Bariatric patients and the use of mobile hoists : user experiences from three hospitals in South Australia

Nursing personnel are consistently identified as one of the occupational groups most at risk of work-related musculoskeletal disorders. During the moving and handling of bariatric patients, the weight of the patient combined with atypical body mass contributes to a significant risk of injury to the care provider and patient. This is further compounded by the shape, mobility and co-operation of the patient. The aim of this study was determine user experiences and design requirements for mobile hoists with bariatric patients. Structured interviews were conducted with six experienced injury management staff from the Manual Task Services department of three hospitals in Adelaide, South Australia. All staff had experience in patient handling, the use of patient handling equipment and the provision of patient handling training. A series of open-ended questions were structured around five main themes: 1) patient factors; 2) building/vehicle space and design; 3) equipment and furniture; 4) communication; and 5) staff issues. Questions focussed on the use of mobile hoists for lifting and transferring bariatric patients. Interviews were supplemented with a walk-through of the hospital to view the types of mobile hoists used, and the location and storage of equipment. Across the three hospitals there were differing classification systems to define bariatric patients. Ensuring patient dignity, respect and privacy were viewed as important in the management and rehabilitation of bariatric patients. Storage and space constraints were considered factors restricting the use of mobile floor hoists, with ceiling hoists being the preferred method for patient transfers. When using mobile floor hoists, the forces required to push, pull and manoeuvre, as well as sudden unstable movements of the hoist were considered important risks factors giving rise to a risk of injury to the care provider. Record keeping and purchasing policies appeared to inhibit the effective use of patient handling equipment. The moving and handling of bariatric patients presents complex and challenging issues. A co-ordinated and collaborative approach for moving and handling bariatric patients is needed across the range of care providers. Designers must consider both user and patient requirements.

Sunscreen application thickness amongst primary school children : the children and sunscreen study

Childhood sun exposure has been associated with increased risk of developing melanoma later in life. Sunscreen, children.s preferred method of sun protection, has been shown to reduce skin cancer risk. However, the effectiveness of sunscreen is largely dependent on user compliance, such as the thickness of application. To reach the sun protection factor (SPF) sunscreen must be applied at a thickness of 2mg/cm2. It has been demonstrated that adults tend to apply less than half of the recommended 2mg/cm2. This was the first study to measure the thickness at which children apply sunscreen. We recruited 87 primary school aged children (n=87, median age 8.7, 5-12 years) from seven state schools within one Brisbane education district (32% consent rate). The children were supplied with sunscreen in three dispenser types (pump, squeeze and roll-on) and were asked to use these for one week each. We measured the weight of the sunscreen before and after use, and calculated the children.s body surface area (based on height and weight) and area to which sunscreen was applied (based on children.s self-reported body coverage of application). Combined these measurements resulted in an average thickness of sunscreen application, which was our main outcome measure. We asked parents to complete a self-administered questionnaire which captured information about potential explanatory variables. Children applied sunscreen at a median thickness of 0.48mg/cm2, significantly less than the recommended 2mg/cm2 (p<0.001). When using the roll-on dispenser (median 0.22mg/cm2), children applied significantly less sunscreen thickness, compared to the pump (median 0.75mg.cm2, p<0.001), and squeeze (median 0.57mg/cm2, p<0.001) dispensers. School grade (1-7) was significantly associated with thickness of application (p=0.032), with children in the youngest grades applying the most. Other variables that were significantly associated with the outcome variable included: number of siblings (p=0.001), household annual income (p<0.001), and the number of lifetime sunburns the child had experienced (p=0.007). This work is the first to measure children.s sunscreen application thickness and demonstrates that regardless of their age or the type of dispenser that they use, children do not apply enough sunscreen to reach the advertised SPF. It is envisaged that this study will assist in the formulation of recommendations for future research, practice and policy aimed at improving childhood sun protection to reduce skin cancer incidence in the future.

Exploring ethical dilemmas for principals arising from role conflict with school counsellors

Acting in the best interests of students is central to the moral and ethical work of schools. Yet tensions can arise between principals and school counsellors as they work from at times opposing professional paradigms. In this article we report on principals’ and counsellors’ responses to scenarios covering confidentiality and the law, student/teacher relationships, student welfare and psychological testing of students. This discussion takes place against an examination of ethics, ethical dilemmas and professional codes of ethics. While there were a number of commonalities among principals and school counsellors that arose from their common belief in education as a moral venture, there were also some key differences among them. These differences centred on the principals’ focus on the school as a whole and counsellors’ focus on the welfare of the individual student. A series of recommendations is offered to assist principals to navigate ethical dilemmas such as those considered in this article.

Move it, use it : university-school collaboration for learning to teach physical education in primary schools

Reports of increasing numbers of obese Australian children and adolescents have raised the alarm to be proactive in reducing this so called epidemic. It has evoked a call for greater emphasis on teaching physical education in schools, as a measure for attaining fitness not only with obese students but for all students. This paper emphasises how preservice teachers need to be a key target for implementing physical education (PE) reform in schools, as many primary teachers will be generalists and may not be confident enough to implement PE effectively. Through a review of existing literature, teaching practices essential for the effective promotion and implementation of PE were identified under six broad categories: personal-professional skills development, addressing system requirements, pedagogical practices, managing student behaviour, providing feedback to students, and reflecting on practice. Subsequently, the development of these practices in preservice teachers is considered in the context of a university-school collaboration where preservice teachers taught physical education to primary school students for one day per week over a four week period. These authentic teaching experiences provided the preservice teachers with vital opportunities to put theory into practice and interact with “real-world” students. Self-evaluative data from 38 of these preservice teachers, in the form of a five-part Likert scale survey and extended response survey, demonstrated that they were able to develop the majority of the essential teaching practices identified by literature. In particular, the preservice teachers developed self efficacy, enthusiasm, and motivation for teaching PE, facets which are often found to be lacking in generalist primary teachers and yet are essential if children’s perceptions and habits regarding physical activity are to be changed.

Development and piloting of a brain tumour-specific question prompt list

The objective of this research was to develop a question prompt list aimed at increasing question asking and reducing the unmet information needs of adults with primary brain tumours, and to pilot the question prompt list to determine its suitability for the intended population. Thematic analysis of existing resources was used to create a draft which was refined via interviews with 12 brain tumour patients and six relatives, readability testing and review by health professionals. A non-randomised before–after pilot study with 20 brain tumour patients was used to assess the acceptability and usefulness of the question prompt list, compared with a ‘standard brochure’, and the feasibility of evaluation strategies. The question prompt list developed covered seven main topics (diagnosis, prognosis, symptoms and changes, treatment, support, after treatment finishes and the health professional team). Pilot study participants provided with the question prompt list agreed that it was helpful (7/7), contained questions that were useful to them (7/7) and prompted them to ask their medical oncologist questions (5/7). The question prompt list is acceptable to patients and contains questions relevant to them. Research is now needed to assess its effectiveness in increasing question asking and reducing unmet information needs.

Application of Geographic Modeling Techniques to Quantify Spatial Access to Health Services Before and After an Acute Cardiac Event: The Cardiac ARIA Project

Background: Access to cardiac services is essential for appropriate implementation of evidence-based therapies to improve outcomes. The Cardiac Accessibility and Remoteness Index for Australia (Cardiac ARIA) aimed to derive an objective, geographic measure reflecting access to cardiac services. Methods: An expert panel defined an evidence-based clinical pathway. Using Geographic Information Systems (GIS), a numeric/alpha index was developed at two points along the continuum of care. The acute category (numeric) measured the time from the emergency call to arrival at an appropriate medical facility via road ambulance. The aftercare category (alpha) measured access to four basic services (family doctor, pharmacy, cardiac rehabilitation, and pathology services) when a patient returned to their community. Results: The numeric index ranged from 1 (access to principle referral center with cardiac catheterization service ≤ 1 hour) to 8 (no ambulance service, > 3 hours to medical facility, air transport required). The alphabetic index ranged from A (all 4 services available within 1 hour drive-time) to E (no services available within 1 hour). 13.9 million (71%) Australians resided within Cardiac ARIA 1A locations (hospital with cardiac catheterization laboratory and all aftercare within 1 hour). Those outside Cardiac 1A were over-represented by people aged over 65 years (32%) and Indigenous people (60%). Conclusion: The Cardiac ARIA index demonstrated substantial inequity in access to cardiac services in Australia. This methodology can be used to inform cardiology health service planning and the methodology could be applied to other common disease states within other regions of the world.

Measuring National Accessibility to Cardiac Services using Geographic Information Systems

The Cardiac Access-Remoteness Index of Australia (Cardiac ARIA) used geographic information systems (GIS) to model population level, road network accessibility to cardiac services before and after a cardiac event for all (20,387) population localities in Australia., The index ranged from 1A (access to all cardiac services within 1 h driving time) to 8E (limited or no access). The methodology derived an objective geographic measure of accessibility to required cardiac services across Australia. Approximately 71% of the 2006 Australian population had very good access to acute hospital services and services after hospital discharge. This GIS model could be applied to other regions or health conditions where spatially enabled data were available.

Cardiac ARIA Index: Measuring Accessibility to Cardiovascular Services in Rural and Remote Australia via Applied Geographic Spatial Technology

Cardiovascular disease (CVD) continues to impose a heavy burden in terms of cost, disability and death in Australia. Evidence suggests that increasing remoteness, where cardiac services are scarce, is linked to an increased risk of dying from CVD. Fatal CVD events are reported to be between 20% and 50% higher in rural areas compared to major cities. The Cardiac ARIA project, with its extensive use of geographic Information Systems (GIS), ranks each of Australia’s 20,387 urban, rural and remote population centres by accessibility to essential services or resources for the management of a cardiac event. This unique, innovative and highly collaborative project delivers a powerful tool to highlight and combat the burden imposed by cardiovascular disease (CVD) in Australia. Cardiac ARIA is innovative. It is a model that could be applied internationally and to other acute and chronic conditions such as mental health, midwifery, cancer, respiratory, diabetes and burns services. Cardiac ARIA was designed to: 1. Determine by expert panel, what were the minimal services and resources required for the management of a cardiac event in any urban, rural or remote population locations in Australia using a single patient pathway to access care. 2. Derive a classification using GIS accessibility modelling for each of Australia’s 20,387 urban, rural and remote population locations. 3. Compare the Cardiac ARIA categories and population locations with census derived population characteristics. Key findings are as follows: • In the event of a cardiac emergency, the majority of Australians had very good access to cardiac services. Approximately 71% or 13.9 million people lived within one hour of a category one hospital. • 68% of older Australians lived within one hour of a category one hospital (Principal Referral Hospital with access to Cardiac Catheterisation). • Only 40% of indigenous people lived within one hour of the category one hospital. • 16% (74000) of indigenous people lived more than one hour from a hospital. • 3% (91,000) of people 65 years of age or older lived more than one hour from any hospital or clinic. • Approximately 96%, or 19 million, of people lived within one hour of the four key services to support cardiac rehabilitation and secondary prevention. • 75% of indigenous people lived within one hour of the four cardiac rehabilitation services to support cardiac rehabilitation and secondary prevention. Fourteen percent (64,000 persons) indigenous people had poor access to the four key services to support cardiac rehabilitation and secondary prevention. • 12% (56,000) of indigenous people were more than one hour from a hospital and only had access one the four key services (usually a medical service) to support cardiac rehabilitation and secondary prevention.

Cultural challenges to secondary prevention: Implications for Saudi women

Like other highly developed countries, cardiovascular disease (CVD) and coronary heart disease (CHD) are major health problems in Saudi Arabia. The aetiology of cardiovascular disease (CVD) burden within the Saudi population is similar to Western countries with atherosclerosis, hypertension, ischemic heart disease and diabetes highly prevalent with the main risk factors being smoking, obesity and inactivity. There are differences between Saudi men and women in epidemiology, risk factors and health service provision for CHD. These sex and gender based factors are important in considering the health and well-being of Saudi women. Currently, there is limited focus on the cardiovascular health of Saudi women. The aim of this paper is to examine culturally specific issues for Saudi women and the implications for secondary prevention.

Peer supporters for cardiac patients with diabetes : a randomised controlled trial

Aims: To determine whether incorporation of patient peer supporters in a Cardiac-Diabetes Self-Management Program (Peer-CDSMP) led to greater improvement in self-efficacy, knowledge and self-management behaviour in the intervention group compared to a control group. Background: Promoting improved self-management for those with diabetes and a cardiac condition is enhanced by raising motivation and providing a model. Peer support from former patients who are able to successfully manage similar conditions could enhance patient motivation to achieve better health outcomes and provide a model of how such management can be achieved. While studies on peer support have demonstrated the potential of peers in promoting self-management, none have examined the impact on patients with two comorbidities. Methods: A randomised controlled trial was used to develop and evaluate the effectiveness of the Peer-CDSMP from August 2009 to December 2010. Thirty cardiac patients with type 2 diabetes were recruited. The study commenced in an acute hospital, follow up at participants’ homes in Brisbane Australia. Results: While both the control and intervention groups had improved self-care behaviour, self-efficacy and knowledge, the improvement in knowledge was significantly greater for the intervention group. Conclusions: Significant improvement in knowledge was achieved for the intervention group. Absence of significant improvements in self-efficacy and self-care behaviour represents an inconclusive effect; further studies with larger sample sizes are recommended.

The SurfAid International Schools Program : opportunities for HPE and senior health education

SurfAid International is a humanitarian organisation that has been delivering a range of evidence based health promotion initiatives, primarily for people living on Nias and the Mentawai Islands off the west coast of Sumatra, Indonesia since 2000. The SurfAid Schools Program launched in 2007, providing opportunities for the development of global awareness, cultural knowledge, empathy and active citizenship among students living in Australia, New Zealand, North America and the United Kingdom. This session will commence with an overview of the work of SurfAid International and resources provided by the SurfAid International Schools Program. The social justice orientation of the Queensland Health Education Senior Syllabus and the HPE Essential Learnings will be reviewed along with a consideration for affective learning through attitudes and values. Participants will be given time to consider how units with a health of specific populations focus could be conceptualised, developed and managed. Opportunities for co-curricular applications will also be discussed.

School policy responses to cyberbullying : an Australian legal perspective

The use of electronic means of contact to support repeated aggressive behaviour by an individual or group, that is intended to harm others – or ‘cyberbullying’ as it is now known – is increasingly becoming a problem for modern students, teachers, parents and schools. Increasingly victims of face to face bullying are looking to the law as a means of recourse, not only against bullies but also school authorities who have the legal responsibility to provide a safe environment for learning. It is likely that victims of cyberbullying will be inclined to do the same. This article examines a survey of the anti-bullying policies of a small sample of Australian schools to gauge their readiness to respond to the challenge of cyberbullying, particularly in the context of the potential liability they may face. It then uses that examination as a basis for identifying implications for the future design of school anti-bullying policies.

Prevalence of malnutrition risk and its relationship with risk factors of hospital re-admission in older adults

Background: Risk of malnutrition in older people continues to be a global problem. Malnutrition is often unrecognized and under-treated across health care settings and may result in undesirable health consequences, impaired recovery from illness and a poorer quality of life. Aim: This study aimed to determine the prevalence of malnutrition risk in a sample of older people at high risk of hospital re-admission. The association between risk factors of hospital re-admission and risk of malnutrition were also explored. Methods: One hundred and twenty five hospitalised patients aged 65 years and older at risk of hospital readmission (24% male, 76% female, mean age 77 ± 6 years) were recruited from a tertiary metropolitan hospital in Australia. The valid and reliable Malnutrition Screen Tool (MST) was employed to screen for malnutrition risk. It consists of two questions related to recent weight loss and appetite. Results: Prevalence of older adults at risk of malnutrition was 27.4%. Risk of malnutrition was not associated with age, gender and living arrangement. However, among risk factors of hospital readmission, lack of social support (χ2 = 4.18, N = 125, p = 0.028), and fair –poor self-rating of health (χ2 = 4.13, N = 125, p = 0.042) were statistically significant associated with risk of malnutrition. Conclusion: Risk of malnutrition in older people continues to be a concern in health care, and increasing psycho social support may help shed light on reducing risk of malnutrition.

Validity of the malnutrition screening tool for older adults at high risk of hospital readmission

Malnutrition is a serious problem in older adults, particularly for those at risk of hospital readmission. The essential step in managing malnutrition is early identification using a valid nutrition screening tool. The purpose of this study was to validate the Malnutrition Screening Tool (MST) in older adults at high risk of hospital readmission. Two registered nurses administered the MST to identify malnutrition risk, and compared it to the comprehensive Subjective Global Assessment (SGA) to assess nutritional status for patients aged 65 years who had at least one risk factor for hospital readmission. The MST demonstrates substantial sensitivity, specificity and agreement with the SGA. These findings indicate that nursing staff can use the MST as a valid tool for routine screening and rescreening to identify patients at risk of malnutrition. Use of the MST may prevent hospital-acquired malnutrition for acute hospitalized older adults at high risk of readmission.