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: Objective: To identify leading injury risk factors and jurisdictional differences in Australian and US child?related product safety regulatory responses to inform the development of Australian policy and reform priorities. Methods: The study established and evaluated a knowledge base of child?related product safety regulatory responses (recalls, bans, standards and warnings) made in Australia and the US over the period 2011?17 to identify risk factors and potential regulatory gaps. Results: The research identified 1,540 Australian and US child?related product safety regulatory responses with the most common response type being product safety recall, and the leading product hazards in responses being choking, fire, fall, strangulation and chemical hazards. Jurisdictional differences identified potential regulatory gaps in Australia related to chemical hazards and high?risk durable infant and toddler products, and some data deficiencies in Australian responses. Conclusions: Priorities include the need to improve the prevention orientation of the Australian product safety framework, to create an intelligence platform to assess injury risks more precisely and to address regulatory gaps related to the use of toxic chemicals in children's products and high?risk durable infant and toddler products. Implications for public health: The study demonstrates the identification of policy and reform priorities for child product safety using a public health lens., The Australian consumer product safety regime is contained in the Australian Consumer Law (ACL), which is administered and enforced jointly by the Australian Competition and Consumer Commission (ACCC) and state [...]

Objective: To identify external causes of unintentional childhood injury presenting to Australian EDs. Methods: Six major paediatric hospitals in four Australian states supplied de‐identified ED data for 2011–2017 on age, sex, attendance time/date, presenting problem, injury diagnosis, triage category and mode of separation. Three hospitals supplied data on external cause and intent of injury. A machine classifier tool was used to supplement the missing external cause coding in the remaining hospitals to enable the compilation of a standardised dataset for childhood injury causes analysis. Results: A total of 486 762 ED presentations for unintentional injury in children aged 0–14 years were analysed. The leading specified cause of ED presentations was low fall (35.0%) followed by struck/collision with an object (13.8%) with little sex difference observed. Males aged 10–14 years had higher rates of motorcycle, pedal cycle and fire/flame‐related injury and lower rates of horse‐related injury and drug/medicinal substance poisoning compared with females. The leading specified external cause resulting in hospitalisation was low fall (32.2%) followed by struck/collision with an object (11.1%). The injuries with the highest proportion of children being hospitalised were drownings (64.4%), pedestrian (53.4%), motorcycle (52.7%) and horse‐related injuries (50.0%). Conclusions: This is the first large‐scale study since the 1980s to explore external causes of unintentional childhood injury presenting to Australian paediatric EDs. It demonstrates a hybrid human–machine learning approach to create a standardised database to overcome data deficiencies. The results supplement existing knowledge of hospitalised paediatric injury to better understand the causes of childhood injury by age and sex, which require health service utilisation. [ABSTRACT FROM AUTHOR]

Objective: To provide an epidemiological understanding of the types of injuries treated in ED in Australian children, describe the impact of these injuries in volume and severity, and assess the patterns by demographic and temporal factors. Methods: ED data from six major paediatric hospitals in four Australian states over the period 2011-2017 were analysed to identify childhood injury patterns by nature of injury and body region, as well as sex, age group and temporal factors. Results: A total of 486 762 ED presentations for injury in children aged 0-14 years were analysed. The most common injuries for all age groups were fractures of the upper extremities. Leading injury diagnosis groups varied by age groups and sex. Overall, children aged 1-2 years had the highest number of ED presentations for injury, and from birth more males than females presented to ED with injuries with the highest absolute sex difference observed for 10- to 14-year-olds. Seventeen percent of children who presented to ED were admitted to hospital with the leading type of hospitalised injury being fractures. Little monthly variation in ED presentations was observed, except for higher presentations for drowning in summer months, and for most injury types, ED presentations were higher during weekends and daytime. Conclusions: This is the first largescale quantification of paediatric injury-related ED presentation patterns in Australia since the conclusion of the National Injury Surveillance and Prevention Program about 30 years ago. It provides valuable information to inform paediatric ED resourcing decisions as well as important evidence for injury prevention practitioners. [ABSTRACT FROM AUTHOR]

Abstract Background The importance of respecting women’s wishes to give birth close to their local community is supported by policy in many developed countries. However, persistent concerns about the quality and safety of maternity care in rural communities have been expressed. Safe childbirth in rural communities depends on good risk assessment and decision making as to whether and when the transfer of a woman in labour to an obstetric led unit is required. This is a difficult decision. Wide variation in transfer rates between rural maternity units have been reported suggesting different decision making criteria may be involved; furthermore, rural midwives and family doctors report feeling isolated in making these decisions and that staff in urban centres do not understand the difficulties they face. In order to develop more evidence based decision making strategies greater understanding of the way in which maternity care providers currently make decisions is required. This study aimed to examine how midwives working in urban and rural settings and obstetricians make intrapartum transfer decisions, and describe sources of variation in decision making. Methods The study was conducted in three stages. 1. 20 midwives and four obstetricians described factors influencing transfer decisions. 2. Vignettes depicting an intrapartum scenario were developed based on stage one data. 3. Vignettes were presented to 122 midwives and 12 obstetricians who were asked to assess the level of risk in each case and decide whether to transfer or not. Social judgment analysis was used to identify the factors and factor weights used in assessment. Signal detection analysis was used to identify participants’ ability to distinguish high and low risk cases and personal decision thresholds. Results When reviewing the same case information in vignettes midwives in different settings and obstetricians made very similar risk assessments. Despite this, a wide range of transfer decisions were still made, suggesting that the main source of variation in decision making and transfer rates is not in the assessment but the personal decision thresholds of clinicians. Conclusions Currently health care practice focuses on supporting or improving decision making through skills training and clinical guidelines. However, these methods alone are unlikely to be effective in improving consistency of decision making.

Abstract Background Vaginal examination (VE) and assessment of the cervix is currently considered to be the gold standard for assessment of labour progress. It is however inherently imprecise with studies indicating an overall accuracy for determining the diameter of the cervix at between 48-56%. Furthermore, VEs can be unpleasant, intrusive and embarrassing for women, and are associated with the risk of introducing infection. In light of increasing concern world wide about the use of routine interventions in labour it may be time to consider alternative, less intrusive means of assessing progress in labour. The presence of a purple line during labour, seen to rise from the anal margin and extend between the buttocks as labour progresses has been reported. The study described in this paper aimed to assess in what percentage of women in labour a purple line was present, clear and measurable and to determine if any relationship existed between the length of the purple line and cervical dilatation and/or station of the fetal head. Methods This longitudinal study observed 144 women either in spontaneous labour (n = 112) or for induction of labour (n = 32) from admission through to final VE. Women were examined in the lateral position and midwives recorded the presence or absence of the line throughout labour immediately before each VE. Where present, the length of the line was measured using a disposable tape measure. Within subjects correlation, chi-squared test for independence, and independent samples t-test were used to analyse the data. Results The purple line was seen at some point in labour for 109 women (76%). There was a medium positive correlation between length of the purple line and cervical dilatation (r = +0.36, n = 66, P = 0.0001) and station of the fetal head (r = +0.42, n = 56, P < 0.0001). Conclusions The purple line does exist and there is a medium positive correlation between its length and both cervical dilatation and station of the fetal head. Where the line is present, it may provide a useful guide for clinicians of labour progress along side other measures. Further research is required to assess whether measurement of the line is acceptable to women in labour and also clinicians.

In a study investigating factors affecting labour pain, 10 out of 97 subjects reported that they had never experienced any pain outwith childbirth. These subjects experienced comparatively low levels of pain within childbirth. They did not differ significantly from the majority of subjects on a large number of obstetric and psychological factors which normally affect pain in labour. It was suggested that these subjects were relatively insensitive to noxious stimulation, in that they do not experience pain when noxious stimulation is mild or moderate (as for example a consequence of menstruation, common accidents or ailments) and experience lower than average levels of pain when noxious stimulation is intense as in labour. Further investigation of such subjects is of theoretical interests and practical importance since it might allow for accurate prediction of pain levels in a proportion of parturants.

Background: Coronary heart disease (CHD) risk factor reduction is required to maximize the benefits to be gained from coronary artery bypass grafting. Risk factor reduction after surgery, however, is often incomplete and adherence rates are poor. The health behaviors of the cardiac partner can be supportive or can act to undermine the patient's motivation for change in risk factors. Concordance in health behaviors in couples can make it more difficult for patients to engage in positive lifestyle changes. Objectives: The aims of this study were to increase understanding of the role of concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after bypass grafting and to examine changes in the pattern of concordance over time. Methods: A prospective study of patients' and partners' CHD risk factors was conducted in the outpatient clinic before and at home 4 months after bypass grafting. Results: There was significant concordance for preoperative physical activity, body mass index, and diabetes mellitus, and postoperatively, there was significant concordance for smoking status, physical activity, body mass index, cholesterol, and diabetes mellitus. There were significant associations between patients' preoperative and postoperative physical activity and cholesterol and between the partners' preoperative and postoperative physical activity. There was a significant change in the pattern of concordance for physical activity from preoperation to postoperation, with more patients but not partners increasing their physical activity levels. Conclusions: Results revealed significant concordance in CHD risk factors and common medical conditions in patients and partners before and 4 months after coronary artery bypass grafting. This indicates that the behaviors of some couples can make it more difficult for patients to change their lifestyle. The health professionals involved in educating patients before and after bypass grafting need to target the patient and partner as a couple to help achieve more successful risk factor reduction. [ABSTRACT FROM AUTHOR]

Background: Continuous support in labour has a significant impact on a range of clinical outcomes, though whether the quality and quantity of support behaviours affects the strength of this impact has not yet been established. To identify the quality and quantity of support, a reliable means of measurement is needed. To this end, a new computerised systematic observation tool, the 'SMILI' (Supportive Midwifery in Labour Instrument) was developed.The aim of the study was to test the validity and usability of the 'Supportive Midwifery in Labour Instrument' (SMILI) and to test the feasibility and acceptability of the systematic observation approach in the clinical intrapartum setting.Methods: Systematic observation was combined with a postnatal questionnaire and the collection of data about clinical processes and outcomes for each observed labour.The setting for the study was four National Health Service maternity units in Scotland, UK. Participants in this study were forty five midwives and forty four women.The SMILI was used by trained midwife observers to record labour care provided by midwives. Observations were undertaken for an average of two hours and seventeen minutes during the active first stage of labour and, in 18 cases, the observation included the second stage of labour. Content validity of the instrument was tested by the observers, noting the extent to which the SMILI facilitated the recording of all key aspects of labour care and interactions. Construct validity was tested through exploration of correlations between the data recorded and women's feelings about the support they received. Feasibility and usability data were recorded following each observation by the observer. Internal reliability and construct validity were tested through statistical analysis of the data.Results: One hundred and four hours of labour care were observed and recorded using the SMILI during forty nine labour episodes.Conclusion: The SMILI was found to be a valid and reliable instrument in the intrapartum setting in which it was tested. The study identified that the SMILI could be used to test correlations between the quantity and quality of support and outcomes. The systematic observational approach was found to be an acceptable and feasible method of enquiry. [ABSTRACT FROM AUTHOR]

Background: Patients having coronary artery bypass grafting (CABG) often depend on their partners for assistance before and after surgery. Whilst patients' physical and mental health usually improves after surgery little is known about the partners' health-related quality of life (HRQoL) in CABG. If the partners' physical and emotional health is poor this can influence their caregiving role and ability to support the patient. This study aimed: to increase understanding of patients' and partners' HRQoL before and after CABG; to explore whether patients' and partners' pre-operative socio-demographics and HRQoL predict their own, and also partners' HRQoL 4 months after CABG. Methods: This prospective study recruited 84 dyads (patients 84% males, aged 64.5 years; partners 94% females, aged 61.05 years). Patients' and partners' perceived health status was assessed using the Short-Form 12 Health Survey. Patients' physical limitation, angina symptoms and treatment satisfaction were assessed using the Seattle Angina Questionnaire. Partners' emotional, physical and social functioning was assessed using the Quality of Life of Cardiac Spouses Questionnaire. Data were analysed using hierarchical multiple (logistic) regressions, repeated measures analysis of variance, paired t test and Chi square. Results: Patients most likely to have poorer physical health post-operatively were associated with partners who had poorer pre-operative physical health. Partners most likely to have poorer emotional, physical and social functioning post-operatively were associated with patients who had poorer pre-operative mental health. Patients" and partners' poorer post-operative HRQoL was also explained by their poorer pre-operative HRQoL. Conclusion: The partners' involvement should be considered as part of patients' pre-operative assessment. Special attention needs be paid to patients' pre-operative mental health since it is likely to impact on their post-operative mental health and the partner's emotional, physical and social functioning. [ABSTRACT FROM AUTHOR]

Infants admitted to a neonatal unit (NNU) are frequently unable to feed by breast or bottle because of ill health or prematurity. These infants require nutritional support until they can start oral feeding. Breastfeeding is advocated for these infants, and mothers are frequently encouraged to express breast milk to be fed via the enteral tube. However, by discharge, breastfeeding rates tend to be low. Oral feeding requires careful management, and although practices may vary because of clinical need, some may be informed by unit norms. There is limited evidence for effective breastfeeding support in this environment and little exploration of the effect of routine feeding decisions. This study aimed to explore feeding decisions and considered how these might affect outcomes. The staff in the two large urban NNUs who participated in the feeding decisions were interviewed and the data were analysed using a theoretical framework. Feeding decisions were made mainly by the unit staff, with limited parental involvement. Subsequent management varied, with differences being related to staff experience and beliefs, unit norms, parent's expectations and physical constraints within the unit. The staff were overtly supportive of breastfeeding, but the need to monitor and quantify milk intake may undermine breastfeeding. Furthermore, feeding breastfed infants during the mothers' absence was controversial and provoked debate. There is a need for clear guidelines and increased parental involvement in feeding decisions. Routine practices within the system may discourage mothers from initiating and persisting with breastfeeding. A change in unit culture is required to fully support the parent's feeding choices. [ABSTRACT FROM AUTHOR]

Background: Vaginal examination (VE) and assessment of the cervix is currently considered to be the gold standard for assessment of labour progress. It is however inherently imprecise with studies indicating an overall accuracy for determining the diameter of the cervix at between 48-56%. Furthermore, VEs can be unpleasant, intrusive and embarrassing for women, and are associated with the risk of introducing infection. In light of increasing concern world wide about the use of routine interventions in labour it may be time to consider alternative, less intrusive means of assessing progress in labour. The presence of a purple line during labour, seen to rise from the anal margin and extend between the buttocks as labour progresses has been reported. The study described in this paper aimed to assess in what percentage of women in labour a purple line was present, clear and measurable and to determine if any relationship existed between the length of the purple line and cervical dilatation and/or station of the fetal head. Methods: This longitudinal study observed 144 women either in spontaneous labour (n = 112) or for induction of labour (n = 32) from admission through to final VE. Women were examined in the lateral position and midwives recorded the presence or absence of the line throughout labour immediately before each VE. Where present, the length of the line was measured using a disposable tape measure. Within subjects correlation, chi-squared test for independence, and independent samples t-test were used to analyse the data. Results: The purple line was seen at some point in labour for 109 women (76%). There was a medium positive correlation between length of the purple line and cervical dilatation (r = +0.36, n = 66, P = 0.0001) and station of the fetal head (r = +0.42, n = 56, P < 0.0001). Conclusions: The purple line does exist and there is a medium positive correlation between its length and both cervical dilatation and station of the fetal head. Where the line is present, it may provide a useful guide for clinicians of labour progress along side other measures. Further research is required to assess whether measurement of the line is acceptable to women in labour and also clinicians. [ABSTRACT FROM AUTHOR]

Background: Predicting suicide risk in psychiatric in-patients in order to inform risk management decisions is compromised by the poor predictive validity of the available models. Aims: This study explored the factors influencing judgements regarding suicide risk in psychiatrists and nurses working in acute psychiatric in-patient units in Scotland. Method: Clinical judgement analysis. Information used by 12 psychiatrists and 52 nurses to make judgements about suicide risk were analysed over 130 hypothetical cases. Correlations and linear regression analysis were used to examine judgement consistency and information use. Results: There was agreement between clinicians on the relative but not absolute degree of risk of each patient case. Consistency of judgments was low, particularly amongst nurses. All clinicians rated those with more previous suicide attempts, men, those with shorter admission times, and those who were less compliant and not improving clinically as at greater risk of suicide. Conclusions: Clinicians use cues that have been associated with suicide in traditional predictive models based on epidemiological studies and short term factors that may be particularly relevant to acute psychiatric settings. The inconsistencies observed can be interpreted to cast doubt on the validity of predictions of risk for imminent suicide and the role of such predictions in the assessment process. Declaration of interest: None. [ABSTRACT FROM AUTHOR]

Abstract: This paper discusses the piloting of a computerised decision aid that provides individualised information about hypertension to patients. The program is based on decision analysis, using decision trees as a way of structuring information. It incorporates the Framingham risk equation to assess a users'' risk of coronary artery disease, together with a detailed assessment of the patient''s current lifestyle and their willingness to change behaviour. Users of the program can decide how much or how little information they access. The program assesses individual''s preferences for different treatment outcomes, before providing them with guidance on what might be the best treatment option for them. The program was evaluated by 10 patients with a diagnosis of mild to moderate hypertension and 8 health care professionals. Overall, both health care professionals and patients assessed the program positively. The use of a decision aid based on decision analysis may be a useful way of providing information to patients in order to promote shared decision making. [Copyright &y& Elsevier]

The use of automated devices for blood spot sampling will ensure safety and benefits for babies and midwives (UKNSPC, 2005). The devices available differ in the technique of incision. The majority, which are less expensive utilise a guillotine incision and the other less common devices utilise an arched shaped incision. The results of a randomised controlled trial comparing two devices with the different techniques of incision suggest that devices with an arched shaped incision provide better quality blood samples, require fewer heel pricks to obtain a quality sample and the devices are cost neutral when all aspects of the blood spot sample are taken into account. [ABSTRACT FROM AUTHOR]

Since the introduction of the Guthrie test in the 1970s, millions of babies have been screened for inborn errors of metabolism. Technological advances in the automated devices used to puncture the heel ensures that they are "safe" in so far as the depth of incision is controlled, eliminating damage to the calcanaus bone. However, the choice of automated or manual device used by midwives is arbitrary and not supported by research findings. The procedure used by midwives today is similar to that issued when the Guthrie test was first introduced despite research findings which contradict parts of the procedure. There is also evidence that the number of insufficient samples have been on the increase since 1998. This, coupled with the need for more blood since the introduction of cystic fibrosis screening in Scotland, points to the need for evidenced-based practice being applied to the newborn bloodspot screening test. [ABSTRACT FROM AUTHOR]

Evaluates a model of peer review for midwives in Great Britain. Application of peer review in midwifery; Role of supervisors of midwives in a peer review; Principle anticipated benefits of peer review; Positive nature of responses.

Features a cross-sectional study on the role of neuroticism in the relationship between self-reported sources of occupational stress and two main-self reported outcome measures. Aims of the study; Methodology; Results; Discussion.

Presents information on a study which examined the relationships between attitudes and three measures of contact derived by health care workers from patients with HIV/AIDS. Methods used in the study; Qualities of the attitude and contact measures; Discussion on the multiple regression analysis performed in the study; Personal characteristics moderated by the relationship between social contact and attitudes.

This review presents evidence of the undertreatment of pain for people with cognitive impairment and explores reasons for this, emphasizing inadequate detection due to lack of suitable pain assessment protocols. Implications for practice and suggestions for further research are made. Copyright © 1999 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background Over the last decade there has been a steadily increasing demand for unscheduled healthcare services, including the ambulance services. To address this demand, various projects have been developed to reduce admissions to the emergency department. One of these was the introduction of Treat and Refer (T and R) guidelines, to allow ambulance clinicians to treat certain groups of patients in the community without the need to convey them to hospital. Aims: This study aims to explore the challenges and barriers faced by ambulance clinicians in the use of T and R guidelines, to inform the future development and governance of non-conveyance guidelines and interventions. Methods Semi-structured interviews were conducted with 18 ambulance clinicians. Data were analysed using framework analysis. Setting: A national UK NHS ambulance service. Results There was a broad support for the concept and policy of T and R; however the participants had mixed views with respect to the actual practice of treating and referring patients. Participants acknowledged the potential benefits of T and R for patients and the NHS, but identified several risks in using T and R in routine practice. Their perceptions of risk seemed to determine whether and how the guidelines were used. Challenges in the use of T and R included: lack of training and knowledge, fear of litigation, a lack of support from the management and difficulties in decisionmaking. Conclusions This study and the supporting literature do not support the use of T and R guidelines in their current format by traditionally trained ambulance clinicians. Ambulance clinicians have identified the need for further education and support. The conceptual support for T and R may provide a foundation to develop and improve the education and support for ambulance clinicians. This should be combined with implementation/review strategies, clinician-led decision support and management support which can provide the ambulance clinician with the skills and confidence to take responsibility for non-conveyance. [ABSTRACT FROM AUTHOR]

Vascular wounds may require frequent dressing changes over a long period of time, often involving pain, which may not be adequately controlled with conventional analgesia. Complementary analgesia may be beneficial as an adjunctive therapy. This pilot study presented eight patients with two odour therapies, lavender and lemon, two music therapies, relaxing and preferred music and a control condition, during vascular wound dressing changes. Although the therapies did not reduce the pain intensity during the dressing change there was a significant reduction in pain intensity for the lavender therapy and a reduction in pain intensity for the relaxing music therapy after the dressing change. This supports the use of these complementary therapies, which are inexpensive, easy to administer and have no known side-effects, as adjunctive analgesia in this patient population. Earlier administration before dressing change may enhance these effects. Further research is required to ascertain why certain complementary therapies are more effective than others at relieving pain. [ABSTRACT FROM AUTHOR]

Summary: Background: Many studies investigating the attenuation of pain by psychological means have confounded cognitive factors with motoric factors. Two experiments were performed to investigate the extent to which intentional movements alone can attenuate experimental pain. Methods: In experiment 1, tolerance and intensity of cold pressor pain administered to the non-dominant hand was measured for two movement conditions, reciprocal eye movements and reciprocal finger movements of the dominant hand. In experiment 2, tolerance and intensity was measured for two reciprocal finger movement conditions, when visual attention was directed to the dominant hand and when visual attention was directed to the location of the noxiously stimulated non-dominant hand. Results: Reciprocal finger movements of the limb contralateral to a noxiously stimulated limb were found to result in significantly longer tolerance times and significantly lower pain intensity ratings when visual attention was directed to and away from the spatial location of the noxious stimulation. Conclusion: These results confirm that movement of the limb contralateral to a noxiously stimulated limb attenuates experimental pain. Further research is required to ascertain whether movement alone attenuates non-experimental pain. [Copyright &y& Elsevier]