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Background: The ineffective implementation of evidence based practice guidelines can mean that the best health outcomes are not achieved. This study examined the barriers and enablers to the uptake and implementation of the new bi-national (Australia and New Zealand) antenatal corticosteroid clinical practice guidelines among health professionals, using the Theoretical Domains Framework.Methods: Semi-structured interviews or online questionnaires were conducted across four health professional groups and three district health boards in Auckland, New Zealand. The questions were constructed to reflect the 14 behavioural domains from the Theoretical Domains Framework. Relevant domains were identified by the presence of conflicting beliefs within a domain; the frequency of beliefs; and the likely strength of the impact of a belief on the behaviour using thematic analysis. The influence of health professional group and organisation on the different barriers and enablers identified were explored.Results: Seventy-three health professionals completed either a semi-structured interview (n = 35) or on-line questionnaire (n = 38). Seven behavioural domains were identified as overarching enablers: belief about consequences; knowledge; social influences; environmental context and resource; belief about capabilities; social professional role and identity; and behavioural regulation. Five behavioural domains were identified as overarching barriers: environmental context and resources; knowledge; social influences; belief about consequences; and social professional role and identity. Differences in beliefs between individual health professional groups were identified within the domains: belief about consequences; social professional role and identity; and emotion. Organisational differences were identified within the domains: belief about consequences; social influences; and belief about capabilities.Conclusion: This study has identified some of the enablers and barriers to implementation of the New Zealand and Australian Antenatal Corticosteroid Clinical Practice Guidelines using the validated Theoretical Domains Framework, as perceived by health professionals. We have identified differences between individual health professional groups and organisations. The identification of these behavioural determinants can be used to enhance an implementation strategy, assist in the design of interventions to achieve improved implementation and facilitate process evaluations to understand why or how change interventions are effective. [ABSTRACT FROM AUTHOR]

Objectives: To examine factors contributing to delaying care home admission; and compare the rates of care home admission and cost consequence between two government subsidised programmes, Veterans' Affairs Community Nursing (VCN) and Home Care Package (HCP)., Methods: Our national, population-based retrospective cohort study and cost analysis used existing, de-identified veterans' claims databases (2010-19) and the Registry of Senior Australians Historical Cohort (2010-17), plus aggregate programme expenditure data. This involved 21,636 VCN clients (20,980 aged 65-100 years), and an age- and sex-matched HCP cohort (N = 20,980)., Results: Service factors associated with lower risk of care home admission in the VCN cohort were periodic (versus continuous) service delivery (HR 0.27 [95%CI, 0.24-0.31] for ≤18 months; HR 0.89 [95%CI, 0.84-0.95] for >18 months), and majority care delivered by registered nurses (versus personal care workers) (HR 0.86 [95%CI, 0.75-0.99] for ≤18 months; HR 0.91 [95%CI, 0.85-0.98] for >18 months). In the matched cohorts, the time to care home admission for VCN clients (median 28 months, IQR 14-42) was higher than for HCP clients (14, IQR 6-27). Within 5 years of service access, 57.6% (95%CI, 56.9-58.4) of HCP clients and 26.6% (95%CI, 26.0-27.2) of VCN clients had care home admission. The estimated cost saving for VCN recipients compared to HCP recipients over 5 years for relevant government providers was over A$1 billion., Conclusions: Compared to an HCP model, individuals receiving VCN services remained at home longer, with potentially significant cost savings. This new understanding suggests timely opportunity for many countries' efforts to enhance community-based care services., (© The Author(s) 2023. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objective: To evaluate the association of donor sex with transfusion-associated recipient immune responses in preterm newborns receiving unwashed and washed blood., Design: A cohort study using data collected during the Effect of Washed versus Unwashed Packed Red Blood Cell Transfusion on Immune Responses in the Extremely Preterm Newborn randomised trial., Setting: Participants were recruited from two South Australian hospitals between September 2015 and December 2020., Patients: Preterm newborns (<29 weeks)., Interventions: Transfusion with unwashed and washed packed red blood cells (PRBCs) from either exclusively male or any female donor for the first three transfusions., Main Outcomes Measures: The primary outcome was the change from baseline in post-transfusion plasma cytokine concentrations, specifically interferon gamma, interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-12, IL-17A and tumour necrosis factor (TNF)., Results: In total, 153 newborns were evaluated. By the third transfusion, the magnitude of pretransfusion to post-transfusion change in cytokines between the groups differed for IL-6 (p=0.003), IL-12 (p=0.008), IL-17A (p=0.003) and TNF (p=0.007). On post hoc comparison, compared with the unwashed-any female donor group, IL-6 (p<0.05), IL-12 (p<0.05) and IL-17A (p<0.01) were lower in the washed-exclusively male donor group, and IL-6 (p<0.01), IL-12 (p<0.05) and TNF (p<0.01) were lower in the washed-any female donor group., Conclusion: These findings suggest that transfusion with unwashed PRBCs from female donors is associated with an increased recipient immune response, an effect that can be ameliorated with pretransfusion washing. Larger randomised controlled studies confirming this mechanistic link between donor sex and transfusion-associated morbidity are warranted., Trial Registration Number: ACTRN12613000237785., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.)

Voltage-gated sodium (Na V ) channels are critical regulators of neuronal excitability and are targeted by many toxins that directly interact with the pore-forming α subunit, typically via extracellular loops of the voltage-sensing domains, or residues forming part of the pore domain. Excelsatoxin A (ExTxA), a pain-causing knottin peptide from the Australian stinging tree Dendrocnide excelsa, is the first reported plant-derived Na V channel modulating peptide toxin. Here we show that TMEM233, a member of the dispanin family of transmembrane proteins expressed in sensory neurons, is essential for pharmacological activity of ExTxA at Na V channels, and that co-expression of TMEM233 modulates the gating properties of Na V 1.7. These findings identify TMEM233 as a previously unknown Na V 1.7-interacting protein, position TMEM233 and the dispanins as accessory proteins that are indispensable for toxin-mediated effects on Na V channel gating, and provide important insights into the function of Na V channels in sensory neurons., (© 2023. The Author(s).)

Objectives: Centre-based aged care services are a key site of early intervention and support for people with dementia and their carers. This paper examines the impact of new aged care funding structures on centre-based aged care service accessibility and delivery. It also examines the challenges and opportunities for change facing the sector in the light of the COVID-19 pandemic., Methods: Semi-structured interviews were conducted online with 29 managers or supervisors of centre-based aged care services in Greater Sydney., Results: The analysis reinforced the essential role of centre-based aged care services in improving the cognitive, physical and psychological health of older people with dementia and their carers. However, the changing funding context and the COVID-19 pandemic have created challenges in access to centre-based services, particularly for the most vulnerable. The challenges created by the COVID-19 pandemic also opened opportunities for the introduction of new models of service practice to meet the individual needs of older people and their carers., Conclusions: Greater investment in, and flexibility in the funding for, centre-based aged care services is needed to facilitate access for people with dementia and their carers and improve their health and well-being., (© 2022 The Authors. Australasian Journal on Ageing published by John Wiley & Sons Australia, Ltd on behalf of AJA Inc'.)

Background: Academic dishonesty is increasing in prevalence in universities globally. Concerns exist that engagement in academic dishonesty by nursing students may transfer to professional misconduct in the clinical setting, thereby jeopardising the quality of patient care., Objectives: To determine the type and prevalence of academic dishonesty engaged in by post-registration nursing students and their understanding of the relationship between academic honesty and professional conduct., Design: An exploratory quantitative study employing a cross sectional survey., Settings and Participants: A convenience sample of undergraduate students enrolled in an Australian post-registration nursing degree program delivered in a Southeast Asian country., Methods: An online anonymous survey comprising 38 Likert-style items was completed by 179 voluntary participants. Descriptive statistics were used to analyse data pertaining to the frequency and type of academic dishonesty. Chi-square tests were used to identify associations between issues such as frequency of engagement to academically dishonest activities and perceptions of professional misconduct. Responses to open-ended questions was undertaken using descriptive summative content analysis., Results: Almost 96% (n = 153) of participants agreed that academic dishonesty constitutes a breach of professional codes of conduct with 97.5% (n = 156) stating it should be viewed as professional misconduct. Findings revealed 44.1% (n = 79) of participants reported engagement with at least one type of academic dishonesty. Of these, 55 (69%) reported involvement in two or more types., Conclusions: Academic dishonesty continues to be an issue in nursing education with serious ramifications for professional conduct and patient outcomes. Educators must take a targeted approach to educating students about the importance of academic integrity and its relationship to professional conduct. This includes supporting students to develop academic skills such as referencing. Appropriate penalties and reporting of students who engage in academic dishonest behaviour to academic and professional regulatory authorities are also essential actions required to prevent academic dishonesty., (Crown Copyright © 2021. Published by Elsevier Ltd. All rights reserved.)

Background and Objective: People living with pulmonary fibrosis (PF) report unmet needs for information and support. Lung Foundation Australia (LFA) have developed the Peer Connect Service to facilitate telephone support for people with PF across Australia. This project documented the experiences of participants and the resources required to support the service., Methods: Consenting participants took part in semi-structured interviews by telephone. Primary peers (peers who agreed to initiate contact) and secondary peers (eligible patients who sought a peer match) were interviewed. Thematic analysis was undertaken by two independent researchers. Data were collected on the number of matches and contacts required to establish each match., Results: Interviews were conducted with 32 participants (16 primary peers, 15 secondary peers and 1 who was both), aged from 53 to 89 years with 56% being male. Major themes included the value of shared experiences, providing mutual support and the importance of shared personal characteristics (e.g. gender and hobbies) in allowing information and emotional support needs to be met. Participants saw face-to-face contact with peers as highly desirable whilst acknowledging the practical difficulties. Primary peers were cognizant that their role was not to provide medical advice but to listen and share experiences. In the 12-month period, 60 peer matches were made, each match requiring a minimum of seven staff contacts., Conclusion: The Peer Connect Service provides a unique opportunity for people with PF to share experiences and offer mutual support. This telephone matching model may be useful in providing peer support for individuals with rare diseases who are geographically dispersed., (© 2020 Asian Pacific Society of Respirology.)

Background: International students report multiple challenges adjusting to educational settings. Instructional strategies such as Team Based Learning (TBL), could provide international students with opportunities that promote academic success, language skills and social connectedness. However, little is known about international students' experience of TBL. The aim of this study was to explore culturally and linguistically diverse (CALD) students' experiences of TBL., Methods: This paper reports on a qualitative study that explored the experiences of 15 international students enrolled in an Australian university nursing program, where TBL is used., Results: Findings indicate that TBL promotes language proficiency and respectful intercultural connections. It also uncovered an unintentional benefit of TBL in interrupting racism towards international students from domestic students. However, it is not enough to rely on TBL to mitigate the impact of racial and cultural power dynamics in educational settings., Conclusion: To improve international student experiences, educators must actively engage students in dialogue about privilege and structural racism as it relates to international students and other people of colour., Competing Interests: Declaration of competing interest None declared., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Australia is increasingly becoming a culturally diverse country, with this trend being reflected in nursing education as significant numbers of students enrol from backgrounds where English is a second/other language (ESL). These students will enable the provision of culturally competent care that a culturally diverse health system requires (Ohr et al., 2010), however they require significant levels of support to not only achieve academically in their nursing programme, but also to perform at the expected level during clinical placements (Boughton et al., 2010). Difficulties communicating with colleagues, patients and their families in the clinical setting have been identified among the challenges that ESL nurses face (Boughton et al., 2010; Jeong et al., 2011). A review of the literature indicates sporadic research into the education of nurses from ESL backgrounds. This paper discusses and raises awareness of common themes such as the challenges of adjusting to Western culture and using the advanced and technical English required by higher education and healthcare. This paper also discusses mixed results reported from a number of English language support programmes. This indicates a need for further research in this area to strengthen support for these nurses who can assist in the provision of culturally competent care., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background: Positioning of patients is a modifiable risk factor for ventilator-associated pneumonia. Current guidelines for prevention of ventilator-associated pneumonia recommend semirecumbency at 30º, with 45º preferable unless contraindicated., Objective: To assess the use of semirecumbency for ventilator patients in Australian and New Zealand intensive care units., Methods: In a multicenter, observational study, backrest elevation, mean arterial pressure, use of inotropic agents, enteral feeding, and weaning status were recorded 3 times per day by using a predetermined randomization schedule for 7 consecutive days (maximum 21 observation episodes). Severity of illness was recorded daily by using the Sepsis-Related Organ Failure Assessment (SOFA) score., Results: Measurements (n = 2112) were recorded for 371 ventilator patients in 32 intensive care units. Backrest elevation at ≥45º was noted for 112 of 2112 (5.3%; 95% confidence interval [CI], 4.3-6.3) measurements; elevation ≥30º but <45º for 472 of 2112 (22.3%; 95% CI, 20.6-24.1). Contraindications to semirecumbency were noted during 447 measurements. Increased back-rest elevation occurred during enteral feeding (2.2º, P < .001) and weaning (3.1º, P < .001). Decreased backrest elevation was associated with inotropic support (2.8º, P < .001), decreased mean arterial pressure (0.7º/10 mm Hg, P < .001), and organ failure (0.5º/1-point increment in SOFA(max) score, P < .001). For measurements recorded with no contraindication to semirecumbency, weaning status (P = .003) and SOFA(max) score (P = .008) remained associated with the degree of backrest elevation., Conclusions: The findings of this multicenter, observational study suggest that backrest elevation was less than recommended and was influenced by clinical practices and patient condition.