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Objective: To quantify the prevalence of known health‐related risk factors for severe COVID‐19 illness among Aboriginal and Torres Strait Islander adults, and their relationship with social determinants. Methods: Weighted cross‐sectional analysis of the 2018‐19 National Aboriginal and Torres Strait Islander Health Survey; Odds Ratios for cumulative risk count category (0, 1, or ≥2 health‐related risk factors) by social factors calculated using ordered logistic regression. Results: Of the adult population, 42.9%(95%CI:40.6,45.2) had none of the examined health‐related risk factors; 38.9%(36.6,41.1) had 1, and 18.2%(16.7,19.7) had ≥2. Adults experiencing relative advantage across social indicators had significantly lower cumulative risk counts, with 30‐70% lower odds of being in a higher risk category. Conclusions: Aboriginal and Torres Strait Islander peoples must continue to be recognised as a priority population in all stages of pandemic preparedness and response as they have disproportionate exposure to social factors associated with risk of severe COVID‐19 illness. Indigeneity itself is not a ‘risk’ factor and must be viewed in the wider context of inequities that impact health Implications for public health: Multi‐sectoral responses are required to improve health during and after the COVID‐19 pandemic that: enable self‐determination; improve incomes, safety, food security and culturally‐safe healthcare; and address discrimination and trauma.

Background Aboriginal and Torres Strait Islander peoples are the first people of Australia. Consequences of historic and contemporary settler-colonialism including racism, trauma, grief and loss (of land, culture, spirituality, and freedoms) have led to substantial negative health and wellbeing impacts. The Kessler Psychological Distress Scales are population and individual-level tools designed to measure general psychological health status. There has been limited assessment of the psychometric properties and validity of the Kessler Psychological Distress Scale for use with the Aboriginal and Torres Strait Islander population in Australia, despite its widespread use. Methods A national sample of Aboriginal and Torres Strait Islander adults (n = 6988 ≥ 16 years) was used in the psychometric assessment of the MK-K5, which involved face validity, acceptability, internal consistency/reliability, construct validity, and convergent and divergent validity testing. Receiver Operator Characteristics (ROC) curves were produced to assess clinical utility for depression and anxiety screening. Results The MK-K5 demonstrated face validity for psychological distress in two focus groups, and had good acceptability, good internal consistency/reliability (α = 0.89), good construct validity (uni-dimensional; one underlying component explaining 70.1% of variance), and demonstrated convergent and divergent validity in the sample. The MK-K5 had good clinical utility at a cut-off score of 11 for detecting ever being diagnosed with depression or anxiety. Conclusions The MK-K5 is a valid measure of psychological distress and has clinical utility in the Aboriginal and Torres Strait Islander population.

Primary hyperparathyroidism is a common endocrine disorder that results in elevated levels of parathyroid hormone and subsequent hypercalcaemia. Nurses have an important role in the support, education and care of the older person undergoing surgical or conservative treatment. Knowledge of pathophysiology is essential to ensure complications of hyperparathyroidism are identified promptly and managed appropriately alongside existing healthcare needs.

Osteoporosis is a chronic skeletal condition characterised by low bone mass and microarchitectural deterioration of the bones that disproportionately affects older people. Older people with osteoporosis are at increased risk of sustaining fragility fractures, and this risk is compounded by factors such as falls and frailty. Fragility fractures can have several physical and psychological effects, potentially affecting an older person's quality of life and reducing their life expectancy. Therefore, it is important that nurses can identify individuals at risk of osteoporosis and recognise the factors that may predict fragility fractures. This article outlines the main risk factors for osteoporosis and details the assessment and management of patients with this condition. It also explains the pharmacological interventions and lifestyle changes that can reduce the risk of fragility fractures in older people with osteoporosis.

Hypercalcaemia is a common biochemical abnormality in the blood that can be caused by malignancy, hyperparathyroidism, medications or underlying medical conditions. Initial signs and symptoms are often vague, however, if someone has severe hypercalcaemia it is treated as an emergency, requiring prompt management to prevent life-threatening complications such as dehydration, cardiac arrhythmias or coma. Understanding the pathophysiology, signs and symptoms of hypercalcaemia enables effective diagnosis and holistic management of the patient with complex health needs.

Infections associated with percutaneous pins and wires are common complications which can have a significant impact on patient outcomes. A survey was undertaken to identify current practice and gain insight into variations of clinical practice. Invitations were sent by email to complete an electronic questionnaire using SurveyMonkey. The survey was left open for 100 days. The single largest group of respondents (37.4%, n = 120) cleansed pin sites daily, with significant differences identified between medical and nursing professions (P = 0.02), and country of practice (P < 0.001). Significant differences were also identified in the use of different cleansing solutions between medical and nursing professions (P < 0.001) and country (P < 0.001). The majority group preferences were saline 30% (n = 96) and alcoholic chlorhexidine 29.6% (n = 95). Pin site crusts were routinely removed by 57.9% (n = 186). Pin sites were left exposed by 50.3% (n = 160). Dry gauze was identified as the most common dressing used to dress pin sites, however, substantial variation was identified in the types of dressings used. Compression was not routinely applied to pin sites by 51.6% (n = 165). There remains considerable diversity of practice when caring for pin sites. Further research is required to identify the most effective methods in preventing pin site infection.

Foot and ankle injuries are common and can have a significant effect on an individual's daily activities. Nurses have an important role in the assessment, management, ongoing care and support of patients with ankle injuries. An understanding of the anatomy and physiology of the ankle enables nurses to identify significant injuries, which may result in serious complications, and communicate effectively with the multidisciplinary team to improve patient care and outcomes.

Patients with fibromyalgia experience chronic widespread pain, with associated symptoms of fatigue, sleep disturbance and memory problems. There are many therapies which may be helpful in managing the symptoms of fibromyalgia; however, these often require a process of trial and error to establish optimum management using a combination of pharmacological and non-pharmacological approaches. Nurses can support patients with fibromyalgia using a biopsychosocial approach to symptom management. Understanding the nature of fibromyalgia and management options will enable nurses to deliver holistic patient-centred care.

Back pain is a common problem that may have physical and psychosocial consequences for the patient if not managed effectively. Assessment should aim to identify any underlying pathology so that targeted treatment can be provided. The nurse has a central role in giving the patient information about managing pain and offering support and reassurance if pain persists.

Residents are at risk of developing complications following amputation. Staff should facilitate their recovery so that they can continue to engage in activities of daily living. Jennie walker explains

• Objective: To determine the incidence of pressure ulceration in patients treated with cervical spine immobilisation. • Method: A retrospective case note analysis was conducted of all patients presenting with cervical spine injuries, who were treated with cervical spine immobilisation. • Results: Ninety consecutive patients were analysed retrospectively. Multiple level injuries were the most common reported injury and mean time until definitive treatment was 7.4 days. Halo immobilisation was used most frequently, with the mean time in halo vest immobilisation being 74 days. One patient was reported to have a pressure ulcer to the scapula relating to the use of halo immobilisation. No pressure ulcers were reported in patients immobilised with the use of cervical collar or occipito-cervico-thoracic immobilisation devices. • Conclusion: Patients with cervical spine immobilisation have an increased risk of developing pressure ulcers. All patients with cervical immobilisation devices require close monitoring to monitor the risk of developing pressure ulcers as well as the overall management of the medical condition. • Declaration of interest: There were not external sources of funding for this study. The author has no conflicts of interest to declare.

Rheumatoid arthritis is a complex chronic inflammatory condition which has both musculoskeletal and extra-articular effects. It is the most common inflammatory arthropathy, and has the potential to cause a significant impact on quality of life. The predominant features of the disease are inflammation, pain, reduced levels of function and increased morbidity. Despite the number of treatments available to suppress the effects of rheumatoid arthritis, it is not always possible to establish good control of the disease. It is imperative that the multidisciplinary team are involved with care to ensure that independence is maintained and function optimized. The role of the nurse in the management of rheumatoid arthritis is varied, ranging from providing specialist advice about how to manage the condition to caring for patients who are having joint replacements as a result of the increased levels of pain and damage it can cause.

External fixation is a well-established mode of treatment within orthopaedics; however, despite continued research, pin site infection is still a problem. Pin site infection may cause pain and discomfort to the patient, and result in osteomyelitis or sepsis if minor infection is not managed in a timely and appropriate manner. Fundamental issues such as the assessment and reporting of infection are important in dealing with pin site infection, as is the ongoing management of the pin site itself. Many types of care are evident, with varying evidence to support their use in clinical practice. This article will discuss the identification and classification of pin site infection and the methods of care.

Musculoskeletal conditions affect a significant number of people regardless of age or race. Osteoporosis, osteoarthritis and rheumatoid arthritis are common conditions, which have a considerable impact on acute and primary healthcare services. The management of musculoskeletal conditions emphasises the need for patient empowerment and education. The involvement of the multidisciplinary team is essential to maximise timely and effective management principles.

Hip and knee replacements are common orthopaedic procedures that can greatly improve patients' quality of life and provide relief from the pain caused by various musculoskeletal diseases. This article considers pre-operative preparation of the patient undergoing joint arthroplasty and significant post-operative clinical considerations. The nurse has an important role in the preparation, care and support of the patient throughout the surgical journey. Holistic assessment and effective pre and post-operative planning facilitate patient-focused care and optimal recovery.

Fractures to the pelvis can occur as a result of low-energy or high-energy trauma. Pelvic fractures may be associated with significant internal bleeding and injury to the organs within the pelvis. Patients with pelvic fractures often have complex healthcare needs; fractures resulting from high-energy trauma may be associated with multiple injuries, whereas fractures resulting from low-energy trauma, such as falls, may be associated with multiple patient comorbidities. Nurses have a fundamental role in the assessment and observation of the patient following pelvic fracture and are crucial in identifying any changes or deterioration in the patient's condition that require prompt intervention. This article focuses on the relevant anatomy of the pelvis, epidemiology and classification of pelvic fractures, and outlines the management and complications of pelvic fractures.

Many older people are affected by osteoarthritis (OA). The main symptoms of this chronic disease are pain, stiffness and potentially reduced function of affected joints. In severe OA the ability to engage in functional and social activities may be restricted and, as a consequence, quality of life may be affected. Nurses have an important role in pain assessment, education and support of people with OA in many different healthcare settings.

Osteoarthritis (OA) is a chronic disease that affects a significant number of people during working life and retirement. The principal symptoms of OA are pain and stiffness and the disease can also reduce movement and the function of the affected joint. In severe OA the ability to engage in work or social activity may be restricted and, as a result, the health-related quality of life of the patient may be affected. There are a variety of approaches that can be implemented to manage symptoms, including the use of orthoses, exercise programmes and, in severe cases, arthroplasty. It is important that emphasis is placed on patient empowerment and shared decision-making with regard to managing symptoms and preserving or improving function of affected joints.

Hip arthroplasty (total hip replacement) is a common orthopaedic procedure that can greatly improve patients' quality of life. This article discusses the pathophysiology of hip dysfunction, the assessment and pre-operative screening of patients with hip pain, and some of the post-operative nursing considerations following hip arthroplasty. Multidisciplinary care of patients undergoing hip arthroplasty is essential to provide optimal care and an efficient service.

Carpal tunnel syndrome is an upper limb entrapment neuropathy that can result in motor and sensory disturbance of the median nerve, affecting the hands. Treatment strategies may include the use of night splints, corticosteroid injections or surgical decompression. The aim of this article is to familiarise readers with carpal tunnel syndrome in relation to the relevant anatomy, signs, symptoms and management.

Osteoarthritis is a degenerative disorder of the synovial joints that is characterised by joint pain, stiffness and limited range of movement. The majority of nurses will encounter patients with this condition even though this might not be the reason they are seeking health care. This article discusses the associated signs and symptoms, investigations, diagnosis and treatment of this condition.

Summary Reflection has long been used as a developmental tool within nursing education, however the benefits of structured reflection for qualified nurses does not receive the same emphasis within clinical practice despite its well documented benefit in terms of professional development. The aim of this paper is to examine a specific clinical experience through the process of structured reflection to demonstrate that nurses can learn through the process of reflection and re-evaluate their perception of expert care. It was found that many nurses do not consider themselves to be expert in the areas in which they work; however, the use of structured reflection can assist nurses to identify areas of practice in which they operate in an expert manner and therefore enable themselves and others to value their work as expert professionals.

Osteoporosis is a multifactorial chronic disease that is characterised by low bone mass. It is important that practitioners are able to identify patients who have or are at risk of developing osteoporosis so that appropriate steps can be taken to diagnose the disease and offer patients appropriate treatment and information on specific lifestyle interventions.

This article explores the management of skeletal pin sites focusing on the research that underpins current practice. The effectiveness of pin site care depends on assessment and delivery of appropriate care. Because pin site management varies greatly between clinical areas, it is important that clinicians are aware of the evidence base on which their current practice is founded.

This article aims to provide a greater understanding of the process involved in diagnosing cancer, particularly that associated with spinal metastasis. The article focuses on the diagnosis of secondary cancer of the spine, however, the information and discussion might also be relevant to other anatomical areas.

Osteomalacia is a musculoskeletal condition that results in soft bones due to ineffective mineralisation. Nurses have a unique opportunity to improve awareness of osteomalacia and reduce its incidence through health education. Multidisciplinary management is important to minimise the effect of osteomalacia on activities of daily living and reduce the risk of fracture due to poor mineralisation of the bones.

Parkinson's is a complex degenerative disease which affects both motor and non-motor function and as such requires regular reassessment and collaboration between the patient and the healthcare team to achieve optimal outcomes. Complex medication regimes are often prescribed to manage symptoms; however, issues such as compliance, adherence and concordance need to be considered. The Parkinson's Nurse Specialist plays a central role in understanding patient needs and ability to manage medication regimes. The nurse has a fundamental function in achieving optimal medication adherence throughout the disease trajectory.

The incidence of fractures increases with advancing age partly due to the presence of multiple comorbidities and increased risk of falls. Common fracture sites in older people include femoral neck, distal radius and vertebral bodies. Nurses have an important role in caring for older patients who have sustained fractures, not only to maximise function and recovery, but as part of a team to minimise the morbidity and mortality associated with fractures in this group.

Cauda equina syndrome is a surgical emergency that requires prompt assessment and swift surgical intervention. Compression of the cauda equina can result in loss of power and sensation to the lower limbs, back pain and loss of bladder and bowel function. Research regarding timing of surgery and surgical outcome continues to be debated. Nurses have an important role in recognising symptoms of cauda equina syndrome and supporting the patient and effectively managing care based on individual healthcare needs.

Pin Site Infection (PSI) has been described as so common that “it seems reasonable to consider it unavoidable”. Infection can range from local soft tissue infection and cellulitis to osteomyelitis, bacterial endocarditis and septic arthritis, in severe cases this may progress to septicaemia [2-4]. In many cases minor infection can be remedied with increased pin site care and antibiotic therapy, whereas major infection requires prolonged treatment with systemic antibiotics and often the removal of pins.

In the management of osteoarthritis, it is important that emphasis be placed on patient empowerment and shared decision-making.

Osteoporosis is a chronic disease which is asymptomatic until fractures occur. It is an increasing problem within an ageing population and has many intrinsic and extrinsic risk factors. This article provides an overview of osteoporosis, including the pathogenesis, diagnosis and management. Multidisciplinary assessment and management of osteoporosis is essential with the apt use of non-pharmacologic and pharmacological options to minimize the risk of fracture and appropriately manage patients in an holistic manner

Spinal cord injury can have a devastating effect on patients and their families. An understanding of the mechanism of injury and how this can relate to functional ability assists healthcare professionals to anticipate the care that is required and any difficulties that the patient may encounter. Knowledge of spinal cord injury and the effects on the cardiorespiratory, gastrointestinal and genitourinary systems enables clinicians to provide effective care tailored to actual and potential complications, such as spinal shock and autonomic dysreflexia.

Drains are a common feature of the post-operative management of surgical patients. While drains serve an important function they are also associated with complications such as haemorrhage, tissue inflammation, retrograde bacterial migration and drain entrapment. It is therefore essential that nurses are familiar with the monitoring and management of surgical drains, but also the process involved in their removal.

The aim of this literature review is to examine the relationship between the provision of written information given to patients’ preoperatively and their postoperative recovery following elective surgery. It is not currently apparent which is the most effective method of delivering preoperative information, or at what stage of the preoperative phase is the optimum time to deliver such important information. The purpose of this review is to briefly outline the affiliation between anxiety experienced by surgical patients and the information received preoperatively and to examine the relationship between the provision of written information given to patients preoperatively and their postoperative recovery following elective surgery. Research findings are contradictory with respect to the effect of preoperative information on postoperative pain and patient satisfaction. However, research does indicate that the provision of good-quality preoperative information facilitates patients’ active involvement in their care, and therefore may contribute to an overall increase in satisfaction. There remains a need for rigorous research that identifies the optimum timing and method of delivering preoperative information to maximize their positive effects on patients undergoing elective surgery

Despite attempts to reduce their incidence, shunt infections remain a major complication of the treatment of hydrocephalus. Various forms of antimicrobial prophylaxis are in use, but no controlled, statistically valid trial has been conducted to assess their efficacy. Such a trial was therefore carried out and its design is described here. After a 1-year retrospective and prospective study by members of the United Kingdom Hydrocephalus Group to establish feasibility and infection rates, a statistical study showed that at least 712 patients would be required. Six centres were enrolled to fulfil these requirements, and ethical committee approval was obtained at each. The chosen prophylactic regimen was 10 mg vancomycin administered into the ventricular system during surgery. Adults and children undergoing insertion or revision of ventriculoperitoneal shunts were included unless they were receiving therapeutic antimicrobials. Randomisation was by computer-generated numbers. Controls received the antimicrobial regimen, if any, currently used in that centre, the only difference between the two groups being intraventricular vancomycin in the test group. Diagnosis of shunt infection included accepted clinical and microbiological criteria reinforced by measurement of serum C-reactive protein levels. Follow-up was for at least six months. After 2.5 years only 158 patients had been enrolled in the trial, 80 controls and 78 tests. There were 5 preventable infections in the control group and 2 in the test group. In view of the small total the planned statistical analysis was not possible. Therefore, while no problems were encountered with toxicity, the trial failed to enroll enough patients to answer the question of efficacy of antimicrobial prophylaxis in shunt surgery and the reasons for this are discussed.

THIS BOOK provides a good overview for any nurse working with neurosurgical patients in acute settings, or those with chronic diseases such as epilepsy or myasthenia gravis. It introduces relevant anatomy and physiology and contains clear illustrations and tables. chapters on the assessment, interpretation and management of specific problems, such as raised intracranial pressure and altered consciousness, provide examples of common scenarios experienced in the specialty.