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Objective: Describe the characteristics and predictors of mortality for patients who spend more than 24 h in the ED waiting for an in‐patient bed and compare baseline clinical and demographic characteristics between tertiary and non‐tertiary hospitals. Methods: This was a state‐wide analysis data linkage analysis of adult (age >16 years) ED presentations across New South Wales from 2019 to 2020. Cases were included if their mode of separation from ED indicated admission to an in‐patient unit including critical care ward and their ED length of stay was greater than or equal to 24 h. Cases were categorised by service‐related groups based on principle diagnosis. Results: A total of 26 854 eligible cases were identified. The most common diagnosis groups were psychiatry, cardiology and respiratory. The odds ratio (OR) for 30‐day all‐cause mortality in admitted patients with an ED length of stay greater than 24 h were highest in those aged >75 years (OR 15.18, 95% confidence interval [CI] 9.99–23.07, P < 0.001), oncology (OR 10.45, 95% CI 7.93–13.77, P < 0.001) and haematology patients (OR 2.95, 95% CI 2.01–4.33, P < 0.001). Conclusion: Interventions and models of care to address ED access block need to focus on mental health patients, older patients particularly those with cardiorespiratory illness and oncology and haematology patients for whom risk of mortality is disproportionately higher. [ABSTRACT FROM AUTHOR]

Purpose: Clinician experience and confidence can negatively impact pediatric feeding service availability, but limited research has investigated what training allied health professionals (AHPs) need to increase these factors. This study developed and distributed a survey investigating Australian AHPs’ self-reported confidence and anxiousness, training needs, factors impacting training access, and training preferences. Method: This study was conducted over two phases. Phase 1 involved development and refinement of the survey, and Phase 2 involved distribution to Australian AHPs. Questions pertained to general demographics, feeding experience, feeding confidence and skills perception, and training needs. The questions were composed of multiple-choice, Likert scale, and short-response options. Results: Overall, 198 complete responses were received. Participants reported significantly lower confidence and higher anxiousness working with infants compared to older children (p < .01). Increased frequency of service provision predicted higher self-reported confidence and lower anxiousness (p < .01). Practical training opportunities including case discussion, videos, and clinical feedback were preferred. Access facilitators were online, on-demand training; however, respondents reported preferring hands-on training opportunities. Common barriers included cost, time, competing professional development priorities, and distance/travel. Conclusions: Findings have highlighted that recency and frequency of practice impact self-reported confidence and anxiousness, and that AHPs self-report lowest confidence and highest anxiety working with infants compared to older age groups. Overall, the findings highlight the need for flexible, practical, and remotely accessible training opportunities, as well as the need for access to regular clinical supervision and a pediatric feeding caseload. [ABSTRACT FROM AUTHOR]

Background: Sexual and romantic satisfaction are important aspects of sexual health and wellbeing, but they have not been thoroughly investigated among transgender and gender diverse ('trans') people in Australia. Aims: To address this gap and improve sexual health and wellbeing, we assessed the sexual behavior and relationships of a national sample of trans people in Australia, and factors associated with sexual and romantic satisfaction. Methods: We conducted a national survey of trans people from Australia in October-November 2018. Results: The sample included 1,613 trans participants, of whom 353 (21.9%) were men, 397 (24.6%) were women and 863 (53.5%) were non-binary. Over 70% of the sample had been sexually active in the previous year, and 56.9% were in a relationship, but only 32.4% were satisfied with the sexual aspects and 47.1% with the romantic aspects of their lives. Sexual satisfaction was associated with younger age, being asexual, having more trans friends, more frequent sex, and using illicit drugs in the context of sexual activity. Anxiety or fear about sex was associated with less sexual satisfaction, as was being in an open relationship. Romantic satisfaction was associated with younger age, having non-binary partners, and being in a current relationship (particularly a monogamous one). Recent distress, anxiety, or fear about sex were associated with less romantic satisfaction. Conclusion: Participants reported a broad range of sexual relationships, but low levels of satisfaction with the sexual and romantic aspects of their lives. The findings underscore the importance of supportive partners, access to social support and peer networks of trans people, as well as access to mental health support and sex-positive, trans affirming counseling in sexual health services. [ABSTRACT FROM AUTHOR]

Background: In high income countries, ~30% of pregnant women are provided with intrapartum antibiotic prophylaxis (IAP) for early‐onset group B streptococcal infection (EOGBSI). The infection rate is low, 0.2/1000 livebirths in our jurisdiction, and others. We hypothesised factors, other than IAP alone, were reasons for the low rate of EOGBSI. Aims: Compliance with our local guideline, referred to here as 'the guideline'. Method: Compliance was defined as an initial dose of benzylpenicillin IAP followed by four‐hourly doses until birth. The study population was drawn from 4098 women who had 4100 pregnancies resulting in 4200 babies in an Australian birth setting from 1/1/2016 to 31/12/2016. Most, 93%, were eligible for universal GBS screening, 67% were reported as screened and 90% of these had a result documented; 23% were positive for GBS. A random sample (n = 223) was taken for further analysis. Results: The adjusted odds of receiving benzylpenicillin IAP in accord with the guideline were three times higher among primiparous compared to multiparous women (P < 0.001, odds ratio (OR) = 3.4, 95% CI 1.7–6.7) and three times higher among women experiencing induction of labour compared to women who commenced labour spontaneously (P < 0.001, OR = 3.4, 95% CI 1.8–6.3). Of the 223 women, 188 received IAP: 176 received benzylpenicillin IAP, 31% (or 24% of the total sample) received this intervention in accord with the guideline, 24% received benzylpenicillin ≥4 h before birth but not in accord with the guideline and 44% received benzylpenicillin <4 h before birth. Conclusion: We conclude that sub‐optimal compliance was largely a consequence of an unrealistic guideline. [ABSTRACT FROM AUTHOR]

Background: In 2018, World Health Organization endorsed universal use of home‐based records to improve care for mothers, pregnant women, newborns and children. New South Wales (NSW), Australia has had universal use of a child health home‐based record since 1988, with the first major update in 2013. Since the update, limitedbelief is sufficient for constituting evidence has been collected about factors influencing parent use of the record. This study aims to examine parent engagement with the record and whether it is influenced by child's first‐born status and Parent Evaluation of Development Status (PEDS) outcome. Method: A survey of 202 parent–child pairs and a review of 20 record books were conducted in NSW, Australia. Odds ratio (OR) at 95% confidence interval (CI) and.05 level of significance, bivariate and multivariate logistic regressions were conducted to examine the influence of first‐born status, child's PEDS outcome and other parent–child characteristics on parent engagement with the record. Results: Parents engaged with the home‐based record by taking it for routine checks (80.7%), writing (74.8%) or reading (75.8%) information. Parents of first‐born children were more than three times likely to take the record book for routine checks compared with parent of later‐born children (adjusted OR [AOR] = 3.70, 95% CI 1.12–12.20). Similarly, parents of children with low PEDS level of risk were significantly less likely to read information in the record book compared with parents of children with high risk (AOR = 0.28, 95% CI 0.08–0.98). Parent record input through direct observation significantly decreased from 85% at 1‐month to 60% at 12‐month postnatal. Data about at least one vaccination event were recorded in all the record books examined, while 85% had all recommended vaccinations recorded. Conclusion: Parents valued/engaged regularly with a child health home‐based record, and the record may be a useful tool for early detection and monitoring of child developmental concerns. Therefore, continued promotion of the use of child health home‐based record appears to play an important role in improving child health and development. [ABSTRACT FROM AUTHOR]

Theoretical models of victimisation emphasise the importance of context. However, few studies have assessed the influence of prison environmental variables on inmate harm in physical assaults. This study used a multilevel model approach to examine individual- and facility-level factors associated with the incidence of assaults among inmates housed at correctional centres in New South Wales, Australia. Results supported proposals that institutional routines and conditions may have an influence on risk. Inmates, who spent less time in employment, were placed in special housing arrangements such as protection, or were located in sites with higher security designations or longer routine hours out of cells were more likely to be harmed in assaults. In addition, more than 40% of variance in assaults was associated with differences across correctional centre sites. We draw on routine activities theory to explain relationships between different prison contexts, provision of guardianship, and exposure to motivated offenders in assault outcomes. [ABSTRACT FROM AUTHOR]

Objective: To describe the roles that Australian nurses play, the breadth of skills that they deploy, and the range of contexts in which they practice. Study design and methods: This cross-sectional study used a descriptive survey where data were collected online using Qualtrics©. Survey respondents were nurses whose primary role was caring for people with intellectual and developmental disability. In addition to demographic data, the main outcome measures were: nursing roles, practice and context. Results: Complete responses were collected from 101 nurses; 78 females and 22 males completed the survey, the majority of whom (n=70) were from New South Wales. The major focus of care was direct assessment and care, followed by supervision of support workers, education, and advocacy for people with intellectual and developmental disability. Physical healthcare was consistent across body systems, as it was for all adaptive behaviour domains. Support for mental illness was more likely to be for depression and anxiety. Nurses liaise with a multitude of health and social agencies as part of their nursing practice. Discussion: This is the first study to capture the roles, practice and contexts of these Australian nurses. Nurses caring for people with IDD play a variety of roles and engage in a vast array of practice related to the physical and social needs of people with intellectual and developmental disability across the whole of the lifespan and in multiple, disparate contexts. Conclusion: It is important for the ongoing care of people with intellectual and developmental disability that the value added by this nursing workforce not be overlooked as disability and health policies evolve. Implications for research, policy and practice: This cross sectional study lays the groundwork for further research about these Australian nurses, in particular more focussed research about the economic benefits of disability services employing nurses, description and effect of nursing interventions specific to people with intellectual and developmental disability, as well as theoretical work to conceptualise new, National Disability Insurance Scheme-ready, models of nursing care for people with intellectual and developmental disability. What is already known about the topic? * In the Australian context, little is known about the contemporary roles and practice of nurses who care for people with intellectual and developmental disability. What this paper adds: * This paper offers a detailed and modern insight into the roles and nursing practice of this marginalised group of nurses. Although all nurses offer physical nursing care, unique to these nurses is the breadth and depth of social, behavioural, emotional and adaptive behaviour support across the lifespan. [ABSTRACT FROM AUTHOR]

Background: Antibiotic resistance is a major global threat to mankind. Inappropriate antibiotic use has been identified as one of the greatest contributors to antibiotic resistance. There is currently a paucity of data on antibiotic use in aged care facilities, globally and in the Australian setting. Aim: To investigate the current antibiotic prescribing practices and use in aged care facilities in the Riverina, New South Wales (NSW), and metropolitan Australian Capital Territory (ACT). Method: Care managers of aged care facilities in the ACT and Riverina, as well as pharmacists who service aged care facilities in regional NSW and ACT, were asked to complete a questionnaire relating to antibiotic use in aged care facilities. Data obtained were subjected to statistical analysis. Results: Most facilities in the ACT (85%) and NSW (90%) had some form of protocol in place for the prescribing and obtaining of antibiotics for residents. The most commonly prescribed antibiotic across participating facilities was cephalexin and the most common indication for antibiotic use was urinary tract infection. No statistically significant differences in antibiotic use and antibiotic prescribing practices were observed between metropolitan ACT and regional NSW aged care facilities. There was a statistically significant association between facilities with residents taking antibiotics for ongoing conditions and those that have experienced situations in the past 12 months in which the initially prescribed antibiotic did not work and another had to be used (p = 0.004944). Conclusion: The data from this study can inform further studies that may be used to inform the development of antimicrobial stewardship initiatives in aged care facilities. [ABSTRACT FROM AUTHOR]

Background Caesarean section rates in Australia have risen to >30%, with repeat caesarean delivery the most common indication. One method of reducing caesarean delivery rates is to increase rates of vaginal birth after caesarean section ( VBAC). Aims To determine the combined effect of two management strategies on the rates of successful VBAC in women experiencing their first pregnancy following primary caesarean section. Methods Prospective cohort study from May 2009 to October 2010 at a metropolitan Australian teaching hospital. The strategies studied were (i) allocating responsibility for VBAC candidates attempting labour to the hospital's three high-risk obstetric consultants and (ii) implementing a next birth after caesarean ( NBAC) antenatal clinic designed to counsel and support women deciding on mode of birth for their next pregnancy after a primary caesarean section. Data were collected from Obstetrix, a NBAC logbook and medical records of 396 eligible women who gave birth during the study period. Results Overall VBAC rates improved from 17.2% in 2006 prior to implementation of the combined strategies, to 27.0% over the studied period ( P < 0.001). Of those women who desired and attempted a VBAC, the success rate was 64.4%. Regression analysis identified an increased likelihood of attempted vaginal birth where malpresentation was the indication for previous caesarean, while Eastern Asian ethnicity was associated with increased likelihood of choosing repeat caesarean. Conclusions A dedicated NBAC clinic and more consistent approach to labour management can help improve VBAC rates. Further targeted counselling towards women with previous malpresentation and/or East Asian descent may further improve VBAC attempt rates. [ABSTRACT FROM AUTHOR]

ABSTRACT The lack of qualified mental health nurses is at critical level with the problem likely to worsen as the aging mental health nursing workforce retires. This study investigates the career preferences of undergraduate nursing students by comparing preferences at the start, middle, and end of the Bachelor of Nursing program. The comparison of the cohorts gave an indication of the change in preferences over the intervening years. It replicates research completed in 1992, 1997, and 2001, and develops a profile of nursing career preferences and the rationale underpinning those preferences in a cohort of students ( n = 150) who began their Bachelor of Nursing studies in 2007 and completed in 2009. The main findings included that, like the previous studies, mental health nursing is one of the least desirable career choices for most nurses at the start of their course and remains so as they approach graduation. The reasons change but the outcome remains the same. The current system of using the Bachelor of Nursing award to produce mental health nurses in Australia does not encourage nurses to consider a career in mental health nursing. Which begs the question: where will mental health nurses in the future come from? [ABSTRACT FROM AUTHOR]

SALAMONSON Y., RAMJAN L., LOMBARDO L., LANSER L.H., FERNANDEZ R. & GRIFFITHS R. (2011) Diversity and demographic heterogeneity of Australian nursing students: a closer look. International Nursing Review 59, 59-65 Background: In the last decade, there has been a rapid growth of international students undertaking nursing studies in Australian universities. At the same time, nursing courses continue to attract local students from a diversity of backgrounds. Aim: The aim of this study is to examine first year nursing students by enrolment classification and country of birth: i) international; ii) local, overseas-born; and iii) local, Australian-born student, and demographic differences of academic performance at the 12-month follow-up. Methods: A prospective, correlational design was used to identify nursing student characteristics as predictors of academic performance in a large university in the western region of Sydney. Results: Of the 806 students enrolled in the course, 540 (67%) completed the survey and consented to data linkage. Fifty-six per cent of the 540 participants were born overseas, of which 38% were local and 18% were international students. Local, overseas-born students originated from 55 different countries, in contrast to international students who were representative of only 16 different countries. International students were younger, spent less time in paid work and were more likely to have a close friend in the same course. Although age was positively related to academic performance, local, overseas-born and international enrolment classifications, and hours in paid work during semester were negatively associated to academic performance. Conclusion: This study has taken a closer look at an important issue that requires further examination, given that international and local, overseas-born students were two distinctive groups. Although both groups underperformed academically compared with Australian-born students, the differences in characteristics between local, overseas-born students and international students suggest that these two student groups are likely to experience different challenges during their nursing studies in Australia. [ABSTRACT FROM AUTHOR]

Conclusion: Whilst objective testing on music perception showed no individual differences between cochlear implant (CI) devices, subjective music perception was found to be superior with the MED-EL device in the majority of cases evaluated. Objective: To compare speech and music perception through two different CI systems in the same individuals. Methods: Six post-lingually deaf patients, who had been implanted with a Cochlear™ Nucleus® device in one ear and a MED-EL SONATATI100 on the contralateral side were evaluated. One subject was excluded from group analysis because of significant differences in performance between ears. Subjects completed a questionnaire designed to assess implant users' listening habits. Subjective assessments of each subject were made for comparison of speech and music perception with each system and preferences of system. The subjects consecutively used each system with the contralateral device turned off, and were objectively assessed for specific musical skills. Speech perception in quiet and in noise was tested. Results: For all objective tests of music discrimination and speech perception in noise, there were no statistically significant differences between MED-EL and Cochlear CI systems. Subjectively, four subjects thought their MED-EL device was better than their Cochlear device for music appreciation. Four thought that music sounded more natural, less tinny and more reverberant with their MED-EL CI than with their Cochlear CI. One subject rated all these to be equal. [ABSTRACT FROM AUTHOR]

Objective: To determine the extent to which (1) promotional characters are used on food packaging for healthful and less-healthful food and (2) different companies use this persuasive marketing strategy. Design: Cross-sectional supermarket audit of all food and beverages featuring promotional characters on the packaging. Setting: Three Australian supermarket chains. Variables Measured: Frequency of observed products, package size, nutritional composition. Analysis: Frequencies and bivariate analyses was conducted. Nutritional composition (healthful vs less healthful) was analyzed by character type and company type, that is, whether the company was signed to the Australian Food and Grocery Council Responsible Marketing to Children Initiative (RMCI) signatory. Results: Products featuring promotional characters on packaging (n = 352) were predominantly less- healthful food and beverages (76%). Nutritional composition varied significantly by character type, with 69% of products with sportspersons, celebrities, or movie tie-ins being healthful, compared with 48% of licensed and 21% of company-owned characters. Only 13 of the 75 companies using characters on packaging were RMCI signatory. Conclusions and Implications: Promotional characters are largely used on food packaging to promote less-healthful food to children. Most of these characters are company-owned characters that are not subject to any form of regulation in Australia. Further efforts to limit this form of marketing to children are required. [ABSTRACT FROM AUTHOR]

Background: Selection of specialist trainees in obstetrics and gynaecology has traditionally been hospital based. Aims: To report the outcomes of a state-wide selection process and suggest possibilities for future trainee selection. Methods: Applicants were screened for interview using a standardised curriculum vitae (CV) and referee reports, and the highest-ranked applicants were offered an interview. Scores from CV, interview and references were collated to give an overall score for each candidate. The candidates were then ranked in order of merit and integrated training program (ITP) hospitals ranked their preferences for candidates. The candidates were then offered positions based on a preference-matching system. Scores for selection components were correlated. Selection matching and trainee retention rates are reported. Results: In a 4 year period, 155 unique applicants made 183 applications, 65% were interviewed and 43% offered a position; 76% of the successful candidates were preference matched to theirs and the ITP's first choice. The retention rate to date is 92%. Conclusion: A state-wide selection process offers a transparent and meritorious means of selection of trainees in obstetrics and gynaecology. It has significant advantages over an individual hospital-based selection process for both trainees and hospitals. Outcome data for the optimal trainee to be selected are difficult to define. Reporting and reviewing data with a national selection process are imperative. The current selection process does not address issues that may be important for selection such as manual dexterity or psychological preparedness for the speciality of obstetrics and gynaecology. [ABSTRACT FROM AUTHOR]

Stroke care across Australian hospitals is variable. The impact on health outcomes, in particular levels of disability for patients in rural areas, is unclear. The aim of this study was to determine whether geographic location and access to stroke units are associated with differences in health outcomes in patients with acute stroke. Retrospective cohort study of consecutive eligible admissions from 32 hospitals (12 rural) in New South Wales between 2003 and 2007. Health status measured at discharge included level of independence (modified Rankin score: mRS) and frequency of severe complications during hospitalization. Multivariable analyses included adjustment for patient casemix and clustering. Among 2254 eligible patients, 55% were treated in metropolitan hospitals. Stroke unit treatment varied significantly (rural 3%; metropolitan 77%). Age, gender and stroke type did not differ by location (mean age 74, 50% female). After adjusting for age, gender, ethnicity, important risk factors and validated stroke prognostic variables, patients treated in rural hospitals had a greater odds of dying during hospitalization compared with those treated in metropolitan hospitals (adjusted odds ratio (aOR) 1.46, 95% confidence interval (CI) 1.03-2.05). There were no differences in mortality or frequency of severe complications between patients treated in rural and metropolitan hospitals when we adjusted for access to stroke units (aOR 1.00, 95% CI 0.62-1.61). Nevertheless, patients treated in rural hospitals were more dependent (mRS 3-5) at discharge (aOR 1.82, 95% CI 1.23-2.70) despite adjusting for stroke unit status. Patients with stroke treated in rural hospitals have poorer health outcomes, especially if not managed in stroke units. [ABSTRACT FROM AUTHOR]

Abstract: Ethnopharmacological relevance: Carpobrotus rossii (CR) has a history of use as a food and therapeutic agent by Australian indigenous peoples and early European settlers and is believed to contain a number of pharmacologically active polyphenolic compounds. Aims of the study: Oxidation of low density lipoprotein (LDL), platelet aggregation, and inflammation contribute to the development and progression of atherosclerosis. The aim of the present study was to investigate the antioxidant, antiplatelet and anti-inflammatory activity of CR extract using human blood components. Materials and methods: An assay employing in vitro copper-induced oxidation of serum lipids was used to assess antioxidant activity of CR extract (and tannin, flavonoid and pre- and post-flavonoid fractions). The effects of CR extract on ADP- and collagen-induced platelet aggregation, and on basal (unstimulated) and lipopolysaccharide (LPS)- and phytohaemagglutinin A (PHA)-stimulated cytokine release from peripheral blood mononuclear cells (PBMC) were also investigated. Results: CR extract increased the lag time of serum oxidation (maximum of ∼4-fold at 20μg/ml) in a concentration-dependent manner. The antioxidant activity resided only in the tannin and post-flavonoid fractions. CR had no effect on ADP-induced platelet aggregation, but significantly decreased collagen-induced platelet aggregation. LPS, but not PHA, significantly increased the release of IL-1β and TNF-α from PBMC. CR extract alone inhibited monocyte chemoattractant protein (MCP)-1 release and in the presence of LPS, inhibited IL-10, TNF-α and MCP-1 release compared to LPS alone. Conclusion: CR has significant in vitro antioxidant, antiplatelet and, potentially, anti-inflammatory activity. [Copyright &y& Elsevier]

Aim. A common concern of prospective in  vitro fertilization (IVF) patients is the effect of treatment on their weight. The aim of this study was to document weight change throughout a long down regulation (LDR) IVF cycle and to examine any relationship between weight change, treatment outcome ovarian responsiveness and bloating. Methods. Following recruitment of women prior to na LDR IVF cycle, four-timed weighings and a control-validated daily bloating questionnaire were completed through the cycle. Results. Sixty-six weight profiles were used in analysis, 66%% ( n==43) of which completed the bloating questionnaire. There was no significant weight change at the conclusion of the cycle ( p == 0.234) despite significant weight gain during stimulation. These changes had no relationship to treatment outcome, the statistically significant reported bloating or to the ovarian responsiveness of participants. Conclusions. Despite anecdotal views to the contrary, LDR IVF cycles do not appear to result in lasting weight gain. Interestingly, there was no statistical association between weight change and the perceived degree of bloating. [ABSTRACT FROM AUTHOR]

Although humans are a major mechanism for short and long distance seed dispersal, there is limited research testing clothing as a vector. The effect of different types of material (sports vs hiking socks), or different items of clothing (boots, socks, laces vs legs) or the same item (socks) worn in different places on seed composition were assessed in Kosciuszko National Park, Australia. Data was analyzed using Repeated Measures ANOVA, independent and paired t-tests, Multi-dimensional Scaling Ordinations and Analysis of Similarity. A total of 24,776 seeds from 70 taxa were collected from the 207 pieces of clothing sampled, with seed identified from 31 native and 19 non-native species. Socks worn off-track collected more native seeds while those worn on roadsides collected more non-native seeds. Sports socks collected a greater diversity of seeds and more native seeds than hiking socks. Boots, uncovered socks and laces collect more seeds than covered socks and laces, resulting in 17% fewer seeds collected when wearing trousers. With seeds from over 179 species (134 recognized weeds) collected on clothing in this, and nine other studies, it is clear that clothing contributes to unintended human mediated seed dispersal, including for many invasive species. [Copyright &y& Elsevier]