Risk factors for delayed healing in venous leg ulcers : a review of the literature

Background Chronic leg ulcers, remaining unhealed after 4–6 weeks, affect 1-3% of the population, with treatment costly and health service resource intensive. Venous disease contributes to approximately 70% of all chronic leg ulcers and these ulcers are often associated with pain, reduced mobility and a decreased quality of life. Despite evidence-based care, 30% of these ulcers are unlikely to heal within a 24-week period and therefore the recognition and identification of risk factors for delayed healing of venous leg ulcers would be beneficial. Aim To review the available evidence on risk factors for delayed healing of venous leg ulcers. Methods: A review of the literature in regard to risk factors for delayed healing in venous leg ulcers was conducted from January 2000 to December 2013. Evidence was sourced through searches of relevant databases and websites for resources addressing risk factors for delayed healing in venous leg ulcers specifically. Results Twenty-seven studies, of mostly low-level evidence (Level III and IV), identified risk factors associated with delayed healing. Risk factors that were consistently identified included: larger ulcer area, longer ulcer duration, a previous history of ulceration, venous abnormalities and lack of high compression. Additional potential predictors with inconsistent or varying evidence to support their influence on delayed healing of venous leg ulcers included decreased mobility and/or ankle range of movement, poor nutrition and increased age. Discussion Findings from this review indicate that a number of physiological risk factors are asso- ciated with delayed healing in venous leg ulcers and that social and/or psychological risk factors should also be considered and examined further. Conclusion The findings from this review can assist health professionals to identify prognostic indicators or risk factors significantly associated with delayed healing in venous leg ulcers. This will facilitate realistic outcome planning and inform implementation of appropriate early strategies to promote healing.

Strategic renewal through design led innovation : findings from embedded practice

Strategic Renewal has been the subject of research in large organisations but has received relatively little attention in small and medium enterprises. Using case study examples of small and medium manufacturing firms, this paper presents the findings from a longitudinal action research project where participating companies explored design led innovation processes to find new ways to renew their businesses. Specifically our findings indicate that when designers act as innovation catalysts in embedded longitudinal action research, SMEs engage in strategic renewal, gain a deeper appreciation of their customers, become more aware of the value proposition of the company and engage in new practices to improve their competitive advantage.

Using strengths-based approaches in early years practice and research

Strengths-based approaches draw upon frameworks and perspectives from social work and psychology but have not necessarily been consistently defined or well articulated across disciplines. Internationally, there are increasing calls for professionals in early years settings to work in strengths-based ways to support the access and participation of all children and families, especially those with complex needs. The purpose of this paper is to examine a potential promise of innovative uses of strengths-based approaches in early years practice and research in Australia, and to consider implications for application in other national contexts. In this paper, we present three cases (summarised from larger studies) depicting different applications of the Strengths Approach, under pinned by collaborative inquiry at the interface between practice and research. Analysis revealed three key themes across the cases: (i) enactment of strengths-based principles, (ii) the bi-directional and transformational influences of the Strengths Approach (research into practice/practice into research), and (iii) heightened practitioner and researcher awareness of, and responsiveness to, the operation of power. The findings highlight synergies and challenges to constructing and actualising strengths-based approaches in early years childhood research and practice. The case studies demonstrate that although constructions of what constitutes strengths-based research and practice requires ongoing critical engagement, redefining, and operationalising, using strengths-based approaches in early years settings can be generative and worthwhile.

From music student to industry professional: An entrepreneurial learning design

This design-based research project addresses the gap between formal music education curricula and the knowledge and skills necessary to enter the professional music industry. It analyses the work of a teacher/researcher who invited her high school students to start their own business venture, Youth Music Industries (YMI). YMI also functioned as a learning environment informed by the theoretical concepts of communities of practice and social capital. The students staged cycles of events of various scales over a three-year period, as platforms for young artists to engage and develop new, young audiences across Queensland, Australia. The study found that students developed an entrepreneurial mindset through acquisition of specific skills and knowledge. Their learning was captured and distilled into a set of design principles, a pedagogical approach transferrable across the creative industries more broadly.

Empowering the disempowered through voice-inclusive practice: Children’s views on adult-centric educational provision

The United Nations Convention on the Rights of the Child provides a significant platform to include children’s views on issues that affect their lives, yet, in many contexts, particularly in educational practice, children’s perspectives continue to be irregularly sought and are rarely acted upon. By providing children’s perspectives on what they would like adults to know, this article explores a unique view of childhood and the interactions with family, community, educational experiences and well-being. The children’s insights about their worlds that they feel adults are missing potentiate the development and incorporation of voice-inclusive practice. While the sense that each child makes of their Lebenswelt – the ‘ingredients’ – is idiosyncratic and will be influenced by many factors, including peers, teachers, parents, other adults and the media, it is the nature of this personal understanding that is poorly understood, and consequently ignored by adults. By exploring the commentary of more than 1000 children across five countries – Australia, England, New Zealand, Italy and Sweden – this research reveals an overwhelming collection of what the authors describe as ‘comments that rhyme’ in terms of the identification of expressed sentiment and thematic representations of their perspectives.

Literacy, place, and pedagogies of possibility: Working against residualization effects and deficit discourses in poor school communities

Australia has a long history of policy attention to the education of poor and working-class youth (Connell, 1994), yet currently on standardized educational outcomes measures the gaps are widening in ways that relate to social background, including race, location and class. An economic analysis of school choice in Australia reveals that a high proportion of government school students now come from lower Socio-Economic Status (SES) backgrounds (Ryan & Watson, 2004), indicating a trend towards a gradual residualisation of the poor in government schools, with increased private school enrolments as a confirmed national trend. The spatial distribution of poverty and the effects on school populations are not unique to Australia (Lupton, 2003; Lipman, 2011; Ryan, 2010). Raffo and colleagues (2010) recently provided a synthesis of socially critical approaches towards schooling and poverty arguing that what is needed are shifts in the balances of power to reposition those within the educational system as having some say in the ways schooling is organized. ‘Disadvantaged’ primary schools are not a marginal concern for education systems, but now account for a large and growing number of schools that serve an ever increasing population being made redundant, in part-time precarious work, under-employed or unemployed (Thomson 2002; Smyth, Down et al 2010). In Australia, the notion of the ‘disadvantaged’ school now refers to those, mostly public schools, being residualised by a politics of parental choice that drives neoliberalising policy logic (Bonner & Caro 2007; Hattam & Comber, forthcoming 2014; Thomson & Reid, 2003)...

Subjective reasons why immigrant patients attend the emergency department

Background Some patients visit a hospital’s emergency department (ED) for reasons other than an urgent medical condition. There is evidence that this practice may differ among patients from different backgrounds. The objective of this study was to examine the reasons why patients from a non-English speaking background (NESB) and patients with an English speaking background but not born in Australia (ESB-NBA) visit the ED, as compared to patients from English-speaking backgrounds but born in Australia (ESB-BA). Methods A cross-sectional survey was conducted at the ED of a tertiary hospital in metropolitan Brisbane, Queensland, Australia. Over a four-month period patients who were assigned an Australasian Triage Scale score of 3, 4 or 5 were surveyed. Pearson chi-square test and multivariate logistic regression analyses were performed to examine the differences between the ESB and NESB patients’ reported reasons for attending the ED. Results A total of 828 patients participated in this study. Compared to ESB-BA patients NESB patients were less likely to consider contacting a general practitioner (GP) before attending the ED (Odds Ratios (OR) 0.6 (95% Confidence Interval (CI) 0.4–0.8, p < .05) While ESB-NBA were more likely to consider contacting a GP 1.7 (1.1–2.5, p < .05). Both the NESB patients and the ESB-NBA patients were far more likely than ESB-BA patients to report that they had visited the ED either because they do not have a GP (OR 7.9, 95% CI 4.7–13.4, p < .001) and 2.2 (95% CI 1.1–4.4, p < .05) respectively and less likely to think that the ED could deal with their problem better than a GP(OR 0.5 (95% CI 0.3–0.8, p < .05) and 0.7 (0.3–0.9, p < .05) respectively. The NESB patients also thought it would take too long to make an appointment to consult a GP (OR 6.2, 95% CI 3.7–10.4, p < 0.001). Conclusions NESB patients were the least likely to consider contacting a GP before attending hospital EDs. Educational interventions may help direct NESB people to the appropriate health services and therefore reduce the burden on tertiary hospitals ED.

Understanding advanced and extended professional practice

The Advanced Pharmacy Practice Framework Steering Committee (now replaced by the Pharmacy Practitioner Development Committee) undertook work to develop an advanced pharmacy practice recognition model. As part of that work, and to assure clarity and consistency in the terminology it uses, the Committee collated the definitions used in literature sources consulted. Most recently, this involved a review of the meaning attributed to the terms ‘advanced’ and ‘extended’ when used in the context of describing aspects of professional practice. Both terms encompass the acquisition of additional expertise. While ‘advanced’ practice involves the acquisition of additional expertise to achieve a higher performance level, ‘extended’ practice relates specifically to scope of practice and involves the acquisition of additional expertise sufficient to provide services or perform tasks that are outside the usual scope of practice of the profession. Performance level operates independently of scope of practice but both must be elucidated to fully describe the professional practice of an individual practitioner.

Biomechanics of transfemoral amputees fitted with osseointegrated fixation: Loading data for evidence-based practice

This presentation will provide an overview of the load applied on the residuum of transfemoral amputees fitted with an osseointegrated fixation during (A) rehabilitation, including static and dynamic load bearing exercises (e.g., rowing, adduction, abduction, squat, cycling, walking with aids), and (B) activities of daily living including standardized activities (e.g., level walking in straight line and around a circle, ascending and descending slopes and stairs) and activities in real world environments.

Review of direct measurement of inner prosthesis loading in transfemoral amputation: Potential benefits for evidence-based practice

The understanding of the load applied on the residuum through the prosthesis of individuals with transfemoral amputation (TFA) is essential to address a number of concerns that could strongly reduce their quality of life (e.g., residuum skin lesion, prosthesis fitting, alignment). This inner prosthesis loading could be estimated using a typical gait laboratory relying on inverse dynamics equations. Alternative, technological advances proposed over the last decade enabled direct measurement of this kinetic information in a broad variety of situations that could potentially be more relevant in clinical settings. The purposes of this presentation are (A) to review the literature about recent developments in measure and analyses of inner prosthesis loading of TFA, and (B) to extract information that could potentially contribute to a better evidence-based practice.

Shared book reading by parents with young children: Evidence-based practice

There is considerable recognition that shared book reading helps develop young children's early reading and literacy skills. Home is an important context in which children first start to develop their early literacy skills. This paper reviews Australian and international literature of shared book-reading intervention pertaining to the effects of two different strategies (dialogic reading and print referencing) on young children's early literacy skills. Further, a brief summary of findings of a recent Australian study are presented that showed some significant effects of shared reading on children's early literacy skills. This research used a pragmatic RCT (randomised controlled trial) to investigate a combination of these two forms of shared book-reading home intervention with parents and their children enrolled in the Prep year of school in Queensland. The paper concludes with a discussion of the significance of the findings and implications for parents and teachers to use an evidence-based approach to help children develop early literacy skills.

Drug administration guides in dysphagia

Aim: The aim of this evaluation was to evaluate the use of Individualised Medication Administration Guides (IMAGs) for patients with dysphagia on one stroke ward over a 6month period. Background: Patients with dysphagia (PWD) are more likely to suffer an administration error than patients without swallowing difficulties. To both standardise and improve medicines administration to patients with dysphagia I-MAGs were introduced on one stroke ward over a 6 month period. Methods: A software package supported with data on current national guidelines on the administration of medicines to PWD was designed by a specialised pharmacist in dysphagia to enable him to create individualised medication administration guides for patients with dysphagia which stated how each medicine should be optimally prepared and administered. On completion of the pilot service a questionnaire was given to all nurses, pharmacist and speech and language therapists who had experienced the I-MAGs. All the professionals received the same questionnaire but questions relevant only to their practice were added to the nurse’s questionnaire. Results: Of 26 Healthcare professionals (HCPs) approached, 19 returned completed questionnaires. Higher variability was found in the 13 responses from the nurse respondents than in the ones from the 3 pharmacist and the 3 SALTs. 8 (61%) of the nurses felt more confident in their practice when I-MAGs were in place. 10 (76%) of the nurses admitted that the guides could sometimes increase the time of the administration, but saw that it made practice safer. All the pharmacists considered the recommendations in the guides useful and all the respondents with the exception of one nurse (12:13) would like this service to continue. Conclusion: I-MAGs were well received on the ward and they support individualised care for patients with dysphagia. But the guides needed additional pharmacist input and greater nursing time. Research to determine the cost effectiveness of I-MAGs is needed.

Implementation of individualised medication administration guides for patients with dysphagia: Results from a pilot controlled trial

Introduction Patients with dysphagia (PWDs) have been shown to be four times more likely to suffer medication administration errors (MAEs).1 2 Individualised medication administration guides (I-MAGs) which outline how each formulation should be administered, have been developed to standardise medication administration by nurses on the ward and reduce the likelihood of errors. This pilot study aimed to determine the recruitment rates, estimate effect on errors and develop the intervention to design a future full scale randomised controlled trial to determine the costs and effects of I-MAG implementation. Ethical approval was granted by local ethics committee. Method Software was developed to enable I-MAG production (based on current best practice)3 4 for all PWDs on two care of the older person wards admitted during a six month period from January to July 2011. I-MAGs were attached to the medication administration record charts to be utilised by nurses when administering medicines. Staff training was provided for all staff on the intervention wards. Two care of the older person wards in the same hospital were used for control purposes. All patients with dysphagia were recruited for follow up purposes at discharge. Four ward rounds at each intervention and control ward were observed pre and post I-MAG implementation to determine the level of medication administration errors. NHS ethical approval for the study was obtained. Results 164 I-MAGs were provided for 75 patients with dysphagia (PWDs) in the two intervention wards. At discharge, 23 patients in the intervention wards and 7 patients in the control wards were approached for recruitment of which 17 (74%) & 5 (71.5%) respectively consented. Discussion Recruitment rates were low on discharge due to the dysphagia remitting during hospitalisation. The introduction of the I-MAG demonstrated no effect on the quality of administration on the intervention ward and interestingly practice improved on the control ward. The observation of medication rounds at least one month post I-MAG removal may have identified a reversal to normal practice and ideally observations should have been undertaken with I-MAGs in place. Identification of the reason for the improvement in the control ward is warranted.

Playing Pranks: Traditions, communities & co-creative cultural performance practice

Pranks, hoaxes and practical jokes are co-creative cultural performance practices that appear across times, contexts and cultures. These practices include everyday play amongst families, friends and coworkers, entertainment programs such as Prank Patrol, Punked or Scare Tactics, and aesthetic and activist pranks perpetrated by situationist artists, guerrilla artists, and, most recently, culture ‘jammers’ or ‘hackers’ intent on turning capitalist systems back on themselves. Although it can, in common usage, describe almost any show off behaviour, a prank in the strictest definition of the term is a performance that deploys a very specific set of strategies. It is an act of trickery, mischief, or deceit, that must be taken as real, and momentarily cause real fear, anger or worry for an unwitting spectator-become-performer, who is meant to play along until the trick is revealed and their response can be represented back to the prankster, other spectators, or society as a whole, either for the sake of entertainment or for the sake of commentary on a cultural phenomenon. A prank, in this sense, deliberately blurs the boundaries between daily and dramatic performance. It creates a moment of uncertainty, in which both the prankster’s ability to be creative, clever, or culturally astute, and the prankee’s ability to play along, discern the trick, discern the point of the trick, and, in the end, be duped, be a good sport, or even play/pay the prankster back, are both put to the test. In this paper, I consider a number of pranking traditions popular where I am in Australia, from the community-building pranks of footballers, bucks parties and ‘drop bear’ tales told to tourists, to the more controversial pranks of radio shock jocks, activists and artists. I use performance, spectatorship and ethical theory to examine the engagement between prankster, pranked spectator, and other spectators, in this most distinctive sort of community-driven performance practice, and the way it builds and breaks status, social and other sorts of relationships within and between specific communities.

Four years on: Are the gazelles still running? A longitudinal study of firm performance after a period of rapid growth

This article examines variations in performance between fast-growth – the so-called gazelle – firms. Specifically, we investigate how the level of growth affects future profitability and how this relationship is moderated by firm strategy. Hypotheses are developed regarding the moderated growth–profitability relationship and are tested using longitudinal data from a sample of 964 Danish gazelle firms. We find a positive relationship between growth and profitability among gazelle firms. This relationship is moderated, however, by market strategy; it is stronger for firms pursuing a broad market strategy rather than a niche strategy. This study contributes to the current literature by providing a more nuanced view of the growth–profitability relationship and investigating the potential for the future performance of gazelle firms.