Conectar
To examine practice nurse knowledge, attitudes, and practices about medication abortion in Australia.
Cross-sectional survey.
A national online survey was conducted from July to December 2021. Nurses working in general practice were recruited using convenience sampling. Data collected included demographics, knowledge, attitudes, and practices in abortion care. Analyses used included descriptive statistics and Poisson regression.
From 489 responses, knowledge about medication abortion, its provision, and efficacy was low. Although many respondents felt it was acceptable to assist in medication abortion, few indicated involvement. Those with advanced qualifications had greater perceived knowledge of abortion counselling. Respondent involvement in medication abortion was more likely if they had worked in general practice for a long time, their primary place of work was outside of general practice, or had advanced nursing qualifications.
Given their role in the community, there is an opportunity to better utilise practice nurses for abortion care. Incorporation of abortion into the nursing curriculum and routine practice, including supportive funding mechanisms for care, is needed.
Low knowledge and a lack of practice nurses providing abortion services adversely impact patient access.
Practice nurse provision of medication abortion has not yet been optimised. While practice nurses reported acceptability to provide abortion care, this could be enhanced with funding, education, and service normalisation. These results will inform policy makers, educators, patients, general practices, and nurses to support patient access to abortion care. Incorporating abortion care into nursing curriculum and practice will support women's access to these services.
CHERRIES guideline.
Professional groups, family planning organisations, industry, and government grant partners supported the study's recruitment.
ACTRN12622000655741
by Takashi Kitagataya, Anuradha Krishnan, Kirsta E. Olson, Florencia Gutierrez, Michelle Baez-Faria, Maria Eugenia Guicciardi, Kevin D. Pavelko, Adiba I. Azad, Gregory J. Gores
AimThe underlying mechanisms contributing to cholestatic liver injury remain unclear. The pro-inflammatory leukocyte-restricted cytokine interleukin-17A (IL-17A) has been implicated in human cholestatic liver injury. However, mechanistic insights are lacking and require further exploration in preclinical models. Herein, we examined the effect of IL-17A genetic ablation in a mouse model of cholestatic liver injury.
MethodAge and gender-matched littermate wild type (WT) and Il-17a-/- C57BL/6 mice were fed an intermittent 0.1% 3,5-diethoxycarbonyl-1,4-dihydrocollidine (DDC) diet for 21 days to induce cholestatic liver injury or a control diet.
ResultsAs compared to WT littermates, Il-17a-/- mice displayed more abundant desmin-positive myofibroblasts and increased fibrosis. NanoString analysis of intrahepatic leukocyte populations using a fibrosis-related gene panel identified upregulation of Tnfsf14 (encoding the protein LIGHT) in the DDC-fed Il-17a-/- mice. Although mass cytometry identified an increase in myeloid cells in both genotypes of the DDC-fed mice, we could not identify LIGHT expression in this cell lineage. Instead, the upregulation of LIGHT expression was largely restricted to a CD4+ T cell population as assessed by flow cytometry. Enhanced LIGHT expression was observed in a Th1+ CD4+ T cell population. LIGHT activated primary human hepatic stellate cells in vitro, suggesting that LIGHT stimulation of hepatic fibrogenesis may be direct.
ConclusionTaken together, these data suggest that IL-17A restrains expression of the profibrogenic cytokine, LIGHT, by Th1-polarized CD4+ T cells, and implicate a role for LIGHT in cholestatic fibrogenesis in DDC-fed mice; a finding which requires validation in additional models.
To describe practice nurse long-acting reversible contraception (LARC) knowledge and practices.
Cross-sectional survey.
Between July and December 2021, we conducted an online survey using convenience sampling to recruit Australian nurses who work in primary care, known as practice nurses. We collected data about demographics and knowledge and practices relating to LARC. Analysis used descriptive statistics and Poisson regression.
From 489 eligible responses, most respondents were women and the majority worked in metropolitan practices. Most (90.4%) believed that their advice could influence women's contraceptive choices. Few inserted/removed intrauterine devices (IUDs) (11.2%) or implants (15.9%). Of those that did insert LARC, most did so one to five times in the last month (IUDs 72.2%; implants 73.6%). General practice as a primary place of work was negatively associated with implant provision. Respondents with more general practice experience (≥ 15 years) and/or higher qualifications were more likely to respond correctly to knowledge questions and provide IUDs or implants. Most (62.8%) correctly identified IUD suitability for nulliparous women.
Practice nurses have knowledge gaps and limited practice opportunities for LARC provision.
Practice nurses need supportive funding policies and ongoing education and skills development to enhance patient access to LARC and their choice of provider.
CHERRIES guideline.
Partner organisations assisted with the study's recruitment.
ACTRN12622000655741
To investigate clinicians' perspectives on the transition from hospital to home and identify gaps in care for older adults living with frailty during the transfer of care.
Qualitative reflexive thematic analysis of focus groups
Focus groups were conducted with clinicians using purposive sampling. Participants were eligible if they had provided or overseen the clinical care of a patient transferring from hospital to home. Verbatim transcripts were analysed, and themes were identified using NVivo through the development of codes and exploration of core commonalities.
A total of 28 clinicians participated in five focus groups. Participants included nurses (n = 14), allied health (n = 8), medical officers (n = 2), managers and hospital executives (n = 4). Themes were categorised into four domains: (1) system fragmentation and finite resources challenge healthcare navigation for everyone; (2) the interplay of cultural and societal considerations in the context of ageing; (3) fragile cycle of care for older patients who frequent hospitalisation; and (4) effective communication and expertise being critical for quality care.
Despite decades of research, the transition from hospital to home for older adults living with frailty remains a persistent challenge. This study identified significant and continued unmet needs in navigating a complex health system, underscoring the evidence-practice gap in transitional care services. Results have informed the development and implementation of a feasibility study (TRANSFER-II), currently underway, that tests the feasibility of a nurse-coordinated model of transitional care support for older adults.
Transfers from hospital to home, frequent readmissions and transitions in care are common for older adults living with frailty. Understanding the enablers and barriers in transitional care for this vulnerable population can enhance the quality of care, improve communication and inform the development of more effective transitional care models. The findings underline the critical role nurses play in addressing systemic gaps and improving continuity of care for older adults across diverse health systems.
Transitional care is complex, and older populations are more at risk of returning to hospital. Findings highlight the significant unmet needs in navigating a complex health system and revealed the fragile cycle of care for older adults who frequent hospital. Reiterating the importance of effective communication and clinical expertise in delivering safe patient-centred nursing care.
This qualitative study was reported in accordance with the consolidated criteria for reporting qualitative research (COREQ) checklist.
Patients and carers contributed to the design of this qualitative study through consultation with a consumer advisory group, where potential transitional care interventions were discussed. These discussions highlighted a need to further explore transitional care unmet needs, informing the development of this focus group study.
Chinese-speaking immigrants in Australia have a higher risk of type 2 diabetes and face more barriers to accessing quality healthcare compared to non-culturally and linguistically diverse populations. This study aimed to explore the self-management experiences of Chinese-speaking Australians with self-reported lived experience of prediabetes following immigration.
Qualitative study.
Semi-structured interviews were conducted with 10 purposively selected Australian Chinese-speaking immigrants aged over 40 years. Data collection was undertaken in Perth, Western Australia between April and August 2024. Data were analysed using reflexive thematic analysis.
Three themes are presented in this paper: (1) An acculturation journey: Reshaping cultural identity and social connections in immigrant lives, (2) Embodying prediabetes: Cognitive reconstruction and emotional adaptation in the transition to the patient role and (3) Decision-behaviour dynamics: Mapping agency and adaptiveness in self-management processes. Participants demonstrated dynamic adjustment through the processes of self-awareness, adaptive behaviours, self-reflection and self-attribution of health outcomes.
Chinese-speaking Australians navigating prediabetes following immigration underwent a complex process of reconstruction across cognitive, cultural and psychological domains. Prediabetes self-management was shaped by cultural values, acculturation, dietary preferences, emotional resilience, local and distant social networks and resource availability. These findings underscore the importance of empowering both individuals and communities through evidence-based and culturally appropriate strategies.
Participants experienced profound transformations in their cultural adaptation, prediabetes cognition, social support networks and emotional–psychological landscape. Future interventions must address identified barriers (e.g., cooking burden, comorbidities, stress), facilitators (e.g., leisure travel, family support), motivations (e.g., cultural heritage, health risk perception) and challenges (e.g., knowledge–behaviour gap, digital health information) that shape self-management behaviours. A community empowerment approach, utilising evidence-based content, flexible delivery formats and existing cultural networks, should be adopted to offer promising pathways for prediabetes health education.
The study adhered to the Consolidated Criteria for Reporting Qualitative Research guidelines.
Limited patient and public involvement was incorporated, with two community representatives providing feedback on interview questions and recruitment strategies.
Housing First (HF) is an evidence-based approach to ending homelessness, particularly for individuals with mental illness. Yet, limited research explores which aspects of HF programmes facilitate change over time, within the context of a programme theory of change (ToC). A particular research gap includes how mechanisms of change within HF programmes differ between men and women. This study examines gender-specific pathways of change in the HF model based on secondary qualitative data from Toronto’s original At Home/Chez Soi (AH/CS) trial, focusing on outcomes of housing stability, socio-economic status, health and overall well-being.
This was a secondary qualitative analysis of the AH/CS trial data. This analysis was guided using a gender-sensitive ToC framework.
This multisector study was conducted in a large Canadian urban centre in Toronto, Canada.
A total of 32 participants (23 men and nine women) who identified themselves as male or female, 18 months after their enrolment in the treatment arm of the Toronto site of the AH/CS randomised controlled trial.
Semistructured interviews were conducted as part of the trial’s qualitative study. Thematic analysis was guided by the ToC framework and conducted using NVivo software. We assessed differences between men and women across the following outcome domains: housing stability, financial status, physical and mental health, substance use recovery and inpatient care.
The findings largely confirmed the ToC with participants, particularly women, experiencing greater improvements across all mechanisms of change, especially in housing stability, financial status and health outcomes. Men faced ongoing challenges, including difficulty maintaining stable income, limited engagement with education/training and continued struggles with mental health and substance use. Despite these improvements, both men and women participants reported ongoing challenges in achieving consistent income and accessing education or training opportunities.
This study provides insight into how mechanisms of change within HF programmes differ between men and women. It underscores the need for ongoing programme adaptation and gender-responsive evaluation to meet the diverse needs of individuals, particularly those with mental health illness and histories of chronic homelessness.
FreshRSS