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Background. Preservation and restoration of skin integrity following surgery is paramount for optimal patient wound healing outcomes. Acute wounds such as incisional wounds, skin tears, trauma or burn injury cause pain, reduce quality of life and are a considerable economic burden to the Australian healthcare system. Despite considerable advances in surgical technique and even with a panacea of innovative novel wound dressings, our scientific and clinical understanding of wound healing prevention and management of acute wound complications continue to present a considerable challenge to clinicians and policy makers. Understanding the gaps in knowledge and identifying clinical practice deficits are key for prevention and management of acute wounds. Aims. This scoping review aims to (i) map current research evidence and outcomes in acute wounds management, (ii) map current research evidence and outcomes in acute wounds prevention and (iii) determine research gaps in acute wound research relevant to Australia. Methods. The framework for this scoping review will utilise the PRISMA-ScR framework developed by Tricco et al.1. We will search the following databases – Medline, CINAHL, Embase, Joanna Briggs Institute (JBI), Cochrane Library and PubMed from January 2010 to March 2021. Trial registries (e.g. ISRCTN, ANZCTR and clinicaltrials.gov) and websites and publications of professional associations for wound care will also be searched. Two reviewers will independently screen all titles, abstracts and full text for articles to include. Conflicts will be solved by a third reviewer. This scoping review will include both qualitative and quantitative studies on acute wounds conducted in Australia. We will extract data from eligible articles and results will be grouped according to area of research and synthesised in a narrative review. Ethics and dissemination. As we will use data (i.e., journal articles) from publicly available platforms this scoping review does not require e

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and severe morbidity globally. When PPH cannot be controlled using standard medical treatments, uterine balloon tamponade (UBT) may be used to arrest bleeding. While UBT is used by healthcare providers in hospital settings internationally, their views and experiences have not been systematically explored. The aim of this review is to identify, appraise and synthesize available evidence about the views and experiences of healthcare providers using UBT to treat PPH. METHODS: Using a pre-determined search strategy, we searched MEDLINE, CINAHL, PsycINFO, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996-2019, reporting qualitative data on the views and experiences of health professionals using UBT to treat PPH. Author findings were extracted and synthesised using techniques derived from thematic synthesis and confidence in the findings was assessed using GRADE-CERQual. RESULTS: Out of 89 studies we identified 5 that met our inclusion criteria. The studies were conducted in five low- and middle-income countries (LMICs) in Africa and reported on the use of simple UBT devices for the treatment of PPH. A variety of cadres (including midwives, medical officers and clinical officers) had experience with using UBTs and found them to be effective, convenient, easy to assemble and relatively inexpensive. Providers also suggested regular, hands-on training was necessary to maintain skills and highlighted the importance of community engagement in successful implementation. CONCLUSIONS: Providers felt that administration of a simple UBT device offered a practical and cost-effective approach to the treatment of uncontrolled PPH, especially in contexts where uterotonics were ineffective or unavailable or where access to surgery was not possible. The findings are limited by the relatively small number of studies contributing to the review and further research in other contexts

BACKGROUND: Postpartum haemorrhage (PPH) is a leading cause of maternal mortality and morbidity. Reducing deaths from PPH is a global challenge. The voices of women and healthcare providers have been missing from the debate around best practices for PPH prevention. The aim of this review was to identify, appraise and synthesize available evidence about the views and experiences of women and healthcare providers on interventions to prevent PPH. METHODS: We searched eight electronic databases and reference lists of eligible studies published between 1996 and 2018, reporting qualitative data on views and experiences of PPH in general, and of any specific preventative intervention(s). Authors' findings were extracted and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed. RESULTS: Thirty-five studies from 29 countries met our inclusion criteria. Our results indicate that women and healthcare providers recognise the dangers of severe blood loss in the perinatal and postpartum period, but don't always share the same beliefs about the causes and consequences of PPH. Skilled birth attendants and traditional birth attendants (TBA's) want to prevent PPH but may lack the required resources and training. Women generally appreciate PPH prevention strategies, especially where their individual needs, beliefs and values are taken into account. Women and healthcare providers also recognize the value of using uterotonics (medications that contract the uterus) to prevent PPH but highlight safety concerns and potential misuse of the drugs as acceptability and implementation issues. CONCLUSIONS: Based on stakeholder views and experiences, PPH prevention strategies are more likely to be successful where all stakeholders agree on the causes and consequences of severe postpartum blood loss, especially in the context

© 2018 The Author(s). Background: Venous leg ulcers (VLUs) are expensive to treat and impair quality of life of affected individuals. Although improved healing and reduced recurrence rates have been observed following the introduction of evidence-based guidelines, a significant evidence-practice gap exists. Compression is the recommended first-line therapy for treatment of VLUs but unlike many other developed countries, the Australian health system does not subsidise compression therapy. The objective of this study is to estimate the cost-effectiveness of guideline-based care for VLUs that includes public sector reimbursement for compression therapy for affected individuals in Australia. Methods: A Markov model was designed to simulate the progression of VLU for patients receiving guideline-based optimal prevention and treatment, with reimbursement for compression therapy, and then compared to usual care in each State and Territory in Australia. Model inputs were derived from published literature, expert opinion, and government documents. The primary outcomes were changes to costs and health outcomes from a decision to implement guideline-based optimal care compared with the continuation of usual care. Sensitivity analyses were performed to test the robustness of model results. Results: Guideline-based optimal care incurred lower total costs and improved quality of life of patients in all States and Territories in Australia regardless of the health service provider. We estimated that providing compression therapy products to affected individuals would cost the health system an additional AUD 270 million over 5 years but would result in cost savings of about AUD 1.4 billion to the health system over the same period. An evaluation of unfavourable values for key model parameters revealed a wide margin of confidence to support the findings. Conclusions: This study shows that guideline-based optimal care would be a cost-effective and cost-saving strategy to manage VLUs i

BACKGROUND: Global uptake of antenatal care (ANC) varies widely and is influenced by the value women place on the service they receive. Identifying outcomes that matter to pregnant women could inform service design and improve uptake and effectiveness. OBJECTIVES: To undertake a systematic scoping review of what women want, need and value in pregnancy. SEARCH STRATEGY: Eight databases were searched (1994-2015) with no language restriction. Relevant journal contents were tracked via Zetoc. DATA COLLECTION AND ANALYSIS: An initial analytic framework was constructed with findings from 21 papers, using data-mining techniques, and then developed using meta-ethnographic approaches. The final framework was tested with 17 more papers. MAIN RESULTS: All continents except Australia were represented. A total of 1264 women were included. The final meta-theme was: Women want and need a positive pregnancy experience, including four subthemes: maintaining physical and sociocultural normality; maintaining a healthy pregnancy for mother and baby (including preventing and treating risks, illness and death); effective transition to positive labour and birth; and achieving positive motherhood (including maternal self-esteem, competence, autonomy). Findings informed a framework for future ANC provision, comprising three equally important domains: clinical practices (interventions and tests); relevant and timely information; and pyschosocial and emotional support; each provided by practitioners with good clinical and interpersonal skills within a high quality health system. CONCLUSIONS: A positive pregnancy experience matters across all cultural and sociodemographic contexts. ANC guidelines and services should be designed to deliver it, and those providing ANC services should be aware of it at each encounter with pregnant women. TWEETABLE ABSTRACT: Women around the world want ANC staff and services to help them achieve a positive pregnancy experience.

Introduction: Adults with venous leg ulcers currently do not meet physical activity guidelines for a myriad of reasons. Research suggests that exercise programmes which are based on theoretical frameworks are more likely to be successful for increasing adherence. Social Cognitive Theory (SCT) is one commonly used health theory that posits that learning occurs in a social context with a dynamic and reciprocal interaction of the person, environment, and behaviour. This study therefore sought to identify the relationships between self-efficacy, outcome expectations, fear-avoidance beliefs, depression and social support and adherence to an exercise for a home-based exercise programme for adults with venous leg ulcers. Methods: Patients were randomised to receive either a 12week exercise intervention with a telephone coaching component, or usual care plus telephone calls at the same timepoints. Data on health, psychosocial variables and adherence to leg exercises were obtained from self-report surveys and data on medical and ulcer history were obtained from medical records. Results: This study included 63 patients with venous leg ulcers. Of those in the exercise intervention group, 59% adhered to the exercise protocol more than 75% of the time. As per SCT there was a significant relationship between self-efficacy and outcome expectations and both of these constructs were significantly related to adherence to the leg exercise programme. Adherence significantly correlated with wound healing indicating a possible pathway to healing. Conclusion: In this sample, self-efficacy and outcome expectations were found to be significantly related to adherence to the prescribed leg exercises.Introduction: Adults with venous leg ulcers currently do not meet physical activity guidelines for a myriad of reasons. Research suggests that exercise programmes which are based on theoretical frameworks a

Chronic wounds cost the Australian health system at least US$2·85 billion per year. Wound care services in Australia involve a complex mix of treatment options, health care sectors and funding mechanisms. It is clear that implementation of evidence-based wound care coincides with large health improvements and cost savings, yet the majority of Australians with chronic wounds do not receive evidence-based treatment. High initial treatment costs, inadequate reimbursement, poor financial incentives to invest in optimal care and limitations in clinical skills are major barriers to the adoption of evidence-based wound care. Enhanced education and appropriate financial incentives in primary care will improve uptake of evidence-based practice. Secondary-level wound specialty clinics to fill referral gaps in the community, boosted by appropriate credentialing, will improve access to specialist care. In order to secure funding for better services in a competitive environment, evidence of cost-effectiveness is required. Future effort to generate evidence on the cost-effectiveness of wound management interventions should provide evidence that decision makers find easy to interpret. If this happens, and it will require a large effort of health services research, it could be used to inform future policy and decision-making activities, reduce health care costs and improve patient outcomes.

Introduction: To provide an overview of Social Cognitive Theory (SCT) in relation to exercise and older adults as a theoretical framework for this study.Method: An extensive literature review has been undertaken on theoretical underpinnings of interventions related to exercise in older adults. The literature was reviewed in 3 areas: 1) exploration of theories relating to chronic disease management and exercise 2) a review of the types and methods of theory based interventions relating to exercise and adults with chronic disease; 3) an analysis of the effectiveness of theory based interventions relating to exercise and adults with chronic disease with regard to disease outcomes.Results: Findings from the review are that a number of theories have been used in chronic disease management and exercise with older adults. A review of the effectiveness of interventions in older adults with chronic disease has found evidence to support the use of SCT. The primary intervention strategy for this study is to enhance self-efficacy which is the main construct of SCT and is known to be an important predictor of exercise. Facets of SCT will be integrated into this intervention such as; goal setting, self-monitoring, reinforcement and cognitive reframing, which are accepted as effective means of promoting physical activity.Conclusion: It is expected that a strong theoretical framework for this study will increase the likelihood of a successful intervention promoting lower limb exercises in this patient population.

Introduction:The objective of this paper is to describe an exercise intervention for treating chronic venous leg ulcer patients using Social Cognitive Theory (SCT) [1]. This study will assess the benefits of an intervention promoting exercise for adults with venous leg ulcers. Physical activity interventions based on SCT are reported to be more successful than those without. Social Cognitive Theory is widely used and accepted within the physical activity domain. The primary intervention strategy for this study is to enhance self-efficacy which is the main construct of SCT and is known to be an important predictor of exercise and a critical concept in chronic disease management.This is Phase Two of a larger project and follows on from previous pilot work by the authors [2]. Phase One of the study involves focus group sessions which will be conducted to understand the meaning of exercise to adults with venous leg ulcers thereby helping to inform the intervention. The presence of venous insufficiency and subsequent venous hypertension may lead to calf muscle changes such as muscle fibre atrophy, abnormal gait and reduced strength and functioning of the calf muscle. Despite evidence to suggest that exercise improves calf muscle function in this patient population [3-5] to date only one study [3] and the author?s pilot work [2] has investigated the effect of improving the calf muscle pump function on healing rates. Methods:An extensive literature review on the theoretical underpinnings of SCT interventions in combination with clinical experience and the results from phase one will inform the intervention. A RCT will be conducted over two clinical sites in South East Queensland. The primary outcomes will be the incidence of complete wound closure at the completion of the study, time to healing and ulcer area percentage reduction. Secondary outcomes will include physical activity levels, functional ability, psychoso

We introduce orthogonal designs with quaternion elements and show their existence. In future work we explore these applications to signal processing.