Conectar
Recognising and acting on the connection to Country as a determinant of Indigenous peoples’ well-being is necessary to improve health inequities. Indigenous Australians experience a greater burden of chronic liver disease and poorer outcomes due to ongoing impacts of colonisation across determinants of health. This is exacerbated by a gradient in health outcomes based on remoteness, lack of specialist healthcare services and barriers to access. Our research aims to explore better ways to provide chronic liver disease screening and surveillance for very remote Indigenous Australian communities using non-invasive technologies On-Country.
Using an innovative combination of Indigenous and Quantitative research methodologies, this project involves 11 communities across four very remote sites in South Australia and Western Australia. The study comprises three parts: (1) site engagement with Aboriginal health services and remote communities; (2) a 12-month liver check (screening) phase and (3) a 24-month liver monitoring (surveillance) phase. The liver monitoring phase will use a stepped-wedge randomised controlled trial design where sites will have usual hepatocellular carcinoma (HCC) monitoring for a period of between 6 and 18 months and then On-Country monitoring for a period of between 6 and 18 months depending on treatment-sequence allocation. Recommended HCC monitoring involves 6 monthly liver ultrasounds and serum alpha-fetoprotein as per the site’s usual care processes, where participants travel to regional centres for liver ultrasound. On-Country monitoring will involve liver ultrasound and serum tumour markers provided On-Country every 6 months. The primary outcome is the difference in adherence to surveillance On-Country compared with usual care. In addition to statistical and health economic methods, yarning circles have been incorporated to explore participant experiences, their knowledge of liver disease and views about the On-Country monitoring.
This study was granted ethics approval from the relevant national and state Aboriginal Health Research Ethics Committees. Findings will be reported to all participants and will be disseminated to the broader community and local health services. Translation of outcomes will be supported by key Indigenous Australian and healthcare stakeholders, including peak health bodies and consumer groups. Dissemination with the academic community will be through peer-reviewed publications and presentations at relevant conferences.
ACTRN12625000256471.
The purpose of this study is to compare health outcomes and flourishing between children (age 6–17) whose mothers experience high versus low exposure to post-separation abuse and coercive control (PSA).
Exploratory sequential mixed-methods study.
Cross-sectional survey with community-based, convenience sample of family court-involved mothers in the United States (N = 497). Independent variable measured by subscales of the Healthcare, Economic, and Legal PSA and Coercive Tactics Scale (HELP-T). Health outcomes measured by items from National Survey of Children's Health.
Children whose mothers experience more frequent PSA face a dual burden: increased odds of unmet mental health needs coupled with increased odds of mental health diagnoses, somatic symptoms and special health care needs. Children in the high-exposure Healthcare PSA group were twice as likely (aOR: 2.01, p-value < 0.001, 95% CI: 1.4–2.9) to report stomach/intestinal problems, 2.3 times more likely (p-value < 0.001, 95% CI: 1.5–3.4) to report chronic pain including headaches in the last 12 months, 2.13 times more likely (p-value < 0.001, 95% CI: 1.4–3.8) to have ever received a diagnosis of anxiety and 2.72 times (p-value < 0.001, 95% CI: 1.60–4.63) more likely to have unmet mental health needs as compared to children in the low-exposure group.
The findings from this study advance the growing body of evidence on how co-parent perpetrated PSA and coercive control harm children's health and access to healthcare.
This study is the first to our knowledge to demonstrate the association between maternal exposure to co-parent perpetrated PSA and children's health outcomes, establishing a foundation for future intervention work to improve children's health and access to health care.
Members of the public were involved in recruitment and cognitive interviewing.
Commentary on: Petty J, Harding C, Whiting L. Investigating parental perspectives of the enablers and barriers to communication with their preterm infants: A narrative study. J Child Health Care. 2024;0(0). doi:10.1177/13674935241302437
Implications for practice and research Healthcare professionals play an important role in educating parents on the significant impact that communication and interaction have on their preterm infant’s speech, language and communication development. Additional research and guidance are required to cultivate ways to support linguistic skills and communication through parent–infant interaction.
Infants born preterm have a higher risk of developing speech, language and social behaviour problems and conditions.
Rising demand for emergency care in England is a continuing challenge driven by population ageing and increasing multimorbidity. Ambulatory emergency care (AEC) refers to the provision of same-day acute care for patients who might otherwise require admission. However, the contribution of AEC conditions to demand remains unclear. This study aimed to examine the proportion and nature of patients attending emergency departments (ED) with AEC-related conditions and to describe variation between hospitals in attendances and emergency admissions for AEC conditions.
A retrospective study of routine data from 21 acute hospitals in England, including adult ED attendances and emergency admissions between 1 November 2021 and 31 October 2022. We used a federated approach to ensure data security, applying established AEC definitions to explore variation by age, socioeconomic status and length of stay.
Primary: Proportion of (i) ED attendances and (ii) emergency admissions for AEC conditions. Secondary: (i) Proportion of patients presenting at ED with an AEC condition who were admitted; (ii) proportion of emergency admissions with an AEC condition with a length of stay
We analysed 1 513 480 attendances (median per hospital: 73 125) and 660 105 admissions (median per hospital: 30 425). AEC accounted for 29.6% of attendances and 40.8% of admissions, with substantial inter-hospital variability. Patients aged ≥65 were more likely to present with an AEC, while patients from deprived areas had lower rates. Among AEC-related admissions, 49.3% had a stay of less than 2 days.
Nearly one-third of attendances and two-fifths of admissions were for conditions potentially manageable in AEC or community settings. Variation between hospitals suggests local factors, including service configuration and primary care access, may influence avoidable acute care use. These findings suggest a need for a more nuanced understanding of the drivers behind AEC, or SDEC Services, to better understand their impact on reducing hospital admissions. Analysing these patterns may inform interventions to reduce avoidable hospital utilisation. Further research is needed to identify drivers of variation and to develop scalable strategies for prevention.
Any tool that can reduce the administrative burden on healthcare providers while preserving safe, accountable and high-quality medical documentation is of immense value both to healthcare institutions and consumers. The key question we need to answer is whether a prospective tool can reduce these burdens while maintaining (and, ideally elevating) quality documentation standards. The goal of this study is to describe the local performance of a large language model-based documentation assistive tool to draft safe, high-quality documentation in the Child Development Unit at the Women’s and Children’s Hospital. By generating local evidence of performance, we can assess the suitability of the artificial intelligence (AI) Scribe and inform a larger interventional study protocol and establish evidence-based governance.
Using an algorithmic audit framework developed specific to our context, we will compare clinician-written clinical notes to AI-generated notes produced in parallel to the standard of care (ie, a ‘silent’ or translational trial paradigm). We will compare the time required to review clinical documentation per the standard of care compared with the AI-supported workflow with consideration to the accuracy of the final documentation. Finally, we will qualitatively describe AI-generated notes and compare them to the current standard to identify specific areas where clinical guidelines (eg, performance information, risk mitigation) would support appropriate clinical use.
Ethics approval has been obtained by the Women’s and Children’s Health Network Human Research Ethics Committee (HREC) (HRE00067) and the South Australian Aboriginal HREC (#04-25-1185). This protocol offers an accessible example for health institutions looking to apply an evidence-based approach to AI Scribe assessment that prioritises clinical documentation standards. We will publish our study results in an academic journal and include a publicly accessible summary for the general public on the Women’s and Children’s website.
10.17605/OSF.IO/P6TM5.
To date, there is no proven licensed systemic treatment for neurofibromatosis type 2 (NF2)-related schwannomatosis patients. There is a need for more effective, less toxic treatments and, as a rare disease, NF2 is often overlooked in targeted drug development. Subcutaneous schwannomas of the skin (CS) are common in the NF2 population.
This trial involves the repurposing of medications already licensed for HIV—ritonavir and lopinavir (Kaletra and Norvir)—that have been shown to reduce tumour growth by reducing cell proliferation in human schwannoma and meningioma tumour cell cultures. The safety and tolerability of these drugs are already known, so they are safe candidates to trial in NF2 patients.
This trial is an open-label, phase 0 design. A maximum of 16 participants diagnosed with NF2-related schwannomatosis will be enrolled in this study. Treatment duration is 30 days, with a 30-day follow-up. Biopsies and blood samples will be collected to assess whether the drugs reach the tumours and to analyse the tumour-cell response. The primary outcome is pharmacodynamic response, defined as a statistically significant decrease in biomarker activity in CS biopsy samples at day 30. The sample size calculation is based on the tissue biomarker response.
The study was approved by an Ethics Committee (West of Scotland Research Ethics Service (23/WS/0178)), the Health Research Authority (HRA), the Medicines and Healthcare products Regulatory Authority (MHRA) and each of the participating NHS Trust’s Research and Development departments. Following analysis of trial data, the trial results will be written up for publication in a peer-reviewed scientific journal and will be disseminated at conferences.
To evaluate the effectiveness of simulation on nursing students' translation into practice of clinical judgement, knowledge about the nursing process self-confidence and to comprehend the learning process and translation into clinical practice of competencies developed through clinical simulation in nursing students.
Two-arm, experimental, randomized controlled study designed using the explanatory sequential mixed method with qualitative step anchored in grounded theory.
Eighty undergraduate nursing students were allocated in practice groups and the groups were randomly assigned to an experimental (simulation; n = 39) or control group (study case; n = 41) and, after the intervention, participated in 3-day clinical practice activities and were assessed regarding clinical judgement, knowledge of the nursing process and self-confidence. Students in the experimental group were invited to focus groups.
Seventy-six students were analysed. The findings showed the effectiveness of simulation combined with clinical practice in the development and translation of clinical judgement (β = 5.03; p = 0.001) and knowledge of nursing process (β = 2.20; p < 0.001). There was no difference regarding self-confidence. A grounded theory emerged with three categories related to consolidation of prior knowledge, translating competencies into clinical practice and application of these competencies in nursing care that explain the theoretical category ‘learning and translating into clinical practice’.
Findings suggest that simulation combined with clinical practice can effectively enhance nursing students' clinical judgement and knowledge of the nursing process, facilitating the translation of these competencies into real-world practice. The qualitative findings suggest that simulation promotes meaningful learning and supports the practical application of nursing competencies.
This study supports the integration of simulation into nursing curricula to enhance clinical judgement and nursing process competencies. By promoting meaningful learning and facilitating knowledge transfer to clinical settings, simulation prepares students for real-world decision-making and strengthens the quality and safety of nursing care delivery.
No patient or public contribution.
RBR-7v374c6 (Brazilian Clinical Trials Registry) https://ensaiosclinicos.gov.br/rg/RBR-7v374c6
Tinnitus is the perception of sound without an external source, often considered a phantom percept similar to phantom limb sensations, resulting from maladaptive plasticity in the brain. The condition lacks an established biomarker for diagnosis but recent studies have linked it to neural changes. The Tinnitus Detection consortium aims to identify and validate potential biomarkers for tinnitus presence and intensity.
This multicentre prospective case–control study will recruit 560 adults (280 chronic tinnitus; 280 controls). Participants will complete standardised audiological and questionnaire assessments and then undergo 64-channel electroencephalography (and magnetoencephalography at one site) to record event-related potentials during (1) a cortical gap prepulse inhibition of the acoustic startle (GPIAS) paradigm assessing gap-related inhibition of the N1 response and (2) an omission auditory oddball paradigm quantifying mismatch negativity and P300 as candidate biomarkers of tinnitus presence and loudness.
The identification of a biomarker for tinnitus is crucial for developing personalised diagnosis and treatment: There is a need for updated guidelines and more effective tinnitus treatments, as existing interventions often rely on subjective measures. The success of biomarkers like GPIAS and oddball paradigms could significantly improve the reliability of tinnitus diagnosis and treatment, marking a transformative step in the field.
Long COVID is a complex, multisystem chronic condition that may persist or fluctuate for months to years after SARS-CoV-2 infection. Despite emerging international research, significant gaps remain in understanding the full breadth of long COVID’s impacts in Australia. No study has yet prospectively examined these multidimensional impacts using a culturally appropriate, user-validated toolkit. Our study aims to characterise symptom profiles, functional outcomes and psychological, social, financial and behavioural impacts of long COVID in Australian adults; identify factors associated with recovery trajectories; and validate a set of measures to support research and clinical care.
This national, multi-site, longitudinal prospective cohort study comprises three phases: (1) survey selection and user-testing; (2) psychometric validation; and (3) a longitudinal cohort study. Survey selection was informed by literature review, Australian parliament inquiry reports and international recommendations, and refined through iterative user-testing and expert review. A total of 1000 participants aged ≥18 years from diverse cultural backgrounds with ongoing symptoms following COVID-19 infection will be divided into three cohorts based on time since infection. Surveys will be administered at seven time points over 24 months, with optional follow-up to 36 months. Data linkage to state and national health datasets will enable an objective assessment of healthcare utilisation and associated costs. Psychometric properties of the tools will be evaluated using baseline responses from the initial 300 participants, including assessments of structural/construct validity, convergent validity, known-groups validity, cross-validity, internal reliability, responsiveness and test–retest reliability. Other data analyses will include descriptive statistics, repeated-measures analysis of variance, linear mixed-effects modelling and multivariable regression models.
Ethics approval was obtained from The St Vincent’s Hospital Melbourne Human Research Ethics Committee (HREC) (112108/2024/PID00364) and RMIT University HREC (28124). Research findings will be disseminated at conferences and in peer-reviewed publications.
Australian New Zealand Clinical Trials Registry (ACTRN12625001415493).
A comprehensive skincare regimen involves cleansing, moisturising, and using skin barrier protectants. Cyanoacrylate-based protectants safeguard vulnerable skin from damage caused by moisture, friction, and shear. This research involved two ex vivo and two clinical studies comparing the wear duration and wash-off resistance of a 100% cyanoacrylate and a solvent-cyanoacrylate mixture. Effectiveness was assessed using an ex vivo porcine skin model simulating urinary incontinence, evaluated with Lucifer yellow dye penetration and Corneometry, and a clinical model using Corneometry. Two single-blind clinical studies measured skin surface electrical capacitance in healthy volunteers. Study 1 (n = 42) evaluated the wear duration over 8 days, while Study 2 (n = 52) examined wash-off resistance after nine washes with various cleansers. Ex vivo results showed that both products were effective under repeated moisture and abrasion conditions, with the 100% cyanoacrylate outperforming the solvent-cyanoacrylate mixture. In clinical studies, both products maintained barrier protection throughout Study 1 (p < 0.007) and none of the cleansers significantly degraded either product in Study 2. In conclusion, the 100% cyanoacrylate provided superior protection compared to the solvent-cyanoacrylate mixture. Both products demonstrated comparable wear duration and wash-off resistance in clinical studies, but the 100% cyanoacrylate was more effective in ex vivo testing under harsh conditions.
This qualitative study aimed to identify nurses' and allied health professionals' perceptions and experiences of providing hospital-acquired pressure injury (HAPI) prevention in a paediatric tertiary hospital in Australia, as well as understand the perceived barriers and facilitators to preventing HAPI.
A qualitative, exploratory study of hospital professionals was undertaken using semi-structured interviews between February 2022 and January 2023.
Two frameworks, the Capability, Opportunity and Motivation Model of Behaviour (COM-B) and the Theoretical Domains Framework (TDF), were used to give both theoretical and pragmatic guidance. Participants included 19 nursing and allied health professionals and data analysis was informed by the framework approach.
Analysis revealed nine core themes regarding professionals' beliefs about the barriers and facilitators to HAPI prevention practices across seven TDF domains. Themes included HAPI prevention skills and education, family-centred care, automated feedback and prompts, allocation and access to equipment, everybody's responsibility, prioritizing patients and clinical demands, organizational expectations and support, integrating theory and reality in practice and emotional influence.
These findings provide valuable insights into the barriers and facilitators that impact paediatric HAPI prevention and can help identify and implement strategies to enhance evidence-based prevention care and prevent HAPI in paediatric settings.
Overcoming barriers through evidence-based interventions is essential to reduce HAPI cases, improve patient outcomes, and cut healthcare costs. The findings have practical implications, informing policy and practice for improved preventive measures, education, and staffing in paediatric care, ultimately benefiting patient well-being and reducing HAPIs.
No patient or public contribution. The focus of the study is on healthcare professionals and their perspectives and experiences in preventing HAPIs in paediatric patients. Therefore, the involvement of patients or the public was not deemed necessary for achieving the specific research objectives.
FreshRSS 