Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

Evaluating equal employment opportunity and its impact on the increased participation of men and women in the transport industry

This paper seeks to identify the approaches undertaken in implementing equal employment opportunity in the transport industry in Australia and the links between these approaches and indicators of increased participation of women. This male dominated industry employs limited numbers of women with fewer numbers of women in management. The study analyses data from a unique set of equal opportunity progress reports from all organisations in the transport industry that are required to provide public reports under Australian legislation. The findings indicate a correlation between some approaches to equal opportunity and increased numbers of women in some areas. The study is equally remarkable for what it does not find. Despite widespread equal opportunity implementation across a broad number of employment measures there are limited measures that predict increases in the numbers of women in management or in non-traditional roles. This study differs from others in that it identifies issues specific to one industry and links organisational approach to equal opportunity with the employment status of both women and men.

A cluster-randomised intervention trial against Schistosoma japonicum in the Peoples' Republic of China: bovine and human transmission

Background Zoonotic schistosomiasis japonica is a major public health problem in China. Bovines, particularly water buffaloes, are thought to play a major role in the transmission of schistosomiasis to humans in China. Preliminary results (1998–2003) of a praziquantel (PZQ)-based pilot intervention study we undertook provided proof of principle that water buffaloes are major reservoir hosts for S. japonicum in the Poyang Lake region, Jiangxi Province. Methods and Findings Here we present the results of a cluster-randomised intervention trial (2004–2007) undertaken in Hunan and Jiangxi Provinces, with increased power and more general applicability to the lake and marshlands regions of southern China. The trial involved four matched pairs of villages with one village within each pair randomly selected as a control (human PZQ treatment only), leaving the other as the intervention (human and bovine PZQ treatment). A sentinel cohort of people to be monitored for new infections for the duration of the study was selected from each village. Results showed that combined human and bovine chemotherapy with PZQ had a greater effect on human incidence than human PZQ treatment alone. Conclusions The results from this study, supported by previous experimental evidence, confirms that bovines are the major reservoir host of human schistosomiasis in the lake and marshland regions of southern China, and reinforce the rationale for the development and deployment of a transmission blocking anti-S. japonicum vaccine targeting bovines.

Implementation of a driving diary intervention to reduce aberrant driving behaviours

Crash data involving taxis indicates that such drivers are over represented in crashes and are one to two times more likely to be involved in a fatality crash. This study reports on the pre intervention survey to provide a baseline measure of the self-reported attitudes and corresponding driving behaviours of a sample of taxi drivers. Results indicate that some taxi drivers willingly admit to engaging in unsafe driving practices. In addition, preliminary results of a post intervention survey revealed that taxi drivers’ safety perceptions, attitude and behaviours improved after completing a Driving Diary intervention.

The research pathway to developing a health promotion intervention for the high school curriculum

Introduction: Schools provide the opportunity to reach a large number of adolescents in a systematic way however there are increasing demands on curriculum providing challenges for health promotion activities. This paper will describe the research processes and strategies used to design an injury prevention program.----- Methods: A multi-stage process of data collection included: (1) Surveys on injury-risk behaviours to identify targets of change (examining behaviour and risk/ protective factors among more than 4000 adolescents); (2) Focus groups (n= 30 high-risk adolescents) to understand and determine risk situations; (3) Hospital emergency outpatients survey to understand injury types/ situations; (4) Workshop (n= 50 teachers/ administrators) to understand the target curriculum and experiences with injury-risk behaviours; (5) Additional focus groups (students and teachers) regarding draft material and processes.----- Results: Summaries of findings from each stage are presented particularly demonstrating the design process. The baseline data identified target risk and protective factors. The following qualitative study provided detail about content and context and with the hospital findings assisted in developing ways to ensure relevance and meaning (e.g. identifying high risk situations and providing insights into language, culture and development). School staff identified links to school processes with final data providing feedback on curriculum fit, feasibility and appropriateness of resources. The data were integrated into a program which demonstrated reduced injury.----- Conclusions: A comprehensive research process is required to develop an informed and effective intervention. The next stage of a cluster randomised control trial is a major task and justifies the intensive and comprehensive development.

A qualitative study of the experience of oral cancer among Taiwanese men

The incidence and mortality of oral cancer in Taiwanese men have increased over the past decade, primarily associated with a surge in the popularity of betel quid chewing. The aim of this study was to examine the experience of six Taiwanese men with oral cancer, who were aged between 40 and 60 years, using a qualitative approach. The three major themes emerging from the data include: (i) understanding the cancer diagnosis; (ii) the challenges of cancer treatment; and (iii) adapting to difference. Increasing nurses' understanding of the experiential aspects of oral cancer in this population is required if nurses are to develop successful health promotion programmes and nursing interventions to meet these patients' needs.

How to progress forward in improving safety outcomes in the work-related driving field : a review of work-related driving research and development of an intervention framework [Extended abstract]

Road crashes are now the most common cause of work-related injury, death and absence in a number of countries. Given the impact of workrelated driving crashes on social and economic aspects of business and the community, workrelated road safety and risk management has received increasing attention in recent years. However, limited academic research has progressed on improving safety within the work-related driving sector. The aim of this paper is to present a review of work-related driving safety research to date, and provide an intervention framework for the future development and implementation of workrelated driving safety intervention strategies.