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BACKGROUNDConfidential inquiries into maternal deaths have reported that recognition and timely interventions can reduce maternal morbidity and mortality. Although research has been undertaken that examines factors impacting registered nurses recognition of and response to the deteriorating patient, there is less literature identifying the factors impacting midwives' recognition of and response to the deteriorating maternal patient in the clinical context.OBJECTIVETo identify, summarize, and critically evaluate peer-reviewed studies that explored factors impacting clinical practice of Australian midwives in relation to maternal deterioration.DESIGNReviewers searched Maternity and Infant Care, EBSCOhost, Medline, CINAHL, SCOPUS, EMCARE, and EMBASE for published literature reporting on factors impacting Australian registered midwives' ability to recognize and respond to maternal deterioration.FINDINGSOf the articles identified and screened (n = 2,412), no studies met the inclusion criteria. This review revealed a lack of published research examining factors impacting Australian midwives' capability to recognize and respond to the deteriorating maternal patient.CONCLUSION AND IMPLICATIONS FOR PRACTICEWhile research shows, for registered nurses, that high workloads and poor skill mix can negatively impact capability to respond to the deteriorating patient, little is known of registered midwives' capability during similar health events. This review highlights a major gap in current knowledge regarding Australian registered midwives' experiences surrounding the recognition of and response to the deteriorating maternal patient. Increasing understanding in this area can inform and support the Australian midwifery education, practice, and National health policies to improve health outcomes for childbearing women. Further research in this area is therefore required.

Background Intensive care unit nurses are critical for managing mechanical ventilation. Continuing education is essential in building and maintaining nurses' knowledge and skills, potentially improving patient outcomes. Aims The aim of this study was to determine whether continuing education programmes on invasive mechanical ventilation involving intensive care unit nurses are effective in improving patient outcomes. Methods Five electronic databases were searched from 2001 to 2016 using keywords such as mechanical ventilation, nursing and education. Inclusion criteria were invasive mechanical ventilation continuing education programmes that involved nurses and measured patient outcomes. Primary outcomes were intensive care unit mortality and in-hospital mortality. Secondary outcomes included hospital and intensive care unit length of stay, length of intubation, failed weaning trials, re-intubation incidence, ventilation-associated pneumonia rate and lung-protective ventilator strategies. Studies were excluded if they excluded nurses, patients were ventilated for less than 24 h, the education content focused on protocol implementation or oral care exclusively or the outcomes were participant satisfaction. Quality was assessed by two reviewers using an education intervention critical appraisal worksheet and a risk of bias assessment tool. Data were extracted independently by two reviewers and analysed narratively due to heterogeneity. Results Twelve studies met the inclusion criteria for full review: 11 pre- and post-intervention observational and 1 quasi-experimental design. Studies reported statistically significant reductions in hospital length of stay, length of intubation, ventilator-associated pneumonia rates, failed weaning trials and improvements in lung-protective ventilation compliance. Non-statistically significant results were reported for in-hospital and intensive care unit mortality, re-intubation and intensive care unit length of stay. Conclusion Limited evidence of the effectiveness of continuing education programmes on mechanical ventilation involving nurses in improving patient outcomes exists. Comprehensive continuing education is required. Relevance to clinical practice Well-designed trials are required to confirm that comprehensive continuing education involving intensive care nurses about mechanical ventilation improves patient outcomes.

Background: Eliminating exacerbations is an important goal of asthma treatment. Our aim was to conduct a systematic review and individual patient data (IPD) meta-analysis to examine whether macrolides reduce exacerbations in asthma, non-eosinophilic asthma, eosinophilic asthma and severe asthma. Methods: In February 2019, we systematically searched multiple databases for parallel-group double-blind randomised controlled trials in adults comparing at least 8 weeks of macrolide antibiotic treatment with placebo, where exacerbations were assessed over at least 6 months. Two authors screened studies, extracted data and assessed bias. A one-step IPD meta-analysis was conducted on available data. Results: Four studies were eligible and three provided data for IPD meta-analysis (AZISAST[1]; AMAZES[2]; AZMATICS). Macrolide treatment (azithromycin) reduced the exacerbation rate (oral corticosteroid or antibiotic use, hospitalisation and/or emergency room visit) in asthma (incident rate ratio [IRR]=0.61 [95%CI 0.49-0.78] p Conclusion: Long-term treatment with azithromycin reduces exacerbations, regardless of whether the patient has eosinophilic, non-eosinophilic or severe asthma. References: 1 Brusselle GG Thorax 2013;68:322-9 2 Gibson PG Lancet 2017;390:659-68

BackgroundPreventing exacerbations is an important goal of asthma treatment. Long-term treatment with azithromycin may help achieve this. Our aim was to conduct a systematic review and individual participant data (IPD) meta-analysis to examine the efficacy of azithromycin in reducing exacerbations in asthma, and in the subphenotypes of noneosinophilic asthma, eosinophilic asthma and severe asthma.MethodWe completed a systematic search of Embase, MEDLINE, PubMed, Cochrane Library, ClinicalTrials.gov and reference lists of previous systematic reviews in February 2019. We included parallel-group, double-blind, randomised controlled trials in adults comparing at least 8 weeks of azithromycin treatment with placebo, where the outcome of exacerbations was assessed over at least 6 months. Data were extracted from published sources, Cochrane Risk of Bias Tool was applied and IPD were sought from authors. Reviews were undertaken in duplicate. We conducted an IPD meta-analysis on the primary outcome of exacerbations and a random effects meta-analysis for secondary outcomes.ResultsThree studies were identified (n=604). In the IPD meta-analysis, treatment with azithromycin was associated with a reduced rate of exacerbations (oral corticosteroid course due to worsening asthma, antibiotic use for lower respiratory tract infection, hospitalisation and/or emergency department visits) in asthma as well as in the noneosinophilic, eosinophilic and severe asthma subgroups. Examining each exacerbation type separately, patients with eosinophilic asthma reported fewer oral corticosteroid courses, and patients with noneosinophilic and severe asthma reported fewer antibiotic courses. Azithromycin was well tolerated.DiscussionMaintenance use of azithromycin reduces exacerbations in patients with eosinophilic, noneosinophilic and severe asthma.