Retrospective observational study of patients who present to Australian rural emergency departments with undifferentiated chest pain

Aim To identify the demographic and clinical characteristics of patients who present to Australian rural emergency departments with chest pain. Design Retrospective, observational study Setting Rural emergency departments (ED) in Queensland, Australia Participants 337 consecutive adult patients with undifferentiated chest pain that presented between 1st September 2013 and 30th November 2013. Main outcome measures Service indicators, discharge diagnoses and disposition Results Presentations for undifferentiated chest pain represented 3.5% of all patient presentations during the sampling period. The mean age of patients was 48 years and 54% were male. Overall, 92% of patients left the ED within the 4-hour NEAT target. The majority of presentations were related to cardiac concerns (39%), followed by non-cardiac chest pain (17%), musculoskeletal (15%) and respiratory (10%) conditions. More than half of these patients were discharged at the completion of the ED service (52.8%), 40.6% were admitted, 3.3% left at own risk, 2.4% did not wait and less than 1% of patients required transfer to another hospital directly from the ED. Conclusions This study has provided information on the characteristics and processes of care for patients presenting to Australian rural EDs with undifferentiated chest pain that will inform service planning and further research to evaluate the effectiveness of care for these patients.

Effect of mobile phone use and aggression on speed selection by young drivers : a driving simulator study

Aggressive driving has been associated with engagement in other risky driving behaviours, such as speeding; while drivers using their mobile phones have an increased crash risk, despite the tendency to reduce their speed. Research has amassed separately for mobile phone use and aggressive driving among younger drivers, however little is known about the extent to which these behaviours may function independently and in combination to influence speed selection behaviour. The main aim of the current study was to investigate the effect of driver aggression (measured by the Driving Anger Expression Inventory) and mobile phone use on speed selection by young drivers. The CARRS-Q advanced driving simulator was used to test the speed selection of drivers aged 18 to 26 years (N = 32) in a suburban (60kph zone) driving context. A 2 (level of driving anger expression: low, high) X 3 (mobile phone use condition: baseline, hands-free, hand-held) mixed factorial ANOVA was conducted with speed selection as the dependent variable. Results revealed a significant main effect for mobile phone use condition such that speed selection was lowest for the hand-held condition and highest for the baseline condition. Speed selection, however, was not significantly different across the levels of driving anger expression; nor was there a significant interaction effect between the mobile phone use and driving anger expression. As young drivers are over-represented in road crash statistics, future research should further investigate the combined impact of driver aggression and mobile phone use on speed selection.

Activity patterns of preschool-aged children at risk for obesity

BACKGROUND Although the prevalence of obesity in young children highlights the importance of early interventions to promote physical activity (PA), there are limited data on activity patterns in this age group. The purpose of this study is to describe activity patterns in preschool-aged children and explore differences by weight status. METHODS Analyses use baseline data from Healthy Homes/Healthy Kids- Preschool, a pilot obesity prevention trial of preschool-aged children overweight or at risk for overweight. A modified parent-reported version of the previous-day PA recall was used to summarize types of activity. Accelerometry was used to summarize daily and hourly activity patterns. RESULTS "Playing with toys" accounted for the largest proportion of a child's previous day, followed by "meals and snacks", and "chores". Accelerometry-measured daily time spent in sedentary behavior, light PA, and moderate-to-vigorous PA (MVPA) was 412, 247, and 69 minutes, respectively. Percent of hourly time spent in MVPA ranged from 3% to 13%, peaking in the late morning and evening hours. There were no statistically significant MVPA differences by weight status. CONCLUSIONS This study extends our understanding of activity types, amounts, and patterns in preschool-age children and warrants further exploration of differences in physical activity patterns by weight status.

Nursing Management : Fluid, Electrolyte, and Acid-Base Imbalances

Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 4th Edition is the most comprehensive go-to reference for essential information about all aspects of professional nursing care of patients. Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment.

Altered Immune Responses and Transplantation

Lewis’s Medical-Surgical Nursing: Assessment and Management of Clinical Problems, 4th Edition is the most comprehensive go-to reference for essential information about all aspects of professional nursing care of patients. Using the nursing process as a framework for practice, the fourth edition has been extensively revised to reflect the rapid changing nature of nursing practice and the increasing focus on key nursing care priorities. Building on the strengths of the third Australian and New Zealand edition and incorporating relevant global nursing research and practice from the prominent US title Medical-Surgical Nursing, 9Th Edition, Lewis’s Medical-Surgical Nursing, 4th Edition is an essential resource for students seeking to understand the role of the professional nurse in the contemporary health environment.

Can we do better? Researchers' experiences with ethical review boards on projects with later life as a focus

The goal of this study was to describe researchers' experiences in submitting ethical proposals focused on older adult populations, including studies with persons with dementia, to ethical review boards. Ethical approval was granted for an online survey. Researchers were recruited via listservs and snowballing techniques. Participants included 157 persons (73% female) from Australia and the United States, with a mean age of 46 (±13). Six main issues were encountered by researchers who participated in this survey. In descending order, these included questions regarding: informed consent and information requirements (61.1%), participants' vulnerability, particularly for those with cognitive impairments (58.6%), participant burden (44.6%), data access (29.3%), adverse effects of data collection/intervention (26.8%), and study methodology (25.5%). An inductive content analysis of responses revealed a range of encounters with ethical review panels spanning positive, negative, and neutral experiences. Concerns voiced about ethical review boards included committees being overly focused on legal risk, as well as not always hearing the voice of older research participants, both potential and actual. Respondents noted inability to move forward on studies, as well as loss of researchers and participant groups from gerontological and clinical research as a result of negative interactions with ethics committees. Positive interactions with the committees reinforced researchers' need to carefully construct their research approaches with persons with dementia in particular. Suggested guidelines for committees when dealing with ethics applications involving older adults include self-reflecting on potential biases and stereotypes, and seeking further clarification and information from gerontological researchers before arriving at decisions.