Search

Importance: Children with chronic medical conditions are at increased risk of severe influenza. Uptake of influenza vaccination in children and adolescents with these identified special risk medical conditions (SRMCs) is suboptimal., Objective: To assess the effectiveness of Flutext-4U, a parent short message service (SMS) reminder nudge intervention, in increasing influenza immunization in children and adolescents with SRMCs., Design, Setting, and Participants: This randomized clinical trial was conducted at a tertiary pediatric hospital in Adelaide, South Australia, from April 15 to September 30, 2021. Children and adolescents aged 6 months to younger than 18 years with SRMCs and a subspecialist outpatient appointment over a 5-month period during the Australian seasonal influenza vaccination season (April-August 2021) were eligible to participate. Follow-up was until September 30, 2021., Interventions: Participants were randomly assigned (1:1 ratio) to control: clinician nudges (hospital vaccine availability, ease of access, and recommendation from hospital subspecialists) or SMS intervention (control conditions plus an additional SMS reminder nudge to parents), with randomization stratified by age group (<5 years, 5-14 years, or >14 to <18 years)., Main Outcomes and Measures: The primary outcome was influenza vaccination, as confirmed by the Australian Immunisation Register., Results: A total of 600 participants (intervention group: 298 [49.7%]; mean [SD] age, 11.5 [4.6] years; 162 female participants [54.4%]; control group: 302 [50.3%]; mean [SD] age, 11.4 [4.7] years; 155 female participants [51.3%]) were included. Influenza vaccination was 38.6% (113 of 293) in the SMS intervention group compared with 26.2% (79 of 302) in the control group (adjusted odds ratio [aOR], 1.79; 95% CI, 1.27-2.55; P = .001). Time to vaccine receipt was significantly lower among SMS participants (adjusted hazard ratio, 1.67; 95% CI, 1.25-2.22; P < .001). For participants randomly assigned by June 15, a significantly greater proportion receiving the SMS intervention were vaccinated during the optimal delivery period April to June 30 (SMS group: 40.0% [76 of 190] vs 25.4% [50 of 197]; aOR, 1.97; 95% CI, 1.28-3.06; P = .002)., Conclusions and Relevance: Results of this randomized clinical trial suggest that an additional SMS reminder nudge for parents delivered in the tertiary care hospital setting to children and adolescents with SMRCs resulted in higher influenza vaccine uptake compared with clinician nudges alone., Trial Registration: ANZCTR Identifier: ACTRN12621000463875.

Introduction: Influenza immunisation is a highly cost-effective public health intervention. Despite a comprehensive National Immunisation Program, influenza vaccination in children and adolescents with special risk medical conditions (SRMCs) is suboptimal. Flutext-4U is an innovative, multi-component strategy targeting paediatric hospitals, general practice and parents of children and adolescents with SRMC. The Flutext-4U study aims to assess the impact of Flutext-4U to increase influenza immunisation in children and adolescents with SRMC., Methods and Analysis: This is a randomised controlled trial involving parents of children and adolescents (aged >6 months to <18 years) with SRMC receiving tertiary care at the Women's and Children's Hospital (WCH), Adelaide, South Australia, who are eligible for funded influenza immunisation with a hospital appointment between the start of the seasonal influenza vaccination season and 31 July 2021, their treating general practitioners (GPs), and WCH paediatric specialists.Parents (of children/adolescents with SRMC) are randomised (1:1 ratio) to standard care plus intervention (SMS reminder messages to parents; reminders (written correspondence) for their child's GP from the hospital's Paediatric Outpatients Department) or standard care (hospital vaccine availability, ease of access and reminders for WCH subspecialists) with randomisation stratified by age-group (<5, 5-14, >14 to <18 years).The primary outcome is influenza vaccination, as confirmed by the Australian Immunisation Register.The proportion vaccinated (primary outcome) will be compared between randomised groups using logistic regression, with adjustment made for age group at randomisation. The effect of treatment will be described using an OR with a 95% CI., Ethics and Dissemination: The protocol and all study materials have been reviewed and approved by the Women's and Children's Health Network Human Research Ethics Committee (HREC/20/WCHN/5). Results will be disseminated via peer-reviewed publication and at scientific meetings, professional and public forums., Trial Registration Number: Australian New Zealand Clinical Trials Registry (ACTRN12621000463875)., Competing Interests: Competing interests: JT is an investigator on a project grant sponsored by Industry. Her institution has received funding from Industry (GSK) for investigator led research. She does not receive any personal payments from Industry. HM is an investigator on clinical vaccine trials sponsored by Industry (Pfizer, GSK). Her institution receives funding for Investigator led research from GSK, Pfizer, Sanofi-Pasteur. All other authors (KH, TRS, JF, JC, NS, AT, AK, RC, MF, LF, MD, CCB) report no conflicts of interest., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: Antenatal breast expression (ABE) has been taught in the past as breast preparation. Now some authorities are advising ABE and storage of colostrum for the feeding the newborn in the treatment and/or prevention of hypoglycaemia in the immediate postnatal period (thus avoiding the need for formula supplementation). The actual incidence of ABE teaching amongst International Board Certified Lactation Consultant (IBCLC) Midwives is unknown. Results of this study will provide valuable baseline data for future randomised controlled trials into this practice., Research Question: What are the teaching practices surrounding ABE and the incidence of this type of teaching by IBCLC Midwives across Australia?, Method: A descriptive cross-sectional Internet survey containing both quantitative and qualitative questions was sent to Australian IBCLC Midwives. Simple descriptive statistics was used to analyse quantitative data. Content analysis examined qualitative textual data of open-ended questions., Findings: Response rate was 27% (n=347/1269). 93% (n=322) of those responding to the survey had heard of ABE. 60% (n=134) actively teach the practice. Descriptive statistics and content analysis revealed marked differences in teaching practices amongst this specialised group of midwives., Conclusion: This study suggested a large proportion of lactation qualified midwife respondents were aware of ABE and some currently teach the skill. However, advice given to women during pregnancy varied substantially., (Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.)

Objective: to examine changes in midwives' attitudes to their professional role following the introduction of midwifery group practice (MGP) (a caseload model of midwifery continuity of care provided to women of all risk levels) and to explore aspects of the model that were working well and those that were not working well., Design: the questionnaire 'Attitudes to Professional Role' was used to measure midwives' satisfaction in terms of professional satisfaction, professional support, client interaction, and professional development. Open-ended questions were also included to offer an opportunity for midwives to expand on their experiences of working in the MGP model. The questionnaire was administered at five time points over the 18-month evaluation period. Round 1 was prior to the implementation of MGP, Rounds 2-4 were at three-month intervals, with Round 5 six months later. Analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from -2 (very negative attitudes) to +2 (very positive attitudes), and the open-ended questions were analysed using qualitative content analysis., Setting: the Women's and Children's Hospital, Adelaide, South Australia., Participants: questionnaires were distributed to all midwives (n=15) working in MGP in Rounds 1, 2 and 3, and to the 12 midwives remaining from the original sample in Rounds 4 and 5. Fourteen questionnaires were returned in Round 1, 12 in Round 2, 10 in Round 3, nine in Round 4, and 10 in Round 5., Findings: overall, a positive change in attitudes to professional role was reflected in all sub-scales in the period between start-up and 18 months later; a reduction in scores occurred in Round 3. The mean increases were significant for all sub-scales apart from professional development. Five main themes were identified across the rounds in the content analysis: 'continuity of care', 'working pattern', 'working environment', 'collegiality' and 'issues relating to midwifery practice'. Midwives gained particular satisfaction from providing continuity of care and building relationships with women and their families, and through practising autonomously as a midwife. While there was a struggle to manage the hours worked and being on call, high levels of professional satisfaction were maintained., Key Conclusions: while there were aspects of MGP that midwives were not satisfied with and wanted to change, overall they were satisfied with the model., Implications: there is a need for ongoing evaluation in order to monitor the short- and long-term impact on midwives of working in a caseload model of continuity of midwifery care., (Copyright 2009. Published by Elsevier Ltd.)

Background: Midwifery Group Practice (MGP) is a continuity of midwifery care model for women of all levels of pregnancy risk available at a tertiary metropolitan hospital in Australia. This paper presents Part II of the demonstration study exploring the effectiveness of MGP, and reports on women's satisfaction with the model of care., Methods: A Maternal Satisfaction Questionnaire was developed and sent to all women (n=120) enrolled in MGP over a three-month period. The questionnaire comprised two open-ended questions asking women to list up to three things they liked and did not like about MGP, and a structured section exploring levels of satisfaction through a five-point Likert response format. The open-ended questions were analysed using qualitative content analysis, and analysis of the structured part of the questionnaire was undertaken by comparing mean scores of satisfaction ranging from -2 (very negative attitudes) to +2 (very positive attitudes)., Results: Of the 120 women who were sent a Maternal Satisfaction Questionnaire, 84 returned their questionnaire (70% response rate). Three overarching themes were identified in the content analysis of open-ended questions, namely: Continuity of care; Accessibility; and Personal and professional attributes of the midwife. Analysis of the structured part of the questionnaire showed that women were satisfied with the care they received in MGP, as indicated by positive scores on all questions., Conclusions: Women being cared for in MGP are satisfied with their care.

Performance feedback has the potential to contribute to a nurse's self-awareness and, in turn, their ability to self-assess their level of competence. Because a declaration of self-assessment of competence is a current requirement for continuing nursing registration within South Australia, Queensland and Tasmania, the search to identify sources and processes that may assist nurses to self-assess their performance is potentially of benefit to the profession. This paper is based on one aspect of a PhD study exploring the utility of performance feedback primarily from a nursing clinicians' perspective. Focus group interviews were conducted with hospital-based nursing clinicians and the data were analysed using a process of thematic analysis. Findings highlighted that nursing clinicians frequently engaged in a process of performance self-monitoring that was a balance between feeling competent and feeling uncertain in relation to their own level of clinical competence. On a daily basis, nursing clinicians held an assumption of competence to practise that was based on their ability to act in a situation, receiving positive feedback from others and in the absence of evidence to the contrary. At times feelings of doubt or uncertainty intervened especially in situations that were unfamiliar or challenging or when receiving feedback from others that questioned their own perceptions of competence. The findings of the study provide support for the types of self-monitoring processes that serve to enhance both the relevance of feedback for nurses and the quality of evaluative data regarding ongoing competence.