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The study aimed to evaluate the effect of an intervention on the prevalence and severity of incontinence-associated dermatitis (IAD) in six hospitals in one state in Australia. This quasi-experimental pre-and post-study, conducted in 18 wards, was part of a larger implementation science study on incontinence-associated dermatitis. Skin and incontinence assessments were conducted on patients during February and March 2020 (pre-intervention) and July and August 2021 (post-intervention). The intervention comprised continence assessment and management, an education brochure for patients, family and caregivers on IAD, the Ghent Global IAD Categorisation Tool (GLOBIAD) and a skin care regime with patient skin protection measures (three-in-one barrier cream cloths, minimisation of bed protection layers, use of appropriate continence aid). A total of 1897 patients were assessed (pre-intervention = 964, post-intervention = 933). A total of 343 (35.6%) pre-intervention patients and 351 (37.6%) post-intervention patients had incontinence. The prevalence of hospital-acquired IAD was 6.71% in the pre-intervention group and 4.27% in the post-intervention group; a reduction of 36.3% (p = 0.159) despite higher patient acuity, prevalence of double incontinence and the COVID-19 pandemic in the post-intervention group compared with the pre-intervention group. Our multisite best practice IAD prevention and treatment intervention was able to reduce the prevalence and severity of hospital-acquired IAD, suggesting enduring effectiveness of the intervention., (© 2024 The Author(s). International Wound Journal published by Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Aim: To establish the prevalence of positional head deformations (PHDs) within a neonatal unit (NU) setting, and to evaluate the subsequent impact that PHDs have on NU graduates and their families., Methods: A prospective audit was conducted over a six-week period within a tertiary NU (Brisbane, Australia). Eligible babies were measured weekly using a craniometer where presence, type and severity of PHD were determined. Univariate analysis was undertaken to establish differences in clinical characteristics between babies with, and without, the presence of PHD. A study-specific survey was completed by a separate set of families returning for outpatient follow-up services who represented similar clinical characteristics and risk factors for PHD., Results: Fifty-three babies were eligible for inclusion in the audit. PHDs were identified in 66% (n = 35) of the cohort, the most common being scaphocephaly (52.8%, n = 28). Within that, 46% (n = 13) were classed as mild, 25% (n = 7) were moderate and 29% (n = 8) were severe. Moderate correlation (r = 0.55) was found between severity of scaphocephaly, and length of time spent in an isolette. Of the 10 (66% response from 15 families) surveys completed, 80% of respondents perceived that their child's PHD had impacted their life., Conclusions: Two-thirds of babies developed a PHD during their neonatal admission. Most families surveyed perceived this condition to have an impact on their lives beyond the confines of the nursery. Further research is needed to identify preventative interventions to decrease the prevalence and severity of this common condition., (© 2023 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Objectives: This study aims to explore the journey to dementia diagnosis and reaction to the diagnosis from the perspective of people with young-onset dementia living in the community from diverse areas in Australia (metropolitan, regional, rural) and their family caregivers., Methods: Semi-structured interviews were conducted with community-dwelling people with early to moderate young-onset Alzheimer's disease ( n = 8) or frontotemporal dementia ( n = 5) and one person with both Alzheimer's disease and frontotemporal dementia, and family caregivers of community-dwelling people with young-onset Alzheimer's disease and/or frontotemporal dementia ( n = 28). This study employed interpretive description. Thematic analysis was conducted for emergent themes, comparisons and interplay between themes., Findings: The journey to the diagnosis is characterised as involving an extensive period of the gradual worsening of symptoms, drawn out investigations, and difficulties facing the prospect of a diagnosis of young-onset dementia. Participants with young-onset dementia struggled to manage their symptoms and the process of seeking a diagnosis was often slow due to difficulties during the course of their medical investigations and feeling reluctance to face the possibility of having dementia. Once participants finally received the diagnosis of young-onset dementia, participants with young-onset dementia and their family caregivers experienced feelings of devastation and shock, in some cases denial and avoidance, and even, confirmation and relief at having received a diagnosis. In some instances, participants experienced more than one of these reactions. There was a profound realisation by participants that a diagnosis of young-onset dementia had serious implications on their life and future., Conclusion: The journey to diagnosis was found to be a drawn-out process and receiving the diagnosis was a shock for both people with young-onset dementia and their family caregivers. The findings highlight the significance of the role healthcare professionals play in both the diagnostic and post-diagnostic journey, particularly in terms of supporting patients with young-onset dementia and their family caregivers.

This article reports of a study on 19 Australian community interpreters and their experience in facilitating mediated communication in the National Disability Insurance Scheme (NDIS), which was introduced in Australia in 2016. These interpreters were among those who attended a training workshop comprising of a pedagogical segment explaining this new scheme in detail, and a hands-on segment to translate a selection of NDIS terms into their target language to highlight possible linguistic and cultural challenges they may encounter. The training aimed to enable the interpreters to facilitate NDIS communication with clients from linguistically and culturally diverse backgrounds in ways that make sense to their culture and experience. The purpose of the current study is to understand the extent the participant interpreters applied their learning in NDIS communication, and their perspective about specific challenges in this new contextual area, where certain concepts and terms may be hard to translate, and the understanding of disability may be culturally bound. The aim of the study is to deepen the understanding of multicultural communication in disability services, and to inform similar future professional development during major changes to systems in the disability sector, and more broadly in health and welfare.

Objectives: To compare time to incidence, extent of incidence and severity of heel pressure injury with a heel off-loading boot (intervention) or pillows (control)., Research Methodology/design: Multi-centre, single-blinded randomised controlled trial of 394 critically ill patients. Patients were randomised to the intervention or control for heel offloading., Setting: Three hospital intensive care units; two in greater Sydney, Australia and one in regional New South Wales, Australia., Main Outcome Measures: Time to intensive care unit-acquired pressure injury in heels of patients without pre-existing heel pressure injury within 28 days from intensive care unit admission., Secondary Outcomes: incidence of heel pressure injury within 28 days of intensive care unit admission; severity of intensive care unit-acquired heel pressure injuries; occurrence of plantar contractures (a change in ankle dorsiflexion of 5° or greater) within 28 days of admission., Results: Within 28 days of admission, one pressure injury was recorded in the intervention group and 11 in the control group. Hazard of pressure injury incidence within 28 days of admission was significantly lower (p = 0.0239) in heels assigned to the intervention (hazard ratio 0.0896 [95% CI 0.0110, 0.727]). Odds of pressure injury incidence within 28 days of admission were significantly lower (p = 0.0261) in the intervention group (odds ratio 0.0883 [95% CI 0.0104, 0.749]). The pressure injury recorded in the intervention group was superficial (stage 1) whereas those recorded in the control group were more severe (stage 2 to 4)., Conclusion: The heel-offloading boot used in this study significantly reduced heel pressure injury occurrence compared with heel offloading using pillows., (Copyright © 2022. Published by Elsevier Ltd.)

Aim: To determine if any cases of culture-positive neonatal early-onset sepsis (EOS) would be missed using the neonatal EOS calculator, when compared with current guidelines and practices., Methods: Retrospective audit of all neonates born at ≥35 weeks and admitted to Royal Brisbane and Women's Hospital with EOS from January 2014 to December 2020. A missed case was defined as antibiotic therapy not being recommended within 24 h of birth. Management recommendations according to the neonatal EOS calculator were compared with current guidelines and current practices., Results: There were significantly more missed cases using the neonatal EOS calculator compared to the current guideline and current management groups. Using the neonatal EOS calculator, 11 neonates (35%, 95% confidence interval 19.2-54.6%) would not have received antibiotics by 24 h of age. In comparison, only one neonate (3%, 95% confidence interval 0.1-16.7%) would not have received antibiotics by 24 h of age using the current guidelines. In terms of the current practice in the cohort of patients, two neonates (6%) did not receive antibiotics by 24 h of age., Conclusions: The significantly higher rate of missed cases using the neonatal EOS calculator compared with current guidelines and practice supports the concerns many neonatologists have regarding safety of the neonatal EOS calculator., (© 2022 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

Purpose: The purpose of this study was to describe the development and evaluation of the psychometric properties of an instrument used to assess clinician knowledge of Incontinence-associated dermatitis (IAD)., Design: The instrument was developed in three phases: Phase 1 involved item development; Phase 2 evaluated content validity of the instrument by surveying clinicians and stakeholders within a single state of Australia and, Phase 3 used a pilot multisite cross-sectional survey design to determine composite reliability and evaluate scores of the knowledge tool., Subjects and Settings: In Phase 1, the instrument was developed by five persons with clinical and research subject expertise in the area of IAD. In Phase 2, content validity was evaluated by a group of 13 clinicians (nurses, physicians, occupational therapists, dietitians, and physiotherapists) working in acute care across one Australian state, New South Wales, along with two consumer representatives. In Phase 3, clinicians, working across six hospitals in New South Wales and on wards with patients diagnosed with incontinence-associated dermatitis, participated in pilot-testing the instrument., Methods: During Phase 1, a group of local and international experts developed items for a draft tool based on an international consensus document, our prior research evaluating incontinence-associated dermatitis knowledge, and agreement among an expert panel of clinicians and researchers. Phase 2 used a survey design to determine content validity of the knowledge tool. Specifically, we calculated item- and scale-level content validity ratios and content validity indices for all questions within the draft instrument. Phase 3 comprised pilot-testing of the knowledge tool using a cross-sectional survey. Analysis involved confirmatory factor analysis to confirm the hypothesized model structure of the knowledge tool, as measured by model goodness-of-fit. Composite reliability testing was undertaken to determine the extent of internal consistency between constituent items of each construct., Results: During Phase 1, a draft version of the Barakat-Johnson Incontinence-Associated Dermatitis Knowledge tool (Know-IAD), comprising 19 items and divided into three domains of IAD-related knowledge: 1) Etiology and Risk, 2) Classification and Diagnosis, and 3) Prevention and Management was developed. In Phase 2, 18 of the 19 items demonstrated high scale content validity ratios scores on relevance (0.75) and clarity (0.82); and high scale-content validity indices scores on relevance (0.87) and clarity (0.91). In Phase 3, the final 18-item Know-IAD tool demonstrated construct validity by a model goodness-of-fit. Construct validity was excellent for the Etiology and Risk domain (root mean squared error=0.02) and Prevention and Management domain (root mean squared error=0.02); it was good for the Classification and Diagnosis domain (root mean squared error=0.04). Composite reliability (CR) was good in the Etiology and Risk domain (CR=0.76), Prevention and Management domains (CR=0.75), and adequate in the Classification and Diagnosis domain (CR=0.64). Respondents had good understanding of etiology and risk (72.6% correct responses); fairly good understanding of prevention and management of IAD (64.0% correct responses) and moderate understanding of classification and diagnosis (40.2% correct responses)., Conclusions: The Know-IAD demonstrated good psychometric properties and provides preliminary evidence that it can be applied to evaluate clinician knowledge on IAD., Competing Interests: The authors declare there is no conflict of interest., (Copyright © 2022 by the Wound, Ostomy and Continence Nurses Society.)

Aims: Incontinence-associated dermatitis (IAD) is an insidious and under-reported hospital-acquired complication which substantially impacts on patients' quality of life. A published international guideline and the Ghent Global IAD Categorisation Tool (GLOBIAD) outline the best available evidence for the optimal management of IAD. This study aims to implement theguideline and the GLOBIAD tool and evaluate the effect on IAD occurrences and sacral pressure injuries as well as patient, clinician and cost-effectiveness outcomes., Materials and Methods: The study will employ a multi-method design across six hospitals in five health districts in Australia, and will be conducted in three phases (pre-implementation, implementation and post-implementation) over 19 months. Data collection will involve IAD and pressure injury prevalence audits for patient hospital admissions, focus groups with, and surveys of, clinicians, patient interviews, and collection of the cost of IAD hospital care and patient-related outcomes including quality of life. Eligible participants will be hospitalised adults over 18 years of age experiencing incontinence, and clinicians working in the study wards will be invited to participate in focus groups and surveys., Conclusion: The implementation of health district-wide evidence-based practices for IAD using a translational research approach that engages key stakeholders will allow the standardisation of IAD care that can potentially be applicable to a range of settings. Knowledge gained will inform future practice change in patient care and health service delivery and improve the quality of care for patients with IAD. Support at the hospital, state and national levels, coupled with a refined stakeholder-inclusive strategy, will enhance this project's success, sustainability and scalability beyond this existing project., (Crown Copyright © 2020. Published by Elsevier Ltd. All rights reserved.)

This qualitative study is conducted via focus groups with 47 Australian public service interpreters to investigate their responses to vicarious trauma (VT) in their practice, the influence of culture, and their views on how to maintain mental well-being. While participant interpreters employ various strategies to deal with traumatic client content and other work stressors, cultural inhibitors are found to prevent some from sharing their emotional vulnerability or seeking professional help. They indicated that they want to be treated with respect and as part of the professional team, rather than a machine or a shadow. Professional development is needed to clarify the limits of confidentiality, explain trauma and its vicarious possibilities, and to establish interpreters' professional entitlement to briefing and debriefing. Stakeholders including educators, professional associations, interpreting agencies, and other professions and institutional users of interpreting services should work respectfully and collaboratively to prevent and help interpreters recover from VT.

Background: Considerable evidence exists on how to prevent hospital-acquired pressure injuries (HAPIs). However, processes employed to implement evidence play a significant role in influencing outcomes., Problem: One Australian health district experienced a substantial increase in HAPIs over a 5-year period (by almost 60%) that required a systemwide practice change., Approach: This article reports on the people, processes, and learnings from using the Promoting Action on Research Implementation in Health Services (PARiHS) framework taking into account the evidence, context, and facilitation to address HAPIs., Outcomes: Applying this approach resulted in a significant decrease in pressure injuries and positive practice change, leading to improved patient outcomes in a shorter time frame than previous strategies., Conclusion: Processes guided by the PARiHS enhanced the effectiveness of translating evidence into practice and positively assisted clinicians to promote optimal patient care. This approach is transferrable to other health care settings.

Objectives The aims of this study were to determine the costs of hospital-acquired pressure injuries (HAPIs) in one local health district in Australia and compare the costs and consequences of an intervention-based program with current practice to reduce HAPI incidence and prevalence. Methods A retrospective cost-consequence analysis was conducted using HAPI incidence rate per occupied bed days, point prevalence rates, Australian Refined-Diagnosis Related Group (AR-DRG) costs and the costs of the program to reduce the HAPI rate. Data were analysed for two phases: preprogram implementation (1 June 2015-1 June 2016) and postprogram implementation (1 August 2016-31 July 2017). Results The HAPI intervention-based program resulted in a 51.4% reduction in the incidence of HAPI (from 1.46 per occupied bed day in 2014 to 0.71 per occupied bed day in 2017) and a 71.6% reduction in the prevalence of HAPI (from 6.7% in 2014 to 1.9% in 2017). The occurrence of HAPI added an average cost of A$3332 per episode, such that the overall program, including implementation, reduced costs by A$837387. The greatest cost reduction was due to the cessation of washable and disposable underpads. The largest contributor to the cost of HAPI prevention was for education and training regarding HAPI prevention initiatives. Conclusions The HAPI intervention-based program halved the incidence and substantially reduced the prevalence of HAPI, with a 23.1% cost saving compared with the previous approach to preventing HAPIs. What is known about the topic? HAPIs are costly to the individual, the organisation and health system. The prevention of HAPIs is a priority in Australia. There is limited research on the economic effect of HAPIs and the costs and consequences for hospitals of implementation strategies to reduce their incidence. What does this paper add? This paper informs health policy and decision makers about the costs and consequences for a local health district of a program to reduce and prevent HAPIs. This paper reports the economic effect of HAPIs, including hospital episode costs per HAPI and length of stay, on one local health district. What are the implications for practitioners? This cost-consequence analysis has shown that the program to reduce HAPIs resulted in a reduction in expenditure and positive patient outcomes. Such a program is potentially transferable to other healthcare settings.

This pilot study aimed to evaluate the clinical efficacy and feasibility of a fluidised positioning device to reduce occipital pressure injuries (PIs). A post-test design with a historical control group was used in a 54-bed intensive care unit between September 2017 and August 2018. Patients who were receiving either extracorporeal membrane oxygenation, were mechanically ventilated, or had raised intracranial pressure (≥20) were recruited. The intervention consisted of a fluidised positioning device under the patient's head, and a skin assessment every 8 h. Outcome measures included the occurrence of occipital PIs and registered nurses (RNs)' perspectives of the intervention. Data collected from patients in the intervention group were compared with data obtained from the historical control group between May 2016 and April 2017. Sixty-four patients were recruited in the intervention phase and 63 were in the historical control group. Results showed a statistically significant reduction in occipital PIs by 87.7% (16/63; 25.4% historical control vs 2/64; 3.13% interventional group). Bedside RNs provided positive evaluation of the fluidised positioning device. The findings demonstrate that the fluidised positioning device is a feasible and effective intervention in reducing the risk of occipital PIs in intensive care patients, which merits the continuation of use and further evaluation through a larger-scale study., (© 2018 Medicalhelplines.com Inc and John Wiley & Sons Ltd.)

Aim: The aim of this study was to (1) examine the reasons for the increased incidence of hospital-acquired pressure injuries (HAPIs) reported in the Incident Information Management System (IIMS), and (2) gain feedback from nurses regarding HAPI being reported in the IIMS at one tertiary hospital in Australia., Materials and Methods: This prospective descriptive study included a review of patients with a reported HAPI from July 2015 to June 2016. Patient assessment and semi-structured interviews with nurses were conducted. Interview data were anonymised and content thematically analysed., Results: Data were collected on 417 patients who were reported to have a HAPI; of these, 363 patients were clinically assessed. 69.7% (253/363) were inaccurately reported in the IIMS, based on stage, location, not a true pressure injury or not hospital-acquired. A high number of patients (176/363, 48.5%) were found to have various skin conditions that were not HAPIs. Three themes were identified from the interviews: (1) meeting the mandated reporting requirements; (2) incident reporting and communication; (3) difficulties documenting aetiology., Conclusion: This study identified inaccuracies in diagnosing, classifying and reporting pressure injuries. Nurses described barriers and challenges to classifying and reporting HAPIs. Inaccurate reporting can lead to incorrect conclusions especially when reported data alone is relied upon for patient treatment, benchmarking and analysis. Guidelines are needed at a national and international level to support the quality of clinical assessment, reporting and documentation. Findings from this study have led to a new approach to patient assessment and to minimise errors in incident reporting at this organisation., (Copyright © 2018 Tissue Viability Society. Published by Elsevier Ltd. All rights reserved.)

Purpose: This purpose of this study was to measure the prevalence of incontinence, incontinence-associated dermatitis (IAD), and pressure injuries (PIs) in a local health district in Australia. We also aimed to determine associated evidence-into-practice gaps., Design: Multisite mixed-methods study., Subjects and Settings: The sample comprised 250 adult patients in 12 units across 4 hospitals; their mean age was 73 years. Nurses caring for the patient at the time of the audit were questioned on nursing practice for patients with incontinence., Methods: A 2-page audit tool was developed and used to capture demographic data, continence and mobility status, IAD and PI, incontinence products, nursing practice observations, and nurses' comments. Each patient was assessed by 2 senior nurses. Quantitative analysis included descriptive statistics and bivariate analysis using a χ test to examine the association between mobility and incontinence and a Fisher exact test to examine the association between IAD and PI. Content analysis was used to analyze qualitative data and develop themes., Results: Almost half of patients had incontinence (n = 111/250), 20.7% of patients with incontinence (n = 23/111) had IAD, and 6.3% (n = 7/111) had hospital-acquired PI. There was a significant association between incontinence and mobility, and between IAD and PIs. In addition, 22.3% of patients who were continent (31/139) were wearing an incontinence product. Analysis of qualitative data found that both incontinence management and language used to refer to incontinence pads were incompatible with current best practices., Conclusion: The prevalence of incontinence among patients observed in this study was similar to rates reported internationally, but the prevalence of IAD was slightly lower. The association between IAD and PIs, as well as incontinence and mobility, was statistically and clinically significant. Nurses commonly used interventions with little or no evidence. Hospitals should put measures in place to improve nurses' knowledge of incontinence, IAD, and PI practices.

Background: Household transmission of influenza-like illness (ILI) may vary with viral and demographic characteristics. We examined the effect of these factors in a population-based sample of adults with ILI., Methods: We conducted a prospective cohort study in community-dwelling Australian adults nested within an influenza vaccine effectiveness trial. On presentation with ILI, participants were swabbed for a range of respiratory viruses and asked to return a questionnaire collecting details of household members with or without similar symptoms. We used logistic and Poisson regression to assess the key characteristics of household transmission., Results: 258 participants from multi-occupancy households experienced 279 ILI episodes and returned a questionnaire. Of these, 183 were the primary case in the household allowing assessment of factors associated with transmission. Transmission was significantly associated in univariate analyses with female sex (27% vs. 13%, risk ratio (RR) = 2.13 (1.08, 4.21)) and the presence of a child in the house (33% vs. 17%, RR = 1.90 (1.11, 3.26)). The secondary household attack proportion (SHAP) was 0.14, higher if influenza was isolated (RR = 2.1 (1.0, 4.5)). Vaccinated participants who nonetheless became infected with influenza had a higher SHAP (Incidence RR = 5.24 (2.17, 12.6))., Conclusions: The increased SHAP in households of vaccinated participants who nonetheless had confirmed influenza infection supports the hypothesis that in years of vaccine mismatch, not only is influenza vaccine less protective for the vaccine recipient, but that the population's immunity is also lower.

Background: Lipids in reef building corals can be divided into two classes; non-polar storage lipids, e.g. wax esters and triglycerides, and polar structural lipids, e.g. phospholipids and cholesterol. Differences among algal endosymbiont types are known to have important influences on processes including growth and the photobiology of scleractinian corals yet very little is known about the role of symbiont types on lipid energy reserves., Methodology/principal Findings: The ratio of storage lipid and structural lipid fractions of Scott Reef corals were determined by thin layer chromatography. The lipid fraction ratio varied with depth and depended on symbiont type harboured by two corals (Seriatopora hystrix and Pachyseris speciosa). S. hystrix colonies associated with Symbiodinium C1 or C1/C# at deep depths (>23 m) had lower lipid fraction ratios (i.e. approximately equal parts of storage and structural lipids) than those with Symbiodinium D1 in shallow depths (<23 m), which had higher lipid fraction ratios (i.e. approximately double amounts of storage relative to structural lipid). Further, there was a non-linear relationship between the lipid fraction ratio and depth for S. hystrix with a modal peak at ∼23 m coinciding with the same depth as the shift from clade D to C types. In contrast, the proportional relationship between the lipid fraction ratio and depth for P. speciosa, which exhibited high specificity for Symbiodinium C3 like across the depth gradient, was indicative of greater amounts of storage lipids contained in the deep colonies., Conclusions/significance: This study has demonstrated that Symbiodinium exert significant controls over the quality of coral energy reserves over a large-scale depth gradient. We conclude that the competitive advantages and metabolic costs that arise from flexible associations with divergent symbiont types are offset by energetic trade-offs for the coral host.