveness of obesity interventions designed both for prevention or management of OA along the disease spectrum and over the life course.

Identifying pedagogy and teaching strategies for achieving nationally prescribed learning outcomes

With the globalisation of university education, national frameworks are commonly used to prescribe standardised learning outcomes and achieve accountability. However, these frameworks are generally not accompanied by guiding pedagogy to support academics in adjusting their teaching practices to achieve the set outcomes. This paper reports the results of a scoping review of health science literature aimed at identifying pedagogy and teaching strategies relevant to achieve the learning outcomes specified by the Australian Qualifications Framework at a master's degree level. Eight practical teaching messages emerged from the review and three broad pedagogical trends were identified: the need to use authentic disciplinary-based learning activities; ensure that students are able to discover different perspectives about future practice and bring student reflection about their own knowledge into curricula. More critically, the review highlights that academics attempting to translate national learning outcome frameworks into their teaching practices face a complex and time-consuming task which may involve searching beyond their own disciplinary focus to identify practical teaching strategies to meet prescribed learning outcomes.