1
|
Macpherson D, Hutchinson A, Bloomer MJ. Factors that influence critical care nurses' management of sedation for ventilated patients in critical care: A qualitative study. Intensive Crit Care Nurs 2024; 83:103685. [PMID: 38493573 DOI: 10.1016/j.iccn.2024.103685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 03/05/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Optimising sedation use is key to timely extubation. Whilst sedation protocols may be used to guide critical care nurses' management of sedation, sedation management and decision-making is complex, influenced by multiple factors related to patients' circumstances, intensive care unit design and the workforce. AIM To explore (i) critical care nurses' experiences managing sedation in mechanically ventilated patients and (ii) the factors that influence their sedation-related decision-making. DESIGN Qualitative descriptive study using semi-structured interviews. Data were analysed using Braun and Clarke's six-step thematic analysis. SETTING AND PARTICIPANTS This study was conducted in a 26-bed level 3 accredited ICU, in a private hospital in Melbourne, Australia. The majority of patients are admitted following elective surgery. Critical care nurses, who were permanently employed as a registered nurse, worked at least 16 h per week, and cared for ventilated patients, were invited to participate. FINDINGS Thirteen critical care nurses participated. Initially, participants suggested their experiences managing sedation were linked to local unit policy and learning. Further exploration revealed that experiences were synonymous with descriptors of factors influencing sedation decision-making according to three themes: (i) Learning from past experiences, (ii) Situational awareness and (iii) Prioritising safety. Nurses relied on their cumulative knowledge from prior experiences to guide decision-making. Situational awareness about other emergent priorities in the unit, staffing and skill-mix were important factors in guiding sedation decision-making. Safety of patients and staff was essential, at times overriding goals to reduce sedation. CONCLUSION Sedation decision making cannot be considered in isolation. Rather, sedation decision making must take into account outcomes of patient assessment, emergent priorities, unit and staffing factors and safety concerns. IMPLICATIONS FOR CLINICAL PRACTICE Opportunities for ongoing education are essential to promote nurses' situational awareness of other emergent unit priorities, staffing and skill-mix, in addition to evidence-based sedation management and decision making.
Collapse
Affiliation(s)
- Danielle Macpherson
- Intensive Care Unit, Epworth HealthCare Richmond, Victoria, Australia; School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Richmond, Victoria, Australia
| | - Melissa J Bloomer
- School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia; Intensive Care Unit, Princess Alexandra Hospital, Queensland Health, Woolloongabba, Queensland, Australia.
| |
Collapse
|
2
|
McKenna K, Bouchoucha S, Redley B, Hutchinson A. Australian health care workers experience of PPE related side-effects. A cross-sectional survey. Front Public Health 2024; 12:1325376. [PMID: 38384885 PMCID: PMC10880185 DOI: 10.3389/fpubh.2024.1325376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 01/15/2024] [Indexed: 02/23/2024] Open
Abstract
Introduction Protection of health care workers (HCWs) is a fundamental aspect of an effective pandemic response. During the COVID-19 pandemic, frequency, and duration of Personal Protective Equipment (PPE) use increased. The experience of PPE-related side-effects has potential to contribute to decreased compliance resulting in breaches in infection prevention and increasing risk of HCW exposure. This study aims were to measure the frequency of PPE-related side-effects amongst HCW in Australia, and to establish if an increased frequency of adverse reactions was related to the significant increase in use and extended duration of time spent in PPE. Methods A descriptive cross-sectional survey was used. Results Of the 559 respondents the majority were female (83.7%), aged 31-45 years old (33.6%). A pre-existing skin condition was reported by 266 (47.6%). Frequency of PPE related side-effects were: pressure-related 401 (71.7%), skin 321 (57.4%) and respiratory 20 (3.6%). Surgical mask use was significantly associated with pre-exiting skin conditions (β = 1.494 (SE 0.186), df (1), p < 0.001). Side effects to N95 respirator use was more commonly reported by staff working in COVID-19 high-risk areas (β = 0.572 (SE 0.211), df (1), p = 0.007) independent of work duration (β = -0.056 (SE 0.075), df (1), p = 0.456), and pre-existing skin conditions (β = 1.272, (SE.198), df (1), p < 0.001). Conclusion The COVID-19 pandemic has seen a significant increase in the use of PPE. While the preventative benefits of PPE are significant, adverse events related to PPE use are frequently reported by HCW. Findings in this study highlight the need for innovation in PPE design to maximize protection while decreasing adverse effects and maintaining adhere to use.
Collapse
Affiliation(s)
- Karen McKenna
- Deakin University Geelong, Faculty of Health, School of Nursing & Midwifery, Geelong, VIC, Australia
- Deakin University Geelong, Institute of Health Transformation, Centre for Quality & Patient Safety Research, Geelong, VIC, Australia
| | - Stephane Bouchoucha
- Deakin University Geelong, Faculty of Health, School of Nursing & Midwifery, Geelong, VIC, Australia
- Deakin University Geelong, Institute of Health Transformation, Centre for Quality & Patient Safety Research, Geelong, VIC, Australia
- Deakin University Geelong, Centre for Innovation in Infectious Diseases and Immunology Research, Geelong, VIC, Australia
- Adjunct Faculty, Manipal College of Nursing (MCON), Manipal Academy of Higher Education (MAHE), Manipal, India
| | - Bernice Redley
- Deakin University Geelong, Faculty of Health, School of Nursing & Midwifery, Geelong, VIC, Australia
| | - Anastasia Hutchinson
- Deakin University Geelong, Faculty of Health, School of Nursing & Midwifery, Geelong, VIC, Australia
- Deakin University Geelong, Institute of Health Transformation, Centre for Quality & Patient Safety Research, Geelong, VIC, Australia
- Deakin University Geelong, Centre for Innovation in Infectious Diseases and Immunology Research, Geelong, VIC, Australia
| |
Collapse
|
3
|
Koontalay A, Botti M, Hutchinson A. Narrative synthesis of the effectiveness and characteristics of heart failure disease self-management support programmes. ESC Heart Fail 2024. [PMID: 38311880 DOI: 10.1002/ehf2.14701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/21/2023] [Accepted: 01/09/2024] [Indexed: 02/06/2024] Open
Abstract
A deeper understanding of the key elements that should be included in heart failure (HF) disease self-management support (DSMS) programmes is crucial to enhance programme effectiveness and applicability to diverse settings. We investigated the characteristics and effectiveness of DSMS programmes designed to improve survival and decrease acute care readmissions for people with HF and determine the generalizability and applicability of the evidence to low- and middle-income countries (LMICs). A narrative meta-synthesis approach was used, and systematic reviews of randomized controlled trials (RCTs) of DSMS programmes were included. The Cochrane Database of Systematic Reviews, MEDLINE, and Embase were searched without language restriction and guided by the adapted Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Eight high-quality systematic reviews were identified representing 250 studies, of which 138 were unique RCTs measuring the outcomes of interest. The findings revealed statistically significant reductions in HF readmissions [relative risk (RR) range 0.64-0.85, P < 0.5, five out of six reviews], all-cause readmissions (RR range 0.85-0.95, P < 0.5, five out of six reviews), and all-cause mortality (RR range 0.67-0.87, P < 0.5, five out of five reviews). Overall, 44.2% (n = 61) of RCTs reduced acute care readmission and improved survival. Studies were categorized according to intensity (low, moderate, moderate+, and high) based on the opportunity for immediate treatment of HF instability; 29.2% (14/48) of low-intensity, 63.6% (21/33) of moderate-intensity, 40% (6/15) of moderate+-intensity, and 47.6% (20/42) of high-intensity interventions were effective. Most effective programmes used moderate-intensity (39.4%, 48%, or 50%, respectively) or high-intensity (33.3%, 36%, and 43.7%, respectively) interventions. The majority of studies (90.6%) were conducted in high-income countries. Programmes that provided opportunities for early recognition and response to HF instability were more likely to reduce acute care readmission and enhance survival. Generalizability and applicability to LMICs are clearly limited. Tailoring HF DSMS programmes to accommodate cultural, resource, and environmental challenges requires careful consideration of intervention intensity, duration of follow-up, and feasibility in low-resource settings.
Collapse
Affiliation(s)
- Apinya Koontalay
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Mari Botti
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Burwood, Victoria, Australia
- Centre for Quality and Patient Safety Research-Epworth HealthCare Partnership, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
4
|
McKenna K, Bouchoucha S, Redley B, Hutchinson A. "Building the plane while flying it" Reflections on pandemic preparedness and response; an organisational case study. BMC Health Serv Res 2023; 23:940. [PMID: 37658384 PMCID: PMC10472588 DOI: 10.1186/s12913-023-09874-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 08/04/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic provided a unique opportunity to learn about acute health organisations experiences implementing a pandemic response plan in real-time. This study was conducted to explore organisational leader's perspectives and experience activating a COVID-19 pandemic response plan in their health service and the impact of this on service provision, clinicians, and consumers. METHODS This study was conducted at a large metropolitan health service in Australia that provides acute, subacute, and residential aged care services. Semi-structured interviews were conducted with 12 key participants from the COVID-19 leadership team between November-January 2021/2022. A semi-structured interview guide was developed to explore how the health service developed a clinical governance structure, policy and procedures and experience when operationalising each element within the Hierarchy of Controls Framework. Thematic analysis was used to code data and identify themes. A cross-sectional survey of frontline healthcare workers on the impacts and perceptions of infection control practices during the COVID-19 pandemic, was also completed in 2021 with 559 responses. RESULTS Twelve organisational leaders completed the semi-structured interviews. Key themes that emerged were: (1) Building the plane while flying it, (2) A unified communications strategy, (3) Clinicians fear 'my job is going to kill me', (4) Personal Protective Equipment (PPE) supply and demand, and (5) Maintaining a workforce. When surveyed, front-line healthcare workers responded positively overall about the health services pandemic response, in terms of communication, access to PPE, education, training, and availability of resources to provide a safe environment. CONCLUSION Health service organisations were required to respond rapidly to meet service needs, including implementing a pandemic plan, developing a command structure and strategies to communicate and address the workforce needs. This study provides important insights for consideration when health service leaders are responding to future pandemics. Future pandemic plans should include detailed guidance for acute and long-term care providers in relation to organisational responsibilities, supply chain logistics and workforce preparation.
Collapse
Affiliation(s)
- Karen McKenna
- Health Services Manager Infection Prevention, Mercy Health, Victoria, Australia.
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia.
| | - Stéphane Bouchoucha
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, VIC, Australia
| | - Bernice Redley
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery, Deakin University Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- Centre for Innovation in Infectious Disease and Immunology Research (CIIDIR), Deakin University, Geelong, VIC, Australia
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, School of Nursing and Midwifery Geelong, Epworth Health/Deakin University Partnership, Victoria, Australia
| |
Collapse
|
5
|
Kukafka R, Hutchinson A, Khaw D. Handheld Computer Devices to Support Clinical Decision-making in Acute Nursing Practice: Systematic Scoping Review. J Med Internet Res 2023; 25:e39987. [PMID: 36780222 PMCID: PMC9972202 DOI: 10.2196/39987] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/11/2022] [Accepted: 09/28/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Nursing care is increasingly supported by computerized information systems and decision support aids. Since the advent of handheld computer devices (HCDs), there has been limited exploration of their use in nursing practice. OBJECTIVE The study aimed to understand the professional and clinical impacts of the use of mobile health apps in nursing to assist clinical decision-making in acute care settings. The study also aimed to explore the scope of published research and identify key nomenclature with respect to research in this emerging field within nursing practice. METHODS This scoping review involved a tripartite search of electronic databases (CINAHL, Embase, MEDLINE, and Google Scholar) using preliminary, broad, and comprehensive search terms. The included studies were hand searched for additional citations. Two researchers independently screened the studies for inclusion and appraised quality using structured critical appraisal tools. RESULTS Of the 2309 unique studies screened, 28 (1.21%) were included in the final analyses: randomized controlled trials (n=3, 11%) and quasi-experimental (n=9, 32%), observational (n=10, 36%), mixed methods (n=2, 7%), qualitative descriptive (n=2, 7%), and diagnostic accuracy (n=2, 7%) studies. Studies investigated the impact of HCDs on nursing decisions (n=12, 43%); the effectiveness, safety, and quality of care (n=9, 32%); and HCD usability, uptake, and acceptance (n=14, 50%) and were judged to contain moderate-to-high risk of bias. The terminology used to describe HCDs was heterogenous across studies, comprising 24 unique descriptors and 17 individual concepts that reflected 3 discrete technology platforms ("PDA technology," "Smartphone/tablet technology," and "Health care-specific technology"). Study findings varied, as did the range of decision-making modalities targeted by HCD interventions. Interventions varied according to the level of clinician versus algorithmic judgment: unstructured clinical judgment, structured clinical judgment, and computerized algorithmic judgment. CONCLUSIONS The extant literature is varied but suggests that HCDs can be used effectively to support aspects of acute nursing care. However, there is a dearth of high-level evidence regarding this phenomenon and studies exploring the degree to which HCD implementation may affect acute nursing care delivery workflow. Additional targeted research using rigorous experimental designs is needed in this emerging field to determine the true potential of HCDs in optimizing acute nursing care.
Collapse
Affiliation(s)
| | - Anastasia Hutchinson
- Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Institute of Health Transformation, Deakin University, Burwood, Australia
| | - Damien Khaw
- Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Institute of Health Transformation, Deakin University, Burwood, Australia
| |
Collapse
|
6
|
Alhariri S, Gutierrez J, Hutchinson A, Sairam S. Trend of gabapentin use in non-diabetic patients who are referred to a rheumatology clinic. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00536-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
|
7
|
Chew S, Colville D, Hutchinson A, Canty P, Hodgson L, Savige J. Obstructive sleep apnea, chronic obstructive pulmonary disease and hypertensive microvascular disease: a cross-sectional observational cohort study. Sci Rep 2022; 12:13350. [PMID: 35922660 PMCID: PMC9349200 DOI: 10.1038/s41598-022-17481-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Hypertensive microvascular disease is associated with an increased risk of diastolic heart failure, vascular dementia and progressive renal impairment. This study examined whether individuals with obstructive sleep apnoea (OSA) had more retinal hypertensive microvascular disease than those with chronic obstructive pulmonary disease (COPD) and hospital controls. This was a single-centre, cross-sectional, observational study of participants recruited consecutively from a general respiratory clinic and a general medical clinic. OSA was diagnosed on overnight polysomnography study (apnoea:hypopnoea index ≥ 5), and controls with COPD had a forced expiratory volume/forced vital capacity (forced expiratory ratio) < 70%. Individuals with both OSA and COPD were excluded. Hospital controls had no COPD on respiratory function testing and no OSA on specialist physician questioning. Study participants completed a medical questionnaire, and underwent resting BP measurement, and retinal photography with a non-mydriatic camera. Images were deidentified and graded for microvascular retinopathy (Wong and Mitchell classification), and arteriole and venular calibre using a semiautomated method at a grading centre. Individuals with OSA (n = 79) demonstrated a trend to a higher mean arterial pressure than other hospital patients (n = 143) (89.2 ± 8.9 mmHg, p = 0.02), and more microvascular retinopathy (p < 0.001), and narrower retinal arterioles (134.2 ± 15.9 μm and 148.0 ± 16.2 μm respectively, p < 0.01). Microvascular retinopathy and arteriolar narrowing were still more common in OSA than hospital controls, after adjusting for age, BMI, mean arterial pressure, smoking history and dyslipidaemia (p < 0.01, p < 0.01, respectively). Individuals with OSA demonstrated a trend to a higher mean arterial pressure than those with COPD (n = 132, 93.2 ± 12.2 mmHg and 89.7 ± 12.8 mmHg respectively, p = 0.07), and more microvascular retinopathy (p = 0.0001) and narrower arterioles (134.2 ± 15.9 and 152.3 ± 16.8, p < 0.01). Individuals with OSA alone had more systemic microvascular disease than those with COPD alone or other hospital patients without OSA and COPD, despite being younger in age.
Collapse
Affiliation(s)
- Sky Chew
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | - Deb Colville
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia
| | | | | | - Lauren Hodgson
- The University of Melbourne Department of Ophthalmology Royal Victorian Eye and Ear Hospital, East Melbourne, Australia
| | - Judy Savige
- The University of Melbourne Department of Medicine, Northern Health and Melbourne Health, Royal Melbourne Hospital, Parkville, VIC, 3050, Australia.
| |
Collapse
|
8
|
Jarhyan P, Hutchinson A, Khaw D, Prabhakaran D, Mohan S. Prevalence of chronic obstructive pulmonary disease and chronic bronchitis in eight countries: a systematic review and meta-analysis. Bull World Health Organ 2022; 100:216-230. [PMID: 35261410 PMCID: PMC8886252 DOI: 10.2471/blt.21.286870] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/24/2021] [Accepted: 11/24/2021] [Indexed: 11/27/2022] Open
|
9
|
Kramer S, Omonaiye O, Digby R, Berry D, Considine J, Dunning T, Hutchinson AM, Hutchinson A, Manias E, Rasmussen B, Bucknall T. An evaluation of interventions to improve outcomes for hospitalized patients in isolation: A systematic review. Am J Infect Control 2022; 50:193-202. [PMID: 34525405 DOI: 10.1016/j.ajic.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 08/16/2021] [Accepted: 09/06/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Isolation is effective in preventing transmission of infectious disease. However, it has been shown to have negative effects including increased anxiety and poor physical outcomes. OBJECTIVES To summarize the effects of interventions to improve safety and outcomes for patients in isolation DESIGN: Systematic review (PROSPERO protocol registration - CRD42020222779). SETTING Acute hospital PARTICIPANTS: Intervention studies including patients in preventative or protective isolation in a single room. METHODS MEDLINE, Global Health, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Excerpta Medica database were searched from 1996-October 2020. Two independent reviewers screened references and assessed risk of bias. One reviewer extracted data and was checked by another. Main outcomes were Quality of Life and mortality. RESULTS We identified 16,698 references and included 6 studies with different study designs. Average age ranged from 4-71 years. Samples sizes were small (range 10-49 participants) apart from one non-randomized controlled trial including >600 participants. Interventions were music therapy (n = 3), psychological counseling (n = 2) and exercise training (n = 1). One study reporting on Quality of Life and found no change after exercise. None of the studies reported on mortality. Due to heterogeneous results no meta-analyses were performed. CONCLUSIONS There is a lack of high-quality evidence for effective comprehensive interventions to manage adverse effects associated with isolation. Future studies should investigate the effect of multi-component interventions using rigorous methods to improve outcomes for hospitalized isolated patients.
Collapse
Affiliation(s)
- Sharon Kramer
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia.
| | - Olumuyiwa Omonaiye
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Robin Digby
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
| | - Debra Berry
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Julie Considine
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety, Research-Eastern Health Partnership, Nursing Research, Box Hill, Australia
| | - Trisha Dunning
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Barwon Health Partnership, Nursing Research, Geelong, Australia
| | - Alison M Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Monash Health Partnership, Nursing Research, Clayton, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Epworth Healthcare Partnership, Nursing Research, Melbourne, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia
| | - Bodil Rasmussen
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Western Health Partnership, Nursing Research, Sunshine, Australia
| | - Tracey Bucknall
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Burwood, Australia; Centre for Quality and Patient Safety Research-Alfred Health Partnership, Nursing Research, Melbourne, Australia
| |
Collapse
|
10
|
van Gulik N, Bouchoucha S, Apivanich S, Lucas J, Hutchinson A. Factors influencing self-reported adherence to standard precautions among Thai nursing students: A cross sectional study. Nurse Educ Pract 2021; 57:103232. [PMID: 34700259 DOI: 10.1016/j.nepr.2021.103232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/29/2021] [Accepted: 10/12/2021] [Indexed: 12/16/2022]
Abstract
AIM This study explored nursing students' compliance with standard precautions (SPs) and attitudes to SPs in Thailand, to identify factors that may increase adherence to SPs and infection prevention and control best practice. BACKGROUND In the context of high rates of healthcare associated infections as in Thailand, effective strategies to promote high levels of clinician adherence to SPs is a priority. Nursing students are one group of healthcare workers who play a vital role in caring for patients and constitute the future nursing workforce. DESIGN A cross-sectional survey design was used. METHODS A self-reported survey comprising the Compliance with Standard Precautions Scale and the Factors Influencing Adherence to Standard Precautions Scale were distributed to nursing students as a Thai paper-based survey. RESULTS A total of '533 second' to fourth year nursing students from a tertiary nursing school in Bangkok, Thailand completed the survey. The average nursing student compliance to SPs was 68.5%. Most (91.2%) reported only using water for handwashing and 57.2% reported reuse of surgical masks. The fourth-year students had higher compliance (M=3.90, SD=1.12) on the 'prevention of cross infection from person-to-person' dimension while second-year students reported higher compliance on the 'disposal of sharps' (M=2.67, SD=0.57) dimension. 'Contextual Cues' was identified as the factor (M=3.41, SD=0.40) that had the greatest influence on adherence and 'Practice Culture' (M=1.84, SD=0.66) and 'Justification' (M = 1.35, SD.68 had the lowest influence. Fourth year students identified 'Leadership' (M=2.90, SD=0.49) as an important influence on adherence to SPs. CONCLUSIONS To increase nursing students' adherence there needs to be greater emphasis on the importance of SPs in theoretical sessions and regular monitoring and feedback on hand hygiene performance and personal protective equipment use while students are on placements. More visible organizational leadership and promotion of high levels of adherence to SPs may assist students to translate their theoretical knowledge into practice.
Collapse
Affiliation(s)
- Nantanit van Gulik
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand.
| | - Stéphane Bouchoucha
- School of Nursing & Midwifery & Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia
| | - Siriluk Apivanich
- Ramathibodi School of Nursing, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
| | - James Lucas
- Deakin University Geelong, School of Health & Soc. Dev., VIC 3220, Australia
| | - Anastasia Hutchinson
- School of Nursing & Midwifery & Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC 3220, Australia; Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Epworth Health Care Richmond, VIC 3121, Australia
| |
Collapse
|
11
|
Nardella N, Hooper S, Lau R, Hutchinson A. Developing acute care-based mental health nurses' knowledge and skills in providing recovery-orientated care: A mixed methods study. Int J Ment Health Nurs 2021; 30:1170-1182. [PMID: 33848046 DOI: 10.1111/inm.12868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 03/10/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
Recovery-oriented principles have progressively been accepted as a standard of mental health practice in many countries, including Australia. A private mental health Clinic in Melbourne, Australia, is dedicated to embedding the principles of recovery-oriented practice into care by (i) providing recovery education and training for their staff and (ii) co-designing resources with consumers to promote active consumer engagement and participation. The purpose of this study was to evaluate the impact of these initiatives on staff knowledge and provision of recovery-oriented care in acute care. Two groups of study participants were recruited: the first group completed the staff training programme introducing the concept of recovery-oriented practice, and the second group was a convenience sample of nurses recruited 12 months later working on the acute inpatient wards at the study site. Nurses completed Recovery Knowledge Inventory (RKI) and Recovery Self-Assessment (RSA-Provider) surveys and participated in a focus group discussion. The three major themes identified from the focus group discussion were as follows: (i) nurses' understanding of personal recovery-orientated practice, (ii) how to embed personal recovery-oriented care into practice, and (iii) barriers to consumer participation in recovery-oriented activities in acute care. There were significant differences between the two groups on the RKI subscale scores of 'Expectations regarding recovery' and the 'Roles of self-definition and peers in recovery' and 'Life goals' and 'Choice' factors on the RSA subscale scores. There were some gaps in the nurses' knowledge and implementation of personal recovery-oriented concepts, highlighting the need for further training and cultural change.
Collapse
Affiliation(s)
- Natalie Nardella
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Suzie Hooper
- Epworth Rehabilitation and Mental Health, Epworth HealthCare, Melbourne, Victoria, Australia
| | - Rosalind Lau
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research Epworth/Deakin Partnership, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| |
Collapse
|
12
|
Davis KM, Eckert MC, Hutchinson A, Harmon J, Sharplin G, Shakib S, Caughey GE. Effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface: A quantitative systematic review. Int J Nurs Stud 2021; 121:103986. [PMID: 34242979 DOI: 10.1016/j.ijnurstu.2021.103986] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 05/17/2021] [Accepted: 05/18/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND Globally, chronic disease is a leading cause of illness, disability and death and an important driver of health system utilization and spending. Continuity of care is a significant component of quality healthcare. However, an association between nurse-led services, interventions, patient outcomes and continuity of care at the primary and secondary interface as an outcome, has not been established for people with chronic disease. OBJECTIVE To identify the effectiveness of nurse-led services for people with chronic disease in achieving an outcome of continuity of care at the primary-secondary healthcare interface. DESIGN Quantitative systematic review. DATA SOURCES Systematic searches of Medline, Cochrane, Embase, Emcare, JBI and Scopus databases were conducted of studies published between 1946 and May 2019 using the search terms "nurse", "continuity of care" and "chronic disease". REVIEW METHODS Quality of the included studies was assessed using the Cochrane risk of bias tool for randomized controlled trials and Joanna Briggs Institute quality appraisal checklists. A second reviewer screened 10% of full text articles and all articles in critical appraisal. Studies were excluded from the review if they were of poor methodological quality or the description of the effect of the nurse-led service was inadequately reported. RESULTS Fourteen studies were included in the review (n=4,090 participants). All studies incorporated recognized continuity of care interventions. The nurse-led services were associated with fewer hospitalizations, reduced by 2-8.9% and re-admissions reduced by 14.8-51% (n=886). Reporting of positive patient experiences and improvement in symptoms and lifestyle was also evident. An association of nurse-led services with improved continuity of care between primary and secondary health services as an outcome per se could not be concluded. CONCLUSION Nurse-led services for adults provide coordinated interventions that support continuity of care for people with chronic disease in both the primary and secondary healthcare settings that are associated with reduced hospitalizations or readmissions and patient satisfaction. However, the limited use of validated continuity of care outcome measurement tools precluded establishing correlations between interventions, patient outcomes and continuity of care as a specific outcome.
Collapse
Affiliation(s)
- K M Davis
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia.
| | - M C Eckert
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/@DrJoanneHarmon
| | - A Hutchinson
- UniSA, Clinical and Health Sciences, University of South Australia
| | - J Harmon
- UniSA, Clinical and Health Sciences, University of South Australia. https://twitter.com/marioneckert5
| | - G Sharplin
- Rosemary Bryant AO Research Centre, UniSA, Clinical and Health Sciences, University of South Australia
| | - S Shakib
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia
| | - G E Caughey
- Clinical Pharmacology, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Discipline of Pharmacology, Adelaide Medical School, University of Adelaide, Royal Adelaide Hospital, North Terrace, Adelaide, Australia; Registry of Senior Australians, South Australian Health and Medical Research Institute, Adelaide, Australia
| |
Collapse
|
13
|
Fitt C, Luong TV, Cresp D, Hutchinson A, Lim K, Hodgson L, Colville D, Savige J. Increased retinal venular calibre in acute infections. Sci Rep 2021; 11:17280. [PMID: 34446820 PMCID: PMC8390475 DOI: 10.1038/s41598-021-96749-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 07/14/2021] [Indexed: 11/08/2022] Open
Abstract
Population-based studies have demonstrated that increased retinal venular calibre is a risk factor for cardiac disease, cardiac events and stroke. Venular dilatation also occurs with diabetes, obesity, dyslipidemia and autoimmune disease where it is attributed to inflammation. This study examined whether the inflammation associated with infections also affected microvascular calibre. Participants with infections and CRP levels > 100 mg/L were recruited from the medical wards of a teaching hospital and assisted to complete a demographic and vascular risk factor questionnaire, and to undergo non-mydriatic retinal photography (Canon CR5-45NM, Japan). They were then treated with appropriate antibiotics, and underwent repeat retinal imaging when their CRP levels had fallen to less than 100 mg/L. Retinal images were examined for arteriole and venular calibre using validated semi-automated software based on Knudtson's modification of the Parr-Hubbard formula (IVAN, U Wisconsin). Differences in inflammatory markers and calibre were examined using the paired t-test for continuous variables. Determinants of calibre were calculated from multiple linear regression analysis. Forty-one participants with respiratory (27, 66%), urinary (6, 15%), skin (5, 12%), or miscellaneous (3, 7%) infections were studied. After antibiotic treatment, participants' mean CRP levels fell from 172.9 ± 68.4 mg/L to 42.2 ± 28.2 mg/L (p < 0.0001) and mean neutrophil counts fell from 9 ± 4 × 109/L to 6 ± 3 × 109/L (p < 0.0001). The participants' mean venular calibre (CRVE) decreased from 240.9 ± 26.9 MU to 233.4 ± 23.5 MU (p = 0.0017) but arteriolar calibre (CRAE) was unchanged (156.9 ± 15.2 MU and 156.2 ± 16.0 MU, p = 0.84). Thirteen additional participants with infections had a CRP > 100 mg/L that persisted at review (199.2 ± 59.0 and 159.4 ± 40.7 mg/L, p = 0.055). Their CRAE and CRVE were not different before and after antibiotic treatment (p = 0.96, p = 0.78). Hospital inpatients with severe infections had retinal venular calibre that decreased as their infections resolved and CRP levels fell after antibiotic treatment. The changes in venular calibre with intercurrent infections may confound retinal vascular assessments of, for example, blood pressure control and cardiac risk.
Collapse
Affiliation(s)
- Cara Fitt
- Department of Medicine, Melbourne Health and Northern Health, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Thao Vi Luong
- Department of Medicine, Melbourne Health and Northern Health, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | | | | | - Karen Lim
- Northern Health, Epping, VIC, 3076, Australia
| | - Lauren Hodgson
- Department of Ophthalmology, Royal Victorian Eye and Ear Hospital, The University of Melbourne, East Melbourne, VIC, 3010, Australia
| | - Deb Colville
- Department of Medicine, Melbourne Health and Northern Health, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia
| | - Judy Savige
- Department of Medicine, Melbourne Health and Northern Health, Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, 3050, Australia.
| |
Collapse
|
14
|
Ladbrook E, Khaw D, Bouchoucha S, Hutchinson A. A systematic scoping review of the cost-impact of ventilator-associated pneumonia (VAP) intervention bundles in intensive care. Am J Infect Control 2021; 49:928-936. [PMID: 33301781 DOI: 10.1016/j.ajic.2020.11.027] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 11/27/2020] [Accepted: 11/30/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Evidence-based economic decision making is key in health care. Presently, however, studies reporting financial outcomes of ventilator-associated pneumonia (VAP) care bundles have not been systematically evaluated. METHOD This scoping review investigated the characteristics and findings of studies of the economic impact of VAP bundle implementation. A systematic search of electronic databases (MEDLINE, CINAHL) for relevant English language studies was undertaken (January 2000-February 2020). Methodological quality was evaluated using a Joanna Briggs Institute quality appraisal checklist. Article screening and quality appraisals were performed by 2 reviewers. Reference lists of included studies were hand-searched for additional articles. Reporting followed PRISMA Extension for Scoping Reviews (PRISMA-ScR) standards. RESULTS From 181 citations, 10 articles met inclusion criteria. Eight studies evaluated cost impacts on acute care and there were 2 cost-modeling studies. Results consistently indicated that effective VAP bundle implementation decreased healthcare costs. However, studies were heterogeneous with respect to research methods and objectives and were judged to have a moderate-to-high risk of bias. DISCUSSION Effective implementation of VAP care bundles was associated with superior clinical and economic outcomes. However, despite finding a moderate volume of research, study heterogeneity inhibited strong conclusions being drawn regarding the degree of associated cost savings. CONCLUSION Additional research involving multisite/multijurisdiction studies using experimental designs are needed to progress the field and overcome gaps in the existing literature.
Collapse
|
15
|
Martin RS, Hayes BJ, Hutchinson A, Yates P, Lim WK. Healthcare-providers experiences with Advance Care Planning and Goals of Patient Care medical treatment orders in Residential Aged Care Facilities; an explanatory descriptive study. Intern Med J 2021; 52:776-784. [PMID: 34008332 DOI: 10.1111/imj.15374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 05/10/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Advance Care Planning (ACP) is a process by which people communicate their healthcare preferences and values, planning for a time when they are unable to voice them. Within Residential Aged Care Facilities (RACF) both the completion and the clarity of ACP documents is variable and, internationally, medical treatment orders have been used to address these issues. In this study, Goals of Patient Care (GOPC) medical treatment orders were introduced alongside usual ACP in three RACF to improve healthcare decision-making for residents. This study explored the experiences of RACF healthcare-providers with ACP and GOPC medical treatment orders. METHODS The study was of Explanatory Descriptive design. Within three RACF where the GOPC medical treatment orders had been introduced, focus groups and interviews with healthcare-providers were performed. The transcribed interviews were analysed thematically. RESULTS Healthcare-providers reported support for ACP and GOPC but also discussed many problematic issues. Analysis of the data identified four main themes: Enablers, Barriers, Resident autonomy and Advance documentation (ACP and GOPC). CONCLUSION Healthcare-providers identified ACP and GOPC as positive tools for assisting with medical decision-making for residents. Although barriers exist in completion and activation of plans, healthcare-providers described them as progressing resident-centred care. Willingness to follow ACP instructions was reported to be reduced by lack of trust by clinicians. Families were also reported to change their views from those documented in family-completed ACP, attributed to poor understanding of their purpose. Participants reported that GOPC led to clearer documentation of residents' medical treatment-plans than relying on ACP documents alone. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Ruth S Martin
- Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.,University of Melbourne, 1-100 Grattan Street, Melbourne, Victoria, 3010, Australia
| | - Barbara J Hayes
- Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia
| | - Anastasia Hutchinson
- Northern Health, 185 Cooper Street, Epping, Victoria, 3076, Australia.,Deakin University, 75 Pigdons Road, Waurn Ponds, Geelong, Victoria, 3216, Australia
| | - Paul Yates
- University of Melbourne, 1-100 Grattan Street, Melbourne, Victoria, 3010, Australia.,Austin Health, 145 Studley Road, Heidelberg, Victoria, 3084, Australia
| | - Wen Kwang Lim
- University of Melbourne, 1-100 Grattan Street, Melbourne, Victoria, 3010, Australia.,Melbourne Health, 300 Grattan Street, Melbourne, Victoria, 3052, Australia
| |
Collapse
|
16
|
Nieuwoudt L, Hutchinson A, Nicholson P. Pre-registration nursing and occupational therapy students' experience of interprofessional simulation training designed to develop communication and team-work skills: A mixed methods study. Nurse Educ Pract 2021; 53:103073. [PMID: 33991968 DOI: 10.1016/j.nepr.2021.103073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 03/17/2021] [Accepted: 04/26/2021] [Indexed: 11/29/2022]
Abstract
To bridge the gap between university and the clinical environment, the university where this study was conducted incorporated interprofessional simulation sessions into the curricula for pre-registration nursing and occupational therapy students. The purpose of the study was to evaluate the effectiveness of simulation training to support the development of students' interprofessional communication and teamwork skills. Study participants were first-year students. A mixed methods study design was used that included: (1) a cross-sectional survey, (using the Interprofessional Education Collaborative Competency Self-Assessment tool), before and after the simulation session; and (2) two focus groups with students and one with academic staff. A total of 91 students and 5 staff participated. All students increased their self-perceived skills in interprofessional interactions. Two major themes were identified: 'Communication and Teamwork', with four sub-themes, (1) 'Significance of Communication in teamwork'; (2) 'Learning about, from and with each other'; (3) 'Professional role identification and collaborative practice'; and (4) 'Clinical leadership facilitated collaboration' and 'Lessons learnt from the simulation session', with three subthemes: (1) 'enhanced preparation for clinical placement'; (2) 'the experience of interacting with a simulated patient'; and (3) 'holistic patient care'. The results from the study demonstrated that interprofessional simulation sessions are an effective approach to introducing and developing collaborative clinical practice.
Collapse
Affiliation(s)
- Laurina Nieuwoudt
- Department of Health Professions, School of Health Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorne, VIC 3122, Australia
| | - Anastasia Hutchinson
- Centre for Quality and Patient Safety Research - Epworth HealthCare Partnership, Institute of Health Transformation, School of Nursing & Midwifery, Deakin University, Geelong, VIC 3228, Australia
| | - Patricia Nicholson
- Centre for Quality and Patient Safety Research, Institute of Health Transformation, School of Nursing and Midwifery, Deakin University, Geelong, VIC 3228, Australia.
| |
Collapse
|
17
|
Jarhyan P, Hutchinson A, Khatkar R, Kondal D, Botti M, Prabhakaran D, Mohan S. Diagnostic Accuracy of a Two-Stage Sequential Screening Strategy Implemented by Community Health Workers (CHWs) to Identify Individuals with COPD in Rural India. Int J Chron Obstruct Pulmon Dis 2021; 16:1183-1192. [PMID: 33958862 PMCID: PMC8096419 DOI: 10.2147/copd.s293577] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 03/01/2021] [Indexed: 12/16/2022] Open
Abstract
Purpose Undiagnosed Chronic Obstructive Pulmonary Disease (COPD) results in high morbidity, disability and mortality in India. Effective strategies for active COPD screening in community settings are needed to increase early identification, risk reduction and timely management. The objective of this study was to test the diagnostic accuracy of a sequential two-step screening strategy to detect COPD, implemented by community health workers (CHWs), among adults aged ≥40 years in a rural area of North India. Patients and Methods Trained CHWs screened all consenting (n=3256) eligible adults in two villages using the Lung Function Questionnaire (LFQ) to assess their COPD risk and conducted pocket spirometry on 268 randomly selected (132 with high risk ie LFQ score ≤18 and 136 with low risk ie LFQ score >18) individuals. Subsequently, trained researchers conducted post-bronchodilator spirometry on these randomly selected individuals using a diagnostic quality spirometer and confirmed the COPD diagnosis according to the Global Initiative for Obstructive Lung Disease (GOLD) criteria (FEV1/FVC ratio <0.7). Results This strategy of using LFQ followed by pocket spirometry was sensitive (78.6%) and specific (78.8%), with a positive predictive value of 66% and negative predictive value of 88%. It could accurately detect 67% of GOLD Stage 1, 78% of GOLD Stage 2, 82% of GOLD Stage 3 and 100% of GOLD Stage 4 individuals with airflow limitation. Conclusion COPD can be accurately detected by trained CHWs using a simple sequential screening strategy. This can potentially contribute to accurate assessment of COPD and thus its effective management in low-resource settings.
Collapse
Affiliation(s)
- Prashant Jarhyan
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India.,Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia.,Centre for Chronic Disease Control (CCDC), Delhi, India
| | - Anastasia Hutchinson
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India.,Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia
| | - Rajesh Khatkar
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India
| | - Dimple Kondal
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India
| | - Mari Botti
- Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia
| | - Dorairaj Prabhakaran
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India.,Centre for Chronic Disease Control (CCDC), Delhi, India.,Department of Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Sailesh Mohan
- Centre for Chronic Conditions and Injuries (CCCI), Public Health Foundation of India, Gurgaon, India.,Institute of Health Transformation, Faculty of Health, Deakin University, Burwood, Melbourne, Australia.,Centre for Chronic Disease Control (CCDC), Delhi, India
| |
Collapse
|
18
|
Tebbs O, Hutchinson A, Lau R, Botti M. Evaluation of a blended learning approach to developing specialty-nursing practice. An exploratory descriptive qualitative study. Nurse Educ Today 2021; 98:104663. [PMID: 33190953 DOI: 10.1016/j.nedt.2020.104663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 10/02/2020] [Accepted: 11/03/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND An ageing population and a transitioning workforce is creating demands on healthcare workforces. Clinical and procedural knowledge deficits cause anxieties in new and experienced nurses alike when integrating into new teams. Overcoming these boundaries can be achieved with Introductory programs. These develop knowledge, technical skills and non-technical skills. Investigating nurses drive to undertake such programs, and the benefits they perceive for themselves, will help to tailor future programs. OBJECTIVES To explore post-registration nurses' motivations for undertaking an introductory program that utilised a blended learning methodology. Identifying changes in participants understanding and clinical behaviours. METHODS An exploratory descriptive qualitative study design was used to evaluate the Introduction to Specialty Practice (ISP) program that is run by a large private healthcare provider in Melbourne, Australia. The health service includes eight campuses and four intensive care units across the group. Twelve participants from a mixture of critical care and acute care clinical areas were consented. They were interviewed using a semi-structured questionnaire. Responses were transcribed verbatim and thematic analysis of the transcripts then occurred. RESULTS The study demonstrated intrinsic and extrinsic factors influenced participant's desires to undertake this program. Three major themes were evident: 1) that caring without knowledge was daunting, 2) that participants needed to create a clinical and professional identity and 3) that participant's perspective on their delivery of care improved, along with their professional aptitude. CONCLUSION Maintaining currency with knowledge, skills, and technological developments is crucial for nurses to consistently deliver high-level care. The demands that nurses' face within their clinical areas affects their intention to stay within the workforce and their ability to deliver care. Introductory programs that utilise blended learning strategies have a role to play in enabling nurses to create their professional identity, find their position in clinical teams, and meet the requirements of organisations.
Collapse
Affiliation(s)
- Owen Tebbs
- Clinical Educator at Epworth HealthCare Richmond, Melbourne 03 9426 6666, Australia.
| | - Anastasia Hutchinson
- Deakin University/Epworth HealthCare Centre for Quality and Patient Safety Research, Australia.
| | - Rosalind Lau
- Deakin University/Epworth HealthCare Centre for Quality and Patient Safety Research, Australia.
| | - Mari Botti
- Deakin University/Epworth HealthCare Centre for Quality and Patient Safety Research, Australia.
| |
Collapse
|
19
|
Bloom J, Andrew E, Nehme Z, Dinh D, Shi W, Vriesendorp P, Nanayakarra S, Fernando H, Dawson L, Brennan A, Noaman S, Layland J, William J, Al-Fiadh A, Brookes M, Freeman M, Hutchinson A, McGaw D, Van GW, Wilson W, White A, Prakash R, Reid C, Lefkovits J, Duffy S, Chan W, Kaye D, Stephenson M, Bernard S, Smith K, Stub D. Pre-Hospital Heparin Use for ST-Elevation Myocardial Infarction is Safe and Improves Angiographic Outcomes. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
20
|
McDonall J, Heynsbergh N, Oxley S, Botti M, Hutchinson A. Opportunities for patients to engage in postoperative recovery following cardiac surgery: A systematic narrative review. Patient Educ Couns 2020; 103:2095-2106. [PMID: 32381287 DOI: 10.1016/j.pec.2020.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 03/05/2020] [Accepted: 04/07/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare patient booklets with clinical guidelines and care pathways to assess: gaps in content and depth of information delivered, opportunities for patients participation and to review the trajectory of care to inform recovery. METHODS A systematic review of the grey literature was conducted using Google search engine and a variety of terms related to cardiac surgery, patient outcomes and recovery pathways. Patient books and care pathways were obtained from major hospitals in Melbourne. Resources were included if they were published between January 2013-August 2018 and written in English. RESULTS A total of 31 resources were included in the review, (n = 14 patient booklets, n = 17 clinician guides). Twenty-one topics of recovery were identified. Patient booklets provided information on more topics of recovery than clinician guides (50 % and 24 % respectively). Clinician guides provided more depth on information on topics of recovery than patient booklets (85 % and 73 % respectively). The majority of patient booklets outlined patient participation was in five topics of recovery. CONCLUSIONS Gaps in the type and depth of information exist between patient and clinician guidelines. Clearer guidelines on how patients can participate in care are needed. PRACTICE IMPLICATIONS Nurses are key drivers in facilitating patient participation in postoperative recovery.
Collapse
Affiliation(s)
- Jo McDonall
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia
| | - Natalie Heynsbergh
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia.
| | | | - Mari Botti
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
| | - Anastasia Hutchinson
- Faculty of Health, School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Melbourne, 3220 Australia; Epworth HealthCare, Bridge Road, Melbourne, 3121 Australia
| |
Collapse
|
21
|
Ewers R, Bloomer MJ, Hutchinson A. An exploration of the reliability and usability of two delirium screening tools in an Australian intensive care unit: A pilot study. Intensive Crit Care Nurs 2020; 62:102919. [PMID: 32873426 DOI: 10.1016/j.iccn.2020.102919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 06/26/2020] [Accepted: 07/02/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To compare the inter-rater reliability and usability of two delirium screening tools designed for use in ICU; the Confusion Assessment Method for ICU and the Intensive Care Delirium Screening Checklist. RESEARCH METHODOLOGY/DESIGN A multiple methods design was used. The intra and inter rater reliability of the tools were evaluated using Kappa statistics and intra class correlation coefficients. Focus groups were conducted to explore ICU staff perceptions of the usability of the tools and feasibility of delirium screening. SETTING Private hospital ICU, Melbourne Australia. RESULTS 66 patients were assessed for delirium; median age of 71 (IQR 62-75) years. Seventeen patients (26%) scored positive for delirium using the screening tools and 11 (17%) had delirium confirmed on the medical ICU discharge summary. Ten nurse assessors performed 99 paired assessments using the two tools sequentially, demonstrating the intra and inter-rater agreement and reliability of the tools was moderate to high. Four focus groups were conducted with 16 participants. Content analysis identified three themes: (i) current recognition of delirium, (ii) benefits of delirium screening, and (iii) future directions for delirium management. Time and medical staff indifference were identified as barriers to screening, facilitators were education and having a follow-up plan. CONCLUSION This study found that the reliability and usability of the CAM-ICU and ICDSC were acceptable and that using structured delirium screening was feasible as part of a wider, multi-disciplinary delirium management plan.
Collapse
Affiliation(s)
| | - Melissa J Bloomer
- Deakin University, School of Nursing & Midwifery, Geelong, Vic 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Vic 3220, Australia; Epworth Deakin Centre for Clinical Nursing Research, Richmond, Vic 3121, Australia
| | - Anastasia Hutchinson
- Deakin University, School of Nursing & Midwifery, Geelong, Vic 3220, Australia; Centre for Quality and Patient Safety Research, Deakin University, Geelong, Vic 3220, Australia; Epworth Deakin Centre for Clinical Nursing Research, Richmond, Vic 3121, Australia
| |
Collapse
|
22
|
Cousins JL, Wood-Baker R, Wark PAB, Yang IA, Gibson PG, Hutchinson A, Sajkov D, Hiles SA, Samuel S, McDonald VM. Management of acute COPD exacerbations in Australia: do we follow the guidelines? ERJ Open Res 2020; 6:00270-2019. [PMID: 32337215 PMCID: PMC7167211 DOI: 10.1183/23120541.00270-2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 01/30/2023] Open
Abstract
Objective We aimed to assess adherence to the Australian national guideline (COPD-X) against audited practice, and to document the outcomes of patients hospitalised with an acute exacerbation of chronic obstructive pulmonary disease (COPD) at discharge and 28 days after. Methods A prospective clinical audit of COPD hospital admission from five tertiary care hospitals in five states of Australia was conducted. Post-discharge follow-up was conducted via telephone to assess for readmission and health status. Results There were 207 admissions for acute exacerbation (171 patients; mean 70.2 years old; 50.3% males). Readmission rates at 28 days were 25.4%, with one (0.6%) death during admission and eight (6.1%) post-discharge within 28 days. Concordance to the COPD-X guidance was variable; 22.7% performed spirometry, 81.1% had blood gases collected when forced expiratory volume in 1 s was <1 L, 99.5% had chest radiography performed, 95.1% were prescribed systemic corticosteroids and 95% were prescribed antibiotic therapy. There were 89.1% given oxygen therapy and 92.6% when arterial oxygen tension was <80 mmHg; 65.6% were given ventilatory assistance when pH was <7.35. Only 32.4% were referred to pulmonary rehabilitation but 76.8% had general practitioner follow-up arranged. Conclusion When compared against clinical practice guidelines, we found important gaps in management of patients admitted with COPD throughout tertiary care centres in Australia. Strategies to improve guideline uptake are needed to optimise care. A multisite audit of hospital admissions for patients experiencing #AECOPD in Australia highlighted important gaps in management when compared against national guidelines. Further focus on how we can improve guideline uptake by clinicians is needed.http://bit.ly/2VjGnHw
Collapse
Affiliation(s)
- Joyce L Cousins
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Avondale University College, Faculty of Nursing, Wahroonga, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | | | - Peter A B Wark
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Ian A Yang
- The Prince Charles Hospital and University of Queensland, Chermside, Australia
| | - Peter G Gibson
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - Dimitar Sajkov
- Australian Respiratory and Sleep Medicine Institute, Flinders University and Flinders Medical Centre, Bedford Park, Australia
| | - Sarah A Hiles
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia
| | - Sameh Samuel
- School of Medicine and Public Health, The University of Newcastle, Callaghan, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Vanessa M McDonald
- School of Nursing and Midwifery, The University of Newcastle, Callaghan, Australia.,Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, New Lambton Heights, Australia.,Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| |
Collapse
|
23
|
McDougall R, Hayes B, Sellars M, Pratt B, Hutchinson A, Tacey M, Detering K, Shadbolt C, Ko D. 'This is uncharted water for all of us': challenges anticipated by hospital clinicians when voluntary assisted dying becomes legal in Victoria. AUST HEALTH REV 2020; 44:399-404. [DOI: 10.1071/ah19108] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 07/22/2019] [Indexed: 11/23/2022]
Abstract
ObjectiveThe aim of this study was to identify the challenges anticipated by clinical staff in two Melbourne health services in relation to the legalisation of voluntary assisted dying in Victoria, Australia.
MethodsA qualitative approach was used to investigate perceived challenges for clinicians. Data were collected after the law had passed but before the start date for voluntary assisted dying in Victoria. This work is part of a larger mixed-methods anonymous online survey about Victorian clinicians’ views on voluntary assisted dying. Five open-ended questions were included in order to gather text data from a large number of clinicians in diverse roles. Participants included medical, nursing and allied health staff from two services, one a metropolitan tertiary referral health service (Service 1) and the other a major metropolitan health service (Service 2). The data were analysed thematically using qualitative description.
ResultsIn all, 1086 staff provided responses to one or more qualitative questions: 774 from Service 1 and 312 from Service 2. Clinicians anticipated a range of challenges, which included burdens for staff, such as emotional toll, workload and increased conflict with colleagues, patients and families. Challenges regarding organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and how voluntary assisted dying would fit within the hospital’s overall work were also raised.
ConclusionsThe legalisation of voluntary assisted dying is anticipated to create a range of challenges for all types of clinicians in the hospital setting. Clinicians identified challenges both at the individual and system levels.
What is known about the topic?Voluntary assisted dying became legal in Victoria on 19 June 2019 under the Voluntary Assisted Dying Act 2017. However there has been little Victorian data to inform implementation.
What does this paper add?Victorian hospital clinicians anticipate challenges at the individual and system levels, and across all clinical disciplines. These challenges include increased conflict, emotional burden and workload. Clinicians report concerns about organisational culture, the logistics of delivering voluntary assisted dying under the specific Victorian law and effects on hospitals’ overall work.
What are the implications for practitioners?Careful attention to the breadth of staff affected, alongside appropriate resourcing, will be needed to support clinicians in the context of this legislative change.
Collapse
|
24
|
Friedman J, Hutchinson A, Milad MP. 1181 Laparoscopic Management of Hernia Uterus Inguinale with Associated Unicornuate Uterus: A Case Report. J Minim Invasive Gynecol 2019. [DOI: 10.1016/j.jmig.2019.09.098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
25
|
Mckenna K, Hutchinson A, Butler M. An evaluation of the environmental factors that impact on operating room air quality and the risk for development of surgical site infections. Infect Dis Health 2019. [DOI: 10.1016/j.idh.2019.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
26
|
Hua-Gen Li M, Hutchinson A, Tacey M, Duke G. Reliability of comorbidity scores derived from administrative data in the tertiary hospital intensive care setting: a cross-sectional study. BMJ Health Care Inform 2019; 26:bmjhci-2019-000016. [PMID: 31039124 PMCID: PMC7062318 DOI: 10.1136/bmjhci-2019-000016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/01/2019] [Indexed: 12/22/2022] Open
Abstract
Background Hospital reporting systems commonly use administrative data to calculate comorbidity scores in order to provide risk-adjustment to outcome indicators. Objective We aimed to elucidate the level of agreement between administrative coding data and medical chart review for extraction of comorbidities included in the Charlson Comorbidity Index (CCI) and Elixhauser Index (EI) for patients admitted to the intensive care unit of a university-affiliated hospital. Method We conducted an examination of a random cross-section of 100 patient episodes over 12 months (July 2012 to June 2013) for the 19 CCI and 30 EI comorbidities reported in administrative data and the manual medical record system. CCI and EI comorbidities were collected in order to ascertain the difference in mean indices, detect any systematic bias, and ascertain inter-rater agreement. Results We found reasonable inter-rater agreement (kappa (κ) coefficient ≥0.4) for cardiorespiratory and oncological comorbidities, but little agreement (κ<0.4) for other comorbidities. Comorbidity indices derived from administrative data were significantly lower than from chart review: −0.81 (95% CI − 1.29 to − 0.33; p=0.001) for CCI, and −2.57 (95% CI −4.46 to −0.68; p=0.008) for EI. Conclusion While cardiorespiratory and oncological comorbidities were reliably coded in administrative data, most other comorbidities were under-reported and an unreliable source for estimation of CCI or EI in intensive care patients. Further examination of a large multicentre population is required to confirm our findings.
Collapse
Affiliation(s)
- Michael Hua-Gen Li
- Northern Clinical Research Centre, The Northern Hospital, Epping, Victoria, Australia
| | - Anastasia Hutchinson
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Mark Tacey
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Department of Intensive Care, Box Hill Hospital, Box Hill, Victoria, Australia
| | - Graeme Duke
- Department of Intensive Care, The Northern Hospital, Epping, Victoria, Australia
| |
Collapse
|
27
|
Martin RS, Hayes BJ, Hutchinson A, Tacey M, Yates P, Lim WK. Introducing Goals of Patient Care in Residential Aged Care Facilities to Decrease Hospitalization: A Cluster Randomized Controlled Trial. J Am Med Dir Assoc 2019; 20:1318-1324.e2. [PMID: 31422065 DOI: 10.1016/j.jamda.2019.06.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 06/14/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The "Goals of Patient Care" (GOPC) process uses shared decision making to incorporate residents' prior advance care planning (ACP) or preferences into medical treatment orders, guiding health care decisions at a time of clinical deterioration should they be unable to voice their opinions. The objective was to determine whether GOPC medical treatment orders were more effective than ACP alone in preventing emergency department (ED) visits (no hospitalization), ED visits (with hospitalization), and deaths outside the residential aged care facility (RACF). DESIGN The study was a prospective cluster randomized controlled trial, with the intervention being the completion of GOPC process by a geriatrician, following a shared decision-making process, incorporating ACP documents or residents' preferences. SETTING AND PARTICIPANTS The study took place in 6 RACFs in Northern Metropolitan Melbourne, Australia. Eligible participants included all permanent residents in participating RACFs for whom written informed consent could be obtained. MEASURES The primary outcome was the effect on ED visits and hospitalizations at 6 months. Secondary outcomes included a difference in hospitalization rates at 3 and 12 months, total hospital bed-days, and in-RACF and in-hospital mortality rates. RESULTS More than 75% of residents participated, 181 randomized to Intervention and 145 to Control. The intervention did not result in a statistically significant change at 6 months; however, at 12 months, it reached statistical significance with 40% reduction in ED visits and hospitalizations compared with Control, with an incident rate ratio 0.63 [95% confidence interval (CI) 0.41-0.99, P = .044]. Mortality rates show increased likelihood of dying in the RACF, with statistical significance at 6 months at a relative risk ratio of 2.19 (95% CI 1.16-4.14, P = .016). CONCLUSIONS AND IMPLICATIONS In the RACF population, GOPC medical treatment orders were more effective than ACP alone for decreasing hospitalization and likelihood of dying outside the RACF. GOPC should be considered by both RACF staff and health services to decrease hospitalization and in-hospital mortality.
Collapse
Affiliation(s)
- Ruth S Martin
- University of Melbourne, Melbourne, Victoria, Australia.
| | | | - Anastasia Hutchinson
- Northern Health, Epping, Victoria, Australia; Deakin University, Geelong, Victoria, Australia
| | - Mark Tacey
- Northern Health, Epping, Victoria, Australia
| | - Paul Yates
- Northern Health, Epping, Victoria, Australia
| | - Wen Kwang Lim
- University of Melbourne, Melbourne, Victoria, Australia; Melbourne Health, Melbourne, Victoria, Australia
| |
Collapse
|
28
|
Warren J, Nanayakkara S, Andrianopoulos N, Brennan A, Dinh D, Yudi M, Clark D, Ajani AE, Reid CM, Selkrig L, Shaw J, Hiew C, Freeman M, Kaye D, Kingwell BA, Dart AM, Duffy SJ, Reid C, Andrianopoulos N, Brennan A, Dinh D, Reid C, Ajani A, Duffy S, Clark D, Freeman M, Hiew C, Andrianopoulos N, Oqueli E, Brennan A, Duffy S, Shaw J, Walton A, Dart A, Broughton A, Federman J, Keighley C, Hengel C, Peter K, Stub D, Chan W, Warren J, O’Brien J, Selkrig L, Huntington R, Clark D, Farouque O, Horrigan M, Johns J, Oliver L, Brennan J, Chan R, Proimos G, Dortimer T, Chan B, Nadurata V, Huq R, Fernando D, Al-Fiadh A, Yudi M, Sugumar H, Ramchand J, Han H, Picardo S, Brown L, Oqueli E, Hengel C, Sharma A, Zhu B, Ryan N, Harrison T, New G, Roberts L, Freeman M, Rowe M, Proimos G, Cheong Y, Goods C, Fernando D, Teh A, Parfrey S, Ramzy J, Koshy A, Venkataraman P, Flannery D, Hiew C, Sebastian M, Yip T, Mok M, Jaworski C, Hutchinson A, Cimenkaya C, Ngu P, Khialani B, Salehi H, Turner M, Dyson J, McDonald B, Van Den Nouwelant D, Halliburton K, Reid C, Andrianopoulos N, Brennan A, Dinh D, Yan B, Ajani A, Warren R, Eccleston D, Lefkovits J, Iyer R, Gurvitch R, Wilson W, Brooks M, Biswas S, Yeoh J. Impact of Pre-Procedural Blood Pressure on Long-Term Outcomes Following Percutaneous Coronary Intervention. J Am Coll Cardiol 2019; 73:2846-2855. [DOI: 10.1016/j.jacc.2019.03.493] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 03/06/2019] [Accepted: 03/07/2019] [Indexed: 11/28/2022]
|
29
|
Ali F, Tacey M, Lykopandis N, Colville D, Lamoureux E, Wong TY, Vangaal W, Hutchinson A, Savige J. Microvascular narrowing and BP monitoring: A single centre observational study. PLoS One 2019; 14:e0210625. [PMID: 30870422 PMCID: PMC6417722 DOI: 10.1371/journal.pone.0210625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 12/28/2018] [Indexed: 01/13/2023] Open
Abstract
Introduction Half of all hypertensive individuals have inadequately-controlled BP because monitoring methods are ineffective. This single centre study examined consecutive subjects undergoing 24 hour BP measurements for clinic and ambulatory BP levels, and for end-organ damage (retinal microvascular abnormalities and left ventricular hypertrophy, LVH, > 1.1 cm). Retinal images were graded for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a semiautomated method. Features were compared using chi-squared, Fisher’s exact or the student’s t test. Methods One hundred and thirty-one individuals (59 male, 45.0%, mean age 61.7 ± 14.5 years) were studied. Ninety-nine (76.2%) had a clinic BP ≥ 140/90 mm Hg, 84 (64.6%) had a mean awake systolic BP ≥ 135 mm Hg, 100 (76.9%) had a mean sleeping systolic BP ≥ 120 mm Hg, and 100 (76.2%) had abnormal nocturnal BP dipping patterns. Sixty-nine individuals had undergone echocardiography and 23 (33.3%) had LVH. Results All participants had a mild (88.5%) or moderate (11.5%) microvascular retinopathy. Moderate microvascular retinopathy was found in 86.7% of those with a mean awake systolic BP ≥135 mm Hg (p = 0.058) but was not associated with other abnormal BP measurements, abnormal dipping patterns or LVH. However retinal arteriole calibre was reduced in subjects with a mean 24 hour awake systolic BP ≥ 135 mm Hg (p = 0.05). Retinal arteriole calibre was smaller in subjects with LVH (128.1 ± 13.5 μm compared with 137.6 ± 14.1 μm in normals, p = 0.014). Venular calibre was also less in subjects with LVH (185.4 ± 24.6 μm compared with 203.0 ± 27.2 μm in normals, p = 0.016). Arteriole narrowing predicted an increased risk of LVH (AUC 0.69, 95%CI 0.55 to 0.83) that was comparable with 24 hour systolic BP ≥130 mm Hg (AUC 0.68, 95%CI 0.53 to 0.82) and mean awake systolic BP ≥135 mm Hg (AUC 0.68, 95%CI 0.54 to 0.83). Conclusions This study suggests that retinal arteriole narrowing may be equally accurate in predicting LVH as any clinic or ambulatory BP measurement. The convenience and accuracy of microvascular calibre measurement mean that it should be investigated further for a role in routine hypertension assessment and monitoring.
Collapse
Affiliation(s)
- Fariya Ali
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Mark Tacey
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Nick Lykopandis
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Deb Colville
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Ecosse Lamoureux
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - Tien Y. Wong
- Centre for Eye Research Australia, The Royal Victorian Eye and Ear Hospital, East Melbourne, Victoria, Australia
| | - William Vangaal
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- Department of Cardiology, Northern Health, Epping, Victoria, Australia
| | - Anastasia Hutchinson
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
| | - Judy Savige
- The University of Melbourne Department of Medicine, Northern Health, Epping, Victoria, Australia
- * E-mail:
| |
Collapse
|
30
|
Omair M, Dinh D, Brennan A, Farouque O, Duffy S, Ajani A, Reid C, Oqueli E, Hutchinson A, Andrianopoulos N, Koshy A, Yudi M, Clark D. Impact of Single-Vessel vs Multi-vessel CAD on Long-Term Mortality in Patients with Diabetes Mellitus Undergoing PCI. Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
31
|
Ewers R, Bloomer M, Hutchinson A. An Exploration of the Usability of Two Delirium Screening Tools in Epworth Richmond ICU: A Pilot Study. Aust Crit Care 2019. [DOI: 10.1016/j.aucc.2018.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
32
|
Livingston A, Brooks L, Orford N, Lamb-Jenkins J, Hutchinson A. Excessive Supplemental Oxygen Delivery to Mechanically Ventilated Patients is Based on Unit Culture. Aust Crit Care 2019. [DOI: 10.1016/j.aucc.2018.11.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
33
|
Sungkar Y, Considine J, Hutchinson A. Implementation of guidelines for sepsis management in emergency departments: A systematic review. Australas Emerg Care 2018; 21:111-120. [DOI: 10.1016/j.auec.2018.10.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 09/28/2018] [Accepted: 10/07/2018] [Indexed: 10/27/2022]
|
34
|
McKenna K, Hutchinson A, Butler M. An exploration of the risk factors for developing deep wound infection after joint replacement surgery. Infect Dis Health 2018. [DOI: 10.1016/j.idh.2018.09.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
35
|
Bloomer M, Botti M, Hutchinson A. ISQUA18-1667An Investigation of the Quality of End-Of-Life Care Provision for Older People in a Subacute Care. Int J Qual Health Care 2018. [DOI: 10.1093/intqhc/mzy167.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M Bloomer
- School of Nursing and Midwifery
- Centre for Quality and Patient Safety Research, Deakin University, Geelong
- Epworth Deakin Centre for Clinical Nursing Research, Epworth Healthcare, Richmond
- Centre for Nursing Research, Deakin University and Monash Health, Monash Health, Clayton, Australia
| | - M Botti
- School of Nursing and Midwifery
- Centre for Quality and Patient Safety Research, Deakin University, Geelong
- Epworth Deakin Centre for Clinical Nursing Research, Epworth Healthcare, Richmond
| | - A Hutchinson
- School of Nursing and Midwifery
- Centre for Quality and Patient Safety Research, Deakin University, Geelong
- Centre for Nursing Research, Deakin University and Monash Health, Monash Health, Clayton, Australia
| |
Collapse
|
36
|
Mohammed Iddrisu S, Considine J, Hutchinson A. Frequency, nature and timing of clinical deterioration in the early postoperative period. J Clin Nurs 2018; 27:3544-3553. [DOI: 10.1111/jocn.14611] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 06/01/2018] [Accepted: 06/25/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Suad Mohammed Iddrisu
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Intensive Care Unit; The Northern Hospital; Epping Vic. Australia
- Intensive Care Unit; Box Hill Hospital; Box Hill Vic. Australia
| | - Julie Considine
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research; Eastern Health Partnership; Deakin University; Box Hill Vic. Australia
| | - Anastasia Hutchinson
- School of Nursing and Midwifery; Deakin University; Geelong Vic. Australia
- Centre for Quality and Patient Safety Research; Epworth HealthCare Partnership Health Partnership and Northern Health Partnership; Deakin University; Box Hill Vic. Australia
| |
Collapse
|
37
|
Cheng L, Barlis P, Gibson J, Colville D, Hutchinson A, Gleeson G, Lamoureux E, VanGaal W, Savige J. Microvascular retinopathy and angiographically-demonstrated coronary artery disease: A cross-sectional, observational study. PLoS One 2018; 13:e0192350. [PMID: 29738542 PMCID: PMC5940193 DOI: 10.1371/journal.pone.0192350] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 01/22/2018] [Indexed: 11/24/2022] Open
Abstract
Epidemiological studies suggest retinal microvascular abnormalities predict cardiac events. This study examined microvascular features associated with coronary artery abnormalities. This was a single-centre, cross-sectional, observational study of 144 consecutive subjects undergoing coronary angiography for clinical indications. Their angiograms were deidentified and graded for disease (Leaman score, LAD stenosis ≥ 70%, number of vessels stenosed ≥ 70%), and Thrombolysis in Myocardial Infarction (TIMI) blush score. Subjects also underwent retinal photography (KOWA non-mydriatic camera, Japan), and their deidentified retinal images were graded for hypertensive microvascular retinopathy (Wong and Mitchell classification), vessel calibre using a computer-assisted method (IVAN, U Wisconsin), and diabetic retinopathy (modified Airlie House scheme) independently by a trained grader and an ophthalmologist. Retinal abnormalities were compared between subjects with high and low angiography scores using one way ANOVA, Chi squared and logistic regression analysis (StataCorp, Texas). Subjects had a mean age of 61 years (range 32–88), and included 101 males (70%). Seventeen (12%) had Leaman scores > 10.5, 46 (32%) had LAD stenosis, 13 (9%) had ≥ 3 arteries stenosed, and 20 (14%) had TIMI blush scores < 1. Twenty-six subjects (18%) had a retinal hemorrhage, and 115 (74%) a mild or moderate hypertensive retinopathy. Fifty-five (38%) had diabetes, and 24 (17%) a background (n = 20) or proliferative (n = 4) diabetic retinopathy. A retinal hemorrhage (p = 0.046), moderate microvascular retinopathy (p = 0.08) and proliferative diabetic retinopathy (p = 0.04) were all associated with a higher Leaman score. Venular calibre was increased with triple vessel disease (205.7 ± 21.6 μm, and 193.7 ± 22.3 μm in normals, p = 0.03). Diabetic retinopathy correlated with an increased TIMI blush score (p = 0.01). Retinal microvascular imaging warrants further evaluation in identifying the presence, extent and nature of coronary artery disease.
Collapse
Affiliation(s)
- Lisa Cheng
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Peter Barlis
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Joel Gibson
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Deb Colville
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Anastasia Hutchinson
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
| | - Geoff Gleeson
- Department of Cardiology, Northern Health, Melbourne, Australia
| | - Ecosse Lamoureux
- Singapore Eye Research Institute, National University of Singapore, Singapore, Singapore
| | - William VanGaal
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
- Department of Cardiology, Northern Health, Melbourne, Australia
| | - Judy Savige
- The University of Melbourne, Department of Medicine, Northern Health, Melbourne, Australia
- The University of Melbourne Department of Medicine, Melbourne Health, Melbourne, Australia
- * E-mail:
| |
Collapse
|
38
|
Hutchinson A, Rees S, Young A, Maraveyas A, Date K, Johnson M. Patient and carer experience of oral and injected anticoagulation for cancer-associated thrombosis: select-d trial qualitative sub-study. Thromb Res 2018. [DOI: 10.1016/j.thromres.2018.02.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
39
|
Abstract
In a paper communicated to this Society in March, 1903, it was shown that antimonite is fairly transparent to radiations of long wave-length and that its behaviour between crossed nicols is consistent with orthorhombic symmetry. At the same time it was pointed out that it would be of interest to determine the wave-lengths of the radiations transmitted and the principal indices of refraction of antimonlte for these radiations. On undertaking this investigation it was soon found that antimonite was quite sufficiently transparent to the rays at the extreme red end of the visible spectrum to enable visual observations to, be made, and in a verbal communication to the Society on March 22, 1904, it was stated that the indices of refraction for red light were 4.129 for rays vibrating parallel to the axis Z and 3.873 for rays vibrating parallel to the axis X.
Collapse
|
40
|
Jedwab R, Redley B, Hutchinson A. Magnesium sulphate replacement therapy in cardiac surgery patients: A systematic review. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
|
41
|
Ciampoli N, Bouchoucha S, Currey J, Hutchinson A. Evaluation of current practice for the prevention of ventilator associated pneumonia in four Australian intensive care units. Aust Crit Care 2018. [DOI: 10.1016/j.aucc.2017.12.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
42
|
Hutchinson A, Tiplady S, Tullo E. THE VALUE OF INTERPROFESSIONAL FEEDBACK AS PART OF A PRE-REGISTRATION MODULE IN GERIATRIC NURSING. Innov Aging 2017. [DOI: 10.1093/geroni/igx004.5059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - S. Tiplady
- Northumbria University, Newcastle, United Kingdom,
| | - E. Tullo
- University of Newcastle, Newcastle, United Kingdom
| |
Collapse
|
43
|
Martin RS, Hayes BJ, Hutchinson A, Yates P, Lim WK. Implementation of 'Goals of Patient Care' medical treatment orders in residential aged care facilities: protocol for a randomised controlled trial. BMJ Open 2017; 7:e013909. [PMID: 28283490 PMCID: PMC5353337 DOI: 10.1136/bmjopen-2016-013909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Systematic reviews demonstrate that advance care planning (ACP) has many positive effects for residents of aged care facilities, including decreased hospitalisation. The proposed Residential Aged Care Facility (RACF) 'Goals of Patient Care' (GOPC) form incorporates a resident's prior advance care plan into medical treatment orders. Where none exists, it captures residents' preferences. This documentation helps guide healthcare decisions made at times of acute clinical deterioration. METHODS AND ANALYSIS This is a mixed methods study. An unblinded cluster randomised controlled trial is proposed in three pairs of RACFs. In the intervention arm, GOPC forms will be completed by a doctor incorporating advance care plans or wishes. In the control arm, residents will have usual care which may include an advance care plan. The primary hypothesis is that the GOPC form is superior to standard ACP alone and will lead to decreased hospitalisation due to clearer documentation of residents' medical treatment plans. The primary outcome will be an analysis of the effect of the GOPC medical treatment orders on emergency department attendances and hospital admissions at 6 months. Secondary outcome measurements will include change in hospitalisation rates at 3 and 12 months, length of stay and external mortality rates among others. Qualitative interviews, 12 months post GOPC implementation, will be used for process evaluation of the GOPC and to evaluate staff perceptions of the form's usefulness for improving communication and medical decision-making at a time of deterioration. DISSEMINATION The results will be disseminated in peer review journals and research conferences. This robust randomised controlled trial will provide high-quality data about the influence of medical treatment orders that incorporate ACP or preferences adding to the current gap in knowledge and evidence in this area. TRIAL REGISTRATION NUMBER ACTRN12615000298516, Results.
Collapse
Affiliation(s)
- Ruth S Martin
- Northern Health, Epping, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | | | - Anastasia Hutchinson
- Northern Health, Epping, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Paul Yates
- University of Melbourne, Melbourne, Victoria, Australia
- Austin Health, Heidelberg, Victoria, Australia
| | - Wen Kwang Lim
- Northern Health, Epping, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
- Melbourne Health, Melbourne, Victoria, Australia
| |
Collapse
|
44
|
Cooper E, Sheikh Z, Townend W, Johnson M, Hutchinson A. PALLIATIVE CARE IN THE EMERGENCY DEPARTMENT: A SYSTEMATIC REVIEW. Arch Emerg Med 2016. [DOI: 10.1136/emermed-2016-206402.38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
45
|
Martin R, Hayes B, Hutchinson A, Yates P, Lim WK. 135IMPLEMENTATION OF “GOALS OF PATIENT CARE” MEDICAL TREATMENT ORDERS IN RESIDENTIAL AGED CARE FACILITIES: A RANDOMISED CONTROLLED TRIAL. Age Ageing 2016. [DOI: 10.1093/ageing/afw159.26] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
46
|
Chew SKH, Colville D, Canty P, Hutchinson A, Wong A, Luong V, Wong TY, McDonald C, Savige J. Hypertensive/Microvascular Disease and COPD: a Case Control Study. Kidney Blood Press Res 2016; 41:29-39. [DOI: 10.1159/000368544] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/17/2015] [Indexed: 11/19/2022] Open
|
47
|
Ooi QL, Tow FKNFH, Deva R, Kawasaki R, Wong TY, Colville D, Ierino F, Hutchinson A, Savige J. Microvascular Disease After Renal Transplantation. Kidney Blood Press Res 2015; 40:575-83. [DOI: 10.1159/000368533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/19/2022] Open
|
48
|
|
49
|
Hutchinson A. XXIX. Die chemische Zusammensetzung des Lengenbachits. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1907.43.1.465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
50
|
Hutchinson A. XXVIII. Die optischen Eigenschaften des Antiinonits. Z KRIST-CRYST MATER 2015. [DOI: 10.1524/zkri.1907.43.1.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|