The oral health of critically ill children : an observational cohort study

Aims and objectives: This study will describe the oral health status of critically ill children over time spent in the paediatric intensive care unit, examine influences on the development of poor oral health and explore the relationship between dysfunctional oral health and healthcare-associated infections. Background: The treatment modalities used to support children experiencing critical illness and the progression of critical illness may result in dysfunction in the oral cavity. In adults, oral health has been shown to worsen during critical illness as well as influence systemic health. Design: A prospective observational cohort design was used. Method: The study was undertaken at a single tertiary-referral Paediatric Intensive Care Unit. Oral health status was measured using the Oral Assessment Scale and culturing oropharyngeal flora. Information was also collected surrounding the use of supportive therapies, clinical characteristics of the children and the occurrence of healthcare-associated infections. Results: Of the 46 participants, 63% (n = 32) had oral dysfunction and 41% (n = 19) demonstrated pathogenic oropharyngeal colonisation during their critical illness. The potential systemic pathogens isolated from the oropharynx and included Candida sp., Staphylococcus aureus, Haemophilus influenzae, Enterococcus sp. and Pseudomonas aeruginosa. The severity of critical illness had a significant positive relationship (p < 0·05) with pathogenic and absent colonisation of the oropharynx. Sixty-three percent of healthcare-associated infections involved the preceding or simultaneous colonisation of the oropharynx by the causative pathogen. Conclusions: This study suggests paediatric oral health to be frequently dysfunctional and the oropharynx to repeatedly harbour potential systemic pathogens during childhood critical illness. Relevance to clinical practice: Given the frequency of poor oral health during childhood critical illness in this study and the subsequent potential systemic consequences, evidence based oral hygiene practices should be developed and validated to guide clinicians when nursing critically ill children.

Training the public to collect oral histories of our community : the OHAA Queensland Chapter’s model

In a digital age, the skills required to undertake an oral history project have changed dramatically. For community groups, this shift can be new and exciting, but can also invoke feelings of anxiety when there is a gap in the skill set. Addressing this gap is one of Oral History Association of Australia, Queensland (OHAA Qld) main activities. This paper reports on the OHAA Qld chapter’s oral history workshop program, which was radically altered in 2011.

Artful interviewing: Conducting oral history interviews for practice-led research

Recently, there has been an increased use of oral history as source material and inspiration for creative products, such as new media productions; visual art; theatre and fiction. The rise of the digital story in museum and library settings reflects a new emphasis on publishing oral histories in forms that are accessible and speak to diverse audiences. Visual artists are embracing oral history as a source of emotional, experiential and thematic authenticity (Anderson 2009 and Brown 2009). Rosemary Neill (2010) observes the rise of documentary and verbatim theatre — where the words of real people are reproduced on-stage — in Australia. Authors such as Dave Eggers (2006), M. J. Hyland (2009), Padma Viswanathan (2008) and Terry Whitebeach (2002) all acknowledge that interviews heavily inform their works of fiction. In such contexts, oral histories are not valued so much for their factual content but as sources that are at once dynamic, evolving, emotionally authentic and ambiguous. How can practice-led researchers design interviews that reflect this emphasis? In this paper, I will discuss how I developed an interview methodology for my own practice-led research project, The Artful Life Story: Oral History and Fiction. In my practice, I draw on oral histories to inform a work of fiction. I developed a methodology for eliciting sensory details and stories around place and the urban environment. I will also read an extract from ‘Evelyn on the Verandah,’ a short story based on an oral history interview with a 21 year-old woman who grew up in New Farm, which will be published in the One Book Many Brisbanes short story anthology in June this year (2010).

The effect of oral metformin on insulin sensitivity in insulin-resistant ponies

Metformin may be an effective therapeutic option for insulin-resistant (I-R) horses/ponies because, in humans, it reportedly enhances insulin sensitivity (SI) of peripheral tissues without stimulating insulin secretion. To determine the effect of metformin on insulin and glucose dynamics in I-R ponies, six ponies were studied in a cross-over design by Minimal Model analysis of a frequently-sampled intravenous glucose tolerance test (FSIGT). Metformin was administered at 15. mg/kg bodyweight (BW), orally, twice-daily, for 21. days to the metformin-treated group. The control group received a placebo. A FSIGT was conducted before and after treatment. The Minimal Model of glucose and insulin dynamics rendered indices describing SI, glucose effectiveness (Sg), acute insulin response to glucose (AIRg) and the disposition index (DI). The body condition score (BCS), BW and cresty neck score (CNS) were also assessed. There was no significant change in SI, Sg, AIRg, DI, BW, BCS or CNS in response to metformin, or over time in the control group. There were no measurable benefits of metformin on SI, consistent with recent work showing that the bioavailability of metformin in horses is poor, and chronic dosing may not achieve therapeutic blood concentrations. Alternatively, metformin may only be effective in obese ponies losing weight or with hyperglycaemia.

Orals ain’t orals : the role of prepared oral presentations in the classroom and beyond. How do instruction and feedback practices guide delivery choices?

Despite an ostensibly technology-driven society, the ability to communicate orally continues to feature as an essential ability for students at school and university, as it is for graduates in the workplace. Pedagogically, one rationale is that the need to develop effective oral communication skills is tied to life-long learning which includes successful participation in future work-related tasks. One tangible way that educators have assessed proficiency in the area of communication is through prepared oral presentations. While much of the literature uses the terms 'oral communication' and 'oral presentation' interchangeably, some writers question the role more formal presentations play in the overall development of oral communication skills. However, such formal speaking tasks continue to be a recognised assessment practice in both the secondary school and academy, and, therefore, worthy of further investigation. Adding to the discussion, this thesis explores the knowledge and skills students bring into the academy from previous educational experiences. It examines some of the teaching and assessment methods used in secondary schools to develop oral communication skills through the use of formal oral presentations. Specifically, it investigates criterion-referenced assessment sheets and how these tools are used as a form of instruction, as well as their role and effectiveness in the evaluation of student ability. The focus is on the student's perspective and includes 12 semi-structured interviews with school students. The purpose of this thesis is to explore key thematics underpinning oral communication and to identify tensions between expectations and practice. While acknowledging the breadth and depth of material available under the heading of 'communication theory', this study specifically draws on an expanded view of the rhetorical tradition to fully interrogate the assumptions supporting the practice of assessing oral presentations. Finally, this thesis recommends reconnecting with an updated understanding of rhetoric as a way of assisting in the development of expressive, articulate and discerning communicators.

Jogging alongside or bumping off? oral history and fiction in dialogue

This paper emerges from my practice-led PhD thesis investigating the ways fiction writers can enter a dialogue with the project of oral history in Australia. In this paper, I survey the current literature in order to identify the status of fiction within the practice of oral history in Australia. I argue that oral historians and fiction writers are, among other things, both concerned with understanding subjectivity. I consider how one of the specific qualities of fiction, that of character, can provide a space to explore subjectivity, and rely on my own writing practice in order to demonstrate how oral history theory can enrich fictive writings. This paper, while positioned in the field of oral history, exists within a wider debate around how the past can legitimately be represented; I argue oral historians and fiction writers can enter a dialogue around shared concerns.

Apixaban for the prevention of thromboembolism in adults after elective hip or knee replacement surgery, and in symptomatic venous thromboembolism

The anticoagulant effect of apixaban is due to direct inhibition of FXa in the coagulation cascade. The main advantages apixaban has over the current anti-coagulant drugs is that it is active after oral administration, and its coagulation effect does not require monitoring. Apixaban has been compared to enoxaparin in the prevention of venous thromboembolism associated with knee and hip replacement, where it is as efficacious as enoxaparin, but causes less bleeding. However, apixaban is not the only FXa inhibitor that could replace enoxaparin for this indication, as the FXa inhibitor rivaroxaban is as efficacious and safe as enoxaparin in preventing thromboembolism associated with these surgical procedures. Until the results of the AMPLIFY Phase III trial are known, it is too early to consider apixaban as an alternative to enoxaparin in symptomatic thromboembolism. Apixaban should not be used to prevent thromboembolism in medical immobilised subjects or acute coronary syndromes, as it causes excess bleeding in these conditions without benefit.

More light at the end of the tunnel – apixaban in atrial fibrillation

Introduction: Subjects with atrial fibrillation are at risk of thromboembolic events. The vitamin K antagonists (e.g., warfarin) are useful at preventing coagulation in atrial fibrillation, but are difficult to use. One of the FXa inhibitors, oral apixaban, has been tested as an anticoagulant in atrial fibrillation. Areas covered: In ARISTOTLE (Apixaban for reduction in stroke and other thromboembolic events in atrial fibrillation) apixaban was compared to warfarin in subjects with atrial fibrillation, and shown to cause a lower rate of stroke or systemic embolism and of major bleeding, than warfarin. In the AVERROES (Apixaban versus acetylsalicylic acid [ASA] to prevent stroke in atrial fibrillations patients who have failed or are unsuitable for vitamin K antagonist treatment) trial, stroke or systemic embolism occurred less often with apixaban than aspirin, whereas the occurrence of major bleeding was similar in the groups. Expert opinion: Apixaban is much easier for subjects with atrial fibrillation to use than warfarin, as it does not require regular monitoring by a health professional, with dosage adjustment. In addition to replacing warfarin in subjects with atrial fibrillation who are unable or not prepared to use warfarin, apixaban has the potential to replace warfarin more widely in the prevention of thromboembolism in subjects with atrial fibrillation.