Hypothermia With Paradoxical Symptoms: A Case Series of Cesarean Deliveries With Intrathecal Morphine.

Women receiving intrathecal morphine for cesarean delivery may experience hypothermia with paradoxical symptoms of sweating, nausea, and shivering. Despite being relatively rare in comparison to commonly experienced symptoms of perioperative hypothermia, hypothermia with paradoxical symptoms affects early maternal recovery and comfort. The cause is undetermined, and treatment approaches vary.

Effectiveness of interventions to reduce sexually transmitted infections and blood-borne viruses in incarcerated adult populations: a systematic review protocol.

Objective: This review will identify, synthesize, and make recommendations regarding the effectiveness of interventions to reduce sexually transmitted infections (STIs) and blood-borne viruses (BBVs) in incarcerated adult settings.

Introduction: High-risk sexual behaviors, intravenous drug use, piercing, and tattooing are well documented within incarceration environments. Despite the World Health Organization's Global Health Sector Strategy on Sexually Transmitted Infections 2016-2021 and the Global Health Sector strategies on, respectively, HIV, viral hepatitis, and sexually transmitted infections for the period 2022-2030, STI rates within adult incarceration environments continue to rise.

Exploration of clinicians' decision-making regarding transfer of patient care from the emergency department to a medical assessment unit: A qualitative study.

Background: Hospitals face immense pressures in balancing patient throughput. Medical assessment units have emerged as a commonplace response to improve the flow of medical patients presenting to the emergency department requiring hospital admission and to ease overcrowding in the emergency department. The aim of this study was to understand factors influencing the decision-making behaviour of key stakeholders involved in the transfer of care of medical patients from one service to the other in a large, tertiary teaching hospital in Queensland, Australia.

Introducing a MAP for adherence care in the paediatric cystic fibrosis clinic: a multiple methods implementation study.

Background: People with cystic fibrosis are required to adhere to a burdensome daily treatment regimen. Comprehensive adherence protocols can support more consistent use of adherence interventions and improve treatment adherence rates. This study aimed to explore the feasibility, acceptability, and appropriateness of implementing an adherence protocol into the outpatient cystic fibrosis clinic of a tertiary, paediatric hospital.

Exploring Risk, Antecedents and Human Costs of Living with a Retained Surgical Item: A Narrative Synthesis of Australian Case Law 1981-2018.

Objectives: This study aimed to critically examine the circumstances contributing to, and the human costs arising from, the retention of surgical items through the lens of Australian case law.

Design Setting And Participants: We reviewed Australian cases from 1981 to 2018 to establish a pattern of antecedents and identify long-term patient impacts (human costs) of retained surgical items. We used a modified four-step process to conduct a systematic review of legal doctrine, combined with a narrative synthesis approach to bring the information together for understanding.

Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data.

Background: Medical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia.

Methods: Clinically coded data routinely submitted for inter-hospital benchmarking purposes was used to identify the cohort of medical admission patients presenting to the ED in February 2016 (summer) and June 2016 (winter).

Implementation and Evaluation of a Standardized Nurse-Administered Assessment of Functional and Psychosocial Issues for Patients in Acute Care.

Background: Increasingly, adults presenting to healthcare facilities have multiple morbidities that impact medical management and require initial and ongoing assessment. The interRAI Acute Care (AC), one of a suite of instruments used for integrated care, is a nurse-administered standardized assessment of functional and psychosocial domains that contribute to complexity of patients admitted to acute care.

Aim: This study aimed to implement and evaluate the interRAI AC assessment system using a multi-strategy approach based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework.

Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia.

Unlabelled: CHAPTER 1: RETAIL INITIATIVES TO IMPROVE THE HEALTHINESS OF FOOD ENVIRONMENTS IN RURAL, REGIONAL AND REMOTE COMMUNITIES: Objective: To synthesise the evidence for effectiveness of initiatives aimed at improving food retail environments and consumer dietary behaviour in rural, regional and remote populations in Australia and comparable countries, and to discuss the implications for future food environment initiatives for rural, regional and remote areas of Australia.

Study Design: Rapid review of articles published between January 2000 and May 2020.

Data Sources: We searched MEDLINE (EBSCOhost), Health and Society Database (Informit) and Rural and Remote Health Database (Informit), and included studies undertaken in rural food environment settings in Australia and other countries.

The effectiveness and cost effectiveness of a hospital avoidance program in a residential aged care facility: a prospective cohort study and modelled decision analysis.

Background: Residential aged care facility residents experience high rates of hospital admissions which are stressful, costly and often preventable. The EDDIE program is a hospital avoidance initiative designed to enable nursing and care staff to detect, refer and quickly respond to early signals of a deteriorating resident. The program was implemented in a 96-bed residential aged care facility in regional Australia.

Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study.

Aim: Central venous access devices (CVADs) are vital medical devices to support the treatment of paediatric cancer; however, device occlusion is common, which disrupts treatment. This study aimed to improve the identification and management of CVAD occlusions in children with cancer, as well as to identify the demographic, clinical and device characteristics associated with increased risk for CVAD occlusion.

Methods: A pre-post-implementation study was conducted at a metropolitan paediatric oncology facility in Australia, using the Theoretical Domains Framework.

Oral nutritional supplements for preventing surgical site infections: protocol for a systematic review and meta-analysis.

Background: Surgical site infections (SSIs) are among the most common healthcare-associated infections. Under-nutrition is an important risk factor for SSIs and can lead to delayed wound healing and longer hospital stays. Oral nutritional supplements are prescribed to reduce the risk of infection and improve health status, but data from randomised controlled trials (RCTs) have shown mixed results.

Evaluation of the efficacy of 3D total-body photography with sequential digital dermoscopy in a high-risk melanoma cohort: protocol for a randomised controlled trial.

Introduction: Melanoma is Australia's fourth most common cancer. Early detection is fundamental in maximising health outcomes and minimising treatment costs. To date, population-based screening programmes have not been justified in health economic studies.

Retained Surgical Items: Lessons from Australian Case Law of Items Unintentionally Left Behind in Patients after Surgery.

The retention of items within a patient after surgery is considered to be a serious issue within the health care community. Termed a "sentinel event", a retained surgical item (RSI) is one of eight reportable adverse events deemed to have the potential to seriously undermine the health care system in the eyes of the public. Yet despite the gravity of these events, there has been little opportunity for the courts to examine the liability issues surrounding RSIs.

Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services.

Background: Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear.

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Background: US Centers for Disease Control guidelines recommend replacement of peripheral intravenous catheters (PIVC) no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation or infection.

Cohort study of a specialist social worker intervention on hospital use for patients at risk of long stay.

Background: Long-stay patients in acute hospitals commonly present with complex psychosocial needs and use high levels of hospital resources.

Objective: To determine whether a specialist social worker-led model of care was associated with a reduction in length of stay for medically stable patients with complex psychosocial needs who were at risk of long stay, and to determine the economic value of this model relative to the decision makers' willingness to pay for bed days released.

Design: A prospective, matched cohort study with historical controls.

Intrathecal Morphine-Related Perioperative Hypothermia in Women Undergoing Cesarean Delivery: A Retrospective Case-Control Study.

Purpose: Rates of inadvertent perioperative hypothermia among women undergoing spinal anesthesia for cesarean delivery are reported to be high. Intrathecal morphine has been noted to have a potentially potent effect on thermoregulation. This retrospective case-control study sought to investigate the incidence of perioperative hypothermia in women undergoing cesarean delivery with and without intrathecal morphine and to describe any clinical factors associated with the condition, the identification of which would provide direction for nursing priorities in the care of the condition.

Nursing service innovation: A case study examining emergency nurse practitioner service sustainability.

Aim: This research aimed to explore factors that influence sustainability of health service innovation, specifically emergency nurse practitioner service.

Background: Planning for cost effective provision of healthcare services is a concern globally. Reform initiatives are implemented often incorporating expanding scope of practice for health professionals and innovative service delivery models.

Preoperative Warming Versus no Preoperative Warming for Maintenance of Normothermia in Women Receiving Intrathecal Morphine for Cesarean Delivery: A Single-Blinded, Randomized Controlled Trial.

Background: Rates of hypothermia for women undergoing spinal anesthesia for cesarean delivery are high and prevention is desirable. This trial compared the effectiveness of preoperative warming versus usual care among women receiving intrathecal morphine, which is thought to exacerbate perioperative heat loss.

Methods: A prospective, single-blinded, randomized controlled trial compared 20 minutes of forced air warming (plus intravenous fluid warming) versus no active preoperative warming (plus intravenous fluid warming) in 50 healthy American Society of Anesthesiologists graded II women receiving intrathecal morphine as part of spinal anesthesia for elective cesarean delivery.

Candida albicans colonisation, continence status and incontinence-associated dermatitis in the acute care setting: a pilot study.

Candida albicans is the most prevalent human fungal commensal organism and is reported to be the most frequent aetiological organism responsible for infection associated with incontinence-associated dermatitis. However, it remains unclear whether incontinence predisposes a patient to increased Candida colonisation or whether incontinence acts as a trigger for Candida infection in those already colonised. The purpose of this observational cross-sectional study was to estimate colonisation rates of C.

Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

Aims And Objectives: To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards.

Background: Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach.

The Skin Safety Model: Reconceptualizing Skin Vulnerability in Older Patients.

Purpose: To develop a unique skin safety model (SSM) that offers a new and unified perspective on the diverse yet interconnected antecedents that contribute to a spectrum of potential iatrogenic skin injuries in older hospitalized adults.

Organizing Construct: Discussion paper.

Methods: A literature search of electronic databases was conducted for published articles written in English addressing skin integrity and iatrogenic skin injury in elderly hospital patients between 1960 and 2014.

Clinically-indicated replacement versus routine replacement of peripheral venous catheters.

Background: US Centers for Disease Control guidelines recommend replacement of peripheral intravenous (IV) catheters no more frequently than every 72 to 96 hours. Routine replacement is thought to reduce the risk of phlebitis and bloodstream infection. Catheter insertion is an unpleasant experience for patients and replacement may be unnecessary if the catheter remains functional and there are no signs of inflammation.