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© 2018 The Authors Background: Patients with communication disability, associated with impairments of speech, language, or voice, have a three-fold increased risk of adverse events in hospital. However, little research yet examines the causal relationship between communication disability and risk for specific adverse events in hospital. Objective: To examine the impact of a patient's communication disability on their falls risk in hospital. Methods: This systematic review examined 61 studies on falls of adult hospital patients with communication disability, and patients at high risk of communication disability, to determine whether or not communication disability increased risk for falls, and the nature of and reasons for any increased risk. Results: In total, 46 of the included studies (75%) reported on participants with communication disability, and the remainder included patients with health conditions placing them at high risk for communication disability. Two thirds of the studies examining falls risk identified communication disability as contributing to falls. Commonly, patients with communication disability were actively excluded from participation; measures of communication or cognition were not reported; and reasons for any increased risk of falls were not discussed. Conclusions: There is some evidence that communication disability is associated with increased risk of falls. However, the role of communication disability in falls is under-researched, and reasons for the increased risk remain unclear. Practical applications: Including patients with communication disability in falls research is necessary to determine reasons for their increased risk of adverse events in hospital. Their inclusion might be helped by the involvement of speech-language pathologists in falls research teams.

BACKGROUND: Literature suggests an ongoing gender disparity in the use of coronary angiography and subsequent interventions among patients with acute coronary syndrome (ACS). OBJECTIVES: The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome (ACS) admitted to a major metropolitan hospital in Melbourne during the period 2009-2012. METHODS: We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina (UA), ST-segment-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). RESULTS: The mean age of the patients was 64.3 years and 624 (30%) were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent (adjusted odds ratio 0.61, 95% confidence intervals 0.39-0.96) and 66% less likely to receive grafts (adjusted OR 0.34, 95% CIs 0.13-0.93). Women diagnosed with NSTEMI were 44% less likely to receive grafts (adjusted OR 0.56, 95% CIs 0.37-0.83). Younger women aged 35-49 years were less likely to receive an angioplasty stent, and older women >50 years were less likely to receive grafts. CONCLUSIONS: Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.

ICU readmissions are a commonly used quality measure but despite decades of research, these adverse events continue to occur. Of particular concern is that readmitted patients have much worse prognoses than those not readmitted. In recent years new clinical service roles have evolved to assist ward staff with the care of acutely ill patients, such as those discharged from ICU. Given the recent emergence of these service roles, a review of contemporary ICU readmission studies was warranted to determine their impact on this adverse event. Reviewed studies indicated the incidence of readmissions and outcomes of these patients have changed little in recent years. Few studies mentioned whether clinical service roles existed to support ward staff caring for patients recently discharged from ICU. Future research needs to focus on identifying modifiable factors in care processes to reduce the incidence and outcomes of this adverse event and to determine how clinical service roles can best help prevent its occurrence.

Older people commonly experience difficulty using public transport, and identify a range of barriers and facilitators to bus use. This study aimed to evaluate the impact of implementing age-friendly guidelines for public buses on bus use, useability and social participation for older people. Age-friendly changes were implemented in Hervey Bay, Queensland, over a 3 year period. Changes included more lower floor buses, age-awareness training for bus drivers, more frequent scheduling, improved pedestrian infrastructure, a bus buddy program and trial of a flexible route bus. Brisbane, Queensland, served as a control site. This study adopted two complementary methodologies for evaluating the impact of age-friendly changes. The first study incorporated on-board satisfaction surveys with 335 bus users. The second involved a repeated measures cohort study (n = 100) with bus users and non-users. Implementation of age-friendly changes in Hervey Bay, Queensland, resulted in improved satisfaction with, and perceived useability of, the bus system. Participants in Hervey Bay maintained their bus use and social activity participation, while participants in Brisbane experienced a decline in ease of bus use and social activity participation over the intervention period. The implementation of age-friendly guidelines for public buses may improve the useability of bus systems for older people and result in maintenance of participation in social activities.

Background: A significant number of patients experience an adverse event when discharged from intensive care to a ward. More than half of these events may be preventable with better standards of care. Aim: To explore the opinions of an expert group of clinicians around factors contributing to adverse events in patients discharged from ICU. Method: Online survey of Australian ICU Liaison Nurses (n = 39) using a validated questionnaire of 25 items. Results: The response rate was 92.8%. Key contributing factors included a lack of experienced ward staff, patient co-morbidities and the clinically challenging nature of many patients. Conclusion: Modifying processes of care may decrease the risk or impact of adverse events in this high risk patient population.

Background A long distance to the bus stop, poor pedestrian accessibility and inadequate shelters are barriers to bus use for older people. Flexible route bus transport poses an opportunity to overcome these barriers. Purpose The aim of this study is to investigate whether the replacement of a fixed route bus service with a flexible route bus service improves the use of, and satisfaction with, buses. The study emphasises the impact on older people. Methodology One fixed route service in Hervey Bay, Queensland, Australia, was replaced with a flexible route service. Use of the bus service was monitored via ticket sale data over a nine month period. Pension concession ticket sales were used to estimate use by older people. Satisfaction surveys were conducted before and eight months following the introduction of the flexible route service. Results Use by older people approximately doubled over an eight month period following introduction of the flexible service. In addition, there was a significant ( p =0.002) increase in overall satisfaction with the bus service following the introduction of the flexible route service. Similar improvements were found for younger people. Conclusion Flexible route bus transport is a promising technology to help meet the transport needs of older people. Further research should investigate the cost-benefit ratio of flexible route bus services, and trial flexible route buses in other geographical and socio-cultural contexts. Flexible route bus services are not only “age-friendly”, but “people-friendly”.

Summary Background Cardiovascular disease is the most common cause of death in Australian women. The genesis and progression of cardiovascular disease is modulated by a complex interplay of genetic, physiological, social and economic circumstances. Increasingly the impact of racial, ethic, social and economic inequalities is identified as predictors of cardiovascular disease outcome. Despite important advances over the last 30 years in reducing age adjusted mortality from cardiovascular disease, it continues to represent a major social and economic burden nationally and internationally. Aim This paper provides a critical review of the social issues impacting upon women in Australia. It also identifies areas for future interventions with a view to improving outcomes in women with cardiovascular disease. Method The bibliographic databases; CINAHL, MEDLINE, PsycARTICLES, were searched for relevant studies using the search terms ‘women', ‘cardiovascular disease', and ‘socio-economic status'. Findings While some gains have been made in reducing the risk factor profile and rates of death from cardiovascular disease, it is clear that gender, race and socioeconomic disparities persist. Conclusions New approaches are required to improve health differentials for CVD, and reduce the impact of gender, racial, ethic, social and economic factors on health disparities.

O'Halloran R, Grohn B, Worrall L. Environmental factors that influence communication for patients with a communication disability in acute hospital stroke units: a qualitative metasynthesis. Objective To develop a taxonomy of the environmental factors that influence communication between patients with communication disabilities and their health care providers in hospital stroke units. Data Sources We conducted a metasynthesis of 3 qualitative studies conducted by our research team on the environmental factors that influence communication between patients and health care providers in hospital stroke units. Study Selection These studies identified environmental factors which influence communication from the perspectives of 10 patients with communication disabilities, 10 health care providers, and by direct observation of 65 patients interacting with health care providers. Data Extraction The findings of each study formed the data for the metasynthesis. Data Synthesis The findings of the qualitative studies were analyzed and then synthesized using reciprocal translation. The environmental factors were grouped into 11 higher order categories and 2 overall themes. The themes were (1) health care providers (knowledge, skills, attitude, experience, characteristics) and (2) stroke unit structure and processes (patient opportunities to communicate, family, use of communication aids and equipment, opportunities to learn, policies and procedures, physical environment). Conclusions Acute stroke inpatients with communication disabilities need knowledgeable and skilled health care providers to communicate as effectively as possible. However, there are many environmental barriers and facilitators at the level of stroke unit structures and processes that also impact on the ability of health care providers to communicate with patients. Interventions to improve the communicative accessibility of stroke units need to focus on health care providers and on the processes that govern the unit.

Adults with developmental disability and little or no speech need to communicate with nurses in hospital to (a) express physical needs, (b) discuss health, (c) convey intelligence and emotions, (d) connect socially, and (e) control the environment. All stakeholders need access to a variety of communication strategies to support communication of these needs.

Objectives To identify and appraise the literature concerning nurse-administered procedural sedation and analgesia in the cardiac catheter laboratory. Design and data sources An integrative review method was chosen for this study. MEDLINE and CINAHL databases as well as The Cochrane Database of Systematic Reviews and the Joanna Briggs Institute were searched. Nineteen research articles and three clinical guidelines were identified. Results The authors of each study reported nurse-administered sedation in the CCL is safe due to the low incidence of complications. However, a higher percentage of deeply sedated patients were reported to experience complications than moderately sedated patients. To confound this issue, one clinical guideline permits deep sedation without an anaesthetist present, while others recommend against it. All clinical guidelines recommend nurses are educated about sedation concepts. Other findings focus on pain and discomfort and the cost-savings of nurse-administered sedation, which are associated with forgoing anaesthetic services. Conclusions Practice is varied due to limitations in the evidence and inconsistent clinical practice guidelines. Therefore, recommendations for research and practice have been made. Research topics include determining how and in which circumstances capnography can be used in the CCL, discerning the economic impact of sedation-related complications and developing a set of objectives for nursing education about sedation. For practice, if deep sedation is administered without an anaesthetist present, it is essential nurses are adequately trained and have access to vital equipment such as capnography to monitor ventilation because deeply sedated patients are more likely to experience complications related to sedation. These initiatives will go some way to ensuring patients receiving nurse-administered procedural sedation and analgesia for a procedure in the cardiac catheter laboratory are cared for using consistent, safe and evidence-based practices.

Background Although approximately half of adults with heart failure (HF) are women, relatively little is known about gender differences and similarities in HF self-care. Aims The aim of this study was to describe HF self-care in men and women and to identify gender-specific barriers and facilitators influencing HF self-care. Methods A total of 27 adults (8 women) with chronic HF participated in a cross-sectional, comparative mixed methods study. An analysis of in-depth interviews was used to describe gender-specific barriers and facilitators of self-care. After the interview data were analyzed, the results were confirmed in quantitative data obtained from the same sample and at the same time. Concordance between qualitative and quantitative data was assessed. Results There were no consistent gender-specific differences in self-care practices but there were distinct gender differences in the decisions made in interpreting and responding to symptoms. The men were better than the women at interpreting their symptoms as being related to HF and in initiating treatment. These differences were associated with differences in self-care confidence, social support, and mood. Conclusion Gender-specific differences in self-care behaviors are minimal. However, gender-specific barriers and facilitators greatly influence the choice of self-care behaviors.

This paper aims to provide a better understanding of the nature of functional communication activities so that assessment and treatment efforts are based on a theoretical framework and empirical data. Three sources of information are discussed. The first is the Activity/Participation dimensions of the World Health Organization's International Classification of Functioning, Disability, and Health. The second source is existing assessments of functional communication. The final source is data obtained from observational studies conducted in our research unit. The studies have observed the everyday communication of people with aphasia, people with Traumatic Brain Injury (TBI), and patients in hospital. The simplification of real-life communication in the WHO classification scheme, the variability of item sampling in existing assessments, and the complexity of communication observed in real-life settings has led to the conclusion that there are three levels of functional communication assessment: generic, population-specific, and individualized. Clinicians may choose which level suits their purpose. When clinicians routinely choose from a range of sophisticated functional assessments to inform their therapy, the seed that Martha Taylor Sarno planted and nourished for the past 30 years or more will truly flourish throughout the world of speech-language pathology.As a result of this activity, participants will (1) understand the theoretical framework and data base that motivates assessment and treatment of functional communication activities, (2) be able to discuss the World Health Organization's Classification of Functioning, Disability and Health and (3) gain information about functional assessment and observational sampling of real world communication activities across three levels.

Objectives The aim of the present study was to explore Aboriginal patients' lived experiences of cardiac care at a major metropolitan hospital in Melbourne. Methods The study was a qualitative study involving in-depth interviews with a purposive sample of 10 Aboriginal patients who had been treated in the cardiology unit at the study hospital during 2012-13. A phenomenological approach was used to analyse the data. Results Eight themes emerged from the data, each concerning various aspects of participants' experiences: 'dislike of hospitals', 'system failures', 'engagement with hospital staff', 'experiences of racism', 'health literacy and information needs', 'self-identifying as Aboriginal', 'family involvement in care' and 'going home and difficulties adapting'. Most participants had positive experiences of the cardiac care, but hospitalisation was often challenging because of a sense of dislocation and disorientation. The stress of hospitalisation was greatly mediated by positive engagements with staff, but at times exacerbated by system failures or negative experiences. Conclusion Cardiac crises are stressful and hospital stays were particularly disorienting for Aboriginal people dislocated from their home land and community. What is known about the topic? Aboriginal people have higher mortality rates due to cardiovascular diseases compared with other Australians. Along with different factors contributing to the life expectancy gap, Aboriginal people also face significant barriers in the use of the healthcare system. What does this paper add? Aboriginal patients' lived experience of cardiac care at a major metropolitan hospital in Melbourne is explored in this paper. Different issues were revealed during their interaction with the hospital staff and the hospital system in conjunction with their cultural aspect of patient care. What are the implications for practitioners? Positive interactions with staff, ongoing support from family and community, culturally appropriate cardiac rehabilitation programs can improve the cardiac care experiences of Aboriginal patients.

Objectives: To determine the impact of gender and comorbidity on use of coronary interventions in patients diagnosed with high-risk non-ST-segment acute coronary syndrome (NSTEACS). Background: Guidelines recommend the use of coronary angiography for all patients diagnosed with NSTEACS with high-risk features, except in the presence of severe comorbidities. However, little is understood about the relationship between gender, comorbidity, and the use of coronary interventions. Methods: Retrospective analyses of the Victorian Admitted Episodes Data Set (VAED) including all patients diagnosed with NSTEACS with high-risk features on their first admission for ACS between June 2007 and July 2009. Hierarchical logistic regression models and correspondence analyses were used to understand the relationship between gender, comorbidities, and the use of coronary interventions. Results: Out of 16,771 NSTEACS patients with high-risk features, 6,338 (38%) were female. Females were older than males (aged ≥75: 62% vs 39%, p < 0.001) and more likely to have multiple comorbidities (≥2: 66% vs 59%, p < 0.001). After adjusting for potential confounders, females were more likely to receive no coronary intervention than males with a similar number of comorbid conditions (no comorbidities: OR 1.62, 95% CI 1.28–2.05; 1 comorbidity: OR 1.67, 95% CI 1.44–1.93; 2 comorbidities: OR 1.93, 95% CI 1.66–2.23; ≥3 comorbidities: OR 1.42, 95% CI 1.27–1.60). Conclusions: Lower rates of coronary intervention in females persisted after adjusting for number of comorbidities which suggests that gender may bias decisions regarding referral for coronary intervention in high-risk NSTEACS independent of other factors. © 2015 Wiley Periodicals, Inc.

It is increasingly fashionable in nursing to refer to practice development (PD), a concept that is poorly defined, little questioned and seems to have an evangelical following, especially in the UK and Australia. But what exactly is it and is it a legitimate academic activity? According to the website of the Royal College of Nursing (RCN) in the UK, PD is “… an approach that helps you, your team and organisation to provide care that patients feel is right for them”. There is no indication on this site as to whether this statement is based on opinion or on actual research findings. There are questions about the claims of this activity to contribute to patient care and improve patient outcomes in a sustainable way (Atsalos et al., 2007 C. Atsalos, L. O’Brien and D. Jackson, Against the odds: experiences of nurse leaders in Clinical Development Units (Nursing) in Australia, Journal of Advanced Nursing 58 (2007), pp. 576–584. Full Text via CrossRef | View Record in Scopus | Cited By in Scopus (2)Atsalos et al., 2007). Another issue that deserves professional attention is the question of how this vague and ill defined activity links with the multidisciplinary team, the shared language used by the team and the explicit understanding of nursing’s contribution to patient care. Copyright © 2008 Elsevier Ltd All rights reserved.

Conclusion: RV size and EF assessment by 3D, RV FAC, TAPSE and MPI are reliable and produce results consistent with CMR. This will provide incremental information in the serial assessment of CHD patients. doi:10.1016/j.hlc.2010.06.676