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Background There is growing evidence that internet-delivered cognitive behavioural therapy (iCBT) can improve functioning and reduce psychological distress in people with chronic health conditions. Obesity frequently co-occurs with chronic health conditions, yet its impact on response to psychological interventions in this population is not known. The current study examined associations between BMI and clinical outcomes (depression, anxiety, disability, and satisfaction with life) following a transdiagnostic iCBT program targeting adjustment to chronic illness. Methods Participants from a large randomised controlled trial, who provided information on height and weight, were included (N = 234; mean age= 48.32, SD = 13.80; mean BMI = 30.43, SD = 8.30, range 16.18–67.52; 86.8% female). The influence of baseline BMI range on treatment outcomes at post-treatment and 3-month follow-up was examined using generalized estimating equations. We also examined changes in BMI and in participants’ perceived impact of weight on their health. Results Improvement in all outcomes occurred across BMI ranges; additionally, persons with obesity or overweight generally experienced greater symptom reductions than those within a healthy weight range. A greater proportion of participants with obesity achieved clinically significant change on key outcomes (e.g., depression: 32% [95% CI: 25%, 39%]) than participants with a healthy weight (21% [95% CI: 15%, 26%]) or overweight (24% [95% CI: 18%, 29%], p = 0.016). There were no significant changes in BMI from pre-treatment to 3-month follow-up, however there were significant reductions on the self-rated impact of weight on health. Conclusions Persons with chronic health conditions and with obesity or overweight benefit at least as much as those with a healthy BMI from iCBT programs targeting psychological adjustment to chronic illness, even without changes in BMI. iCBT programs may be an important component in the self-management of this population, and may address barriers implicated in health behaviour change.

Osteoporosis is a common skeletal condition that is characterised by low bone mass, increased bone fragility and an increased risk of fracture. It is important to understand who may be at risk of developing osteoporosis and sustaining fragility fractures so that appropriate steps can be taken to minimise any modifiable risk factors. Simple lifestyle changes, such as increasing physical activity, stopping smoking and ensuring adequate nutritional intake, can improve musculoskeletal health and reduce fracture risk.

Background Mental health and functional difficulties are highly comorbid across neurological disorders, but supportive care options are limited. This randomised controlled trial assessed the efficacy of a novel transdiagnostic internet-delivered psychological intervention for adults with neurological disorders. Methods 221 participants with a confirmed diagnosis of epilepsy, multiple sclerosis, Parkinson's disease, or an acquired brain injury were allocated to either an immediate treatment group (n = 115) or treatment-as-usual waitlist control (n = 106). The intervention, the Wellbeing Neuro Course, was delivered online via the eCentreClinic website. The Course includes six lessons, based on cognitive behavioural therapy, delivered over 10 weeks with support from a psychologist via email and telephone. Primary outcomes were symptoms of depression (PHQ-9), anxiety (GAD-7) and disability (WHODAS 2.0). Results 215 participants commenced the trial (treatment n = 111; control n = 104) and were included in intention-to-treat analysis. At post-treatment, we observed significant between-group differences in depression (PHQ-9; difference = 3.07 [95% CI 2.04–4.11], g = 0.62), anxiety (GAD-7; difference = 1.87 [0.92–2.81], g = 0.41) and disability (WHODAS 2.0 difference = 3.08 [1.09–5.06], g = 0.31), that favoured treatment (all ps < 0.001). Treatment-related effects were maintained at 3-month follow-up. Findings were achieved with minimal clinician time (average of 95.7 min [s.d. = 59.3] per participant), highlighting the public health potential of this approach to care. No adverse treatment events were reported. Conclusions Internet-delivered psychological interventions could be a suitable model of accessible supportive care for patients with neurological disorders.

Methods for calculating health indicators profoundly influence understanding of and action on population health and inequities. Age-standardization can be useful and is commonly applied to account for differences in age structures when comparing health indicators across groups. Age-standardized rates have well-acknowledged limitations, including that they are relative indices for comparison, and not accurate measures of actual rates where the age structures of groups diverge. This paper explores these limitations, and demonstrates alternative approaches through a case study quantifying mortality rates within the Aboriginal and Torres Strait Islander (Indigenous) population of Australia and inequities compared with the non-Indigenous population, over 2001–16. Applying the Australian Standard Population, the Aboriginal and Torres Strait Islander age-standardized mortality rate was more than double the crude mortality rate in 2001 and 2016, inflated through high weighting of older age groups. Despite divergent population age structures, age-standardized mortality rates remain a key policy metric for measuring progress in reducing Indigenous-non-Indigenous inequities in Australia. Focusing on outcomes age-standardized to the total population can obscure inequities, and denies Aboriginal and Torres Strait Islander peoples and communities valid, actionable information about their health and well-being. Age-specific statistics convey the true magnitude of health risks and highlight high-risk subgroups. When requiring standardization, standardizing to a population-specific standard (here, an Indigenous standard) generates metrics centred around and reflective of reality for the population of focus, supporting communities’ self-determination to identify priorities and informing resource allocation and service delivery. The principles outlined here apply across populations, including Indigenous and other populations internationally.

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.

The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching and significant effects worldwide. Many of those identified as most vulnerable to the disease reside in long-term care settings such as nursing and residential homes, so infection prevention and control is an essential area of practice. This article describes how COVID-19 is transmitted and discusses various measures that can be taken to reduce the spread of infection to protect residents, staff and visitors. Such measures include social distancing, routine screening, the use of personal protective equipment and cleaning.

Background Evidence on the effectiveness of postal recruitment methods for Indigenous peoples is lacking. Mayi Kuwayu, the National Study of Aboriginal and Torres Strait Islander Wellbeing, uses multi-staged sampling. We aimed to test postal surveys as a primary recruitment method, analysing preliminary response rate data to inform the Study’s ongoing sampling approach. Methods Twenty thousand adults aged ≥16 years were sampled from Aboriginal and Torres Strait Islander people enrolled in the Medicare Australia Enrolment Database. We calculated response rates at 4 and 15 weeks, overall and by age group, gender, state/territory and remoteness. Results The overall response rate was 2.3% (n = 456/20000). Highest response rates were observed among males and females ≥50 years from major cities (6.0, 95%CI 4.4–7.9 and 5.5%, 4.1–7.2, respectively) and regional areas (6.0%, 4.6–7.6 and 6.2%, 4.9–7.7, respectively). Younger age groups and remote areas had lower response rates; all remote age groups Conclusion Using a postal survey, we observed response rates of ≥5.5% among older Aboriginal and Torres Strait Islander adults in major cities and regional areas; response rates were lower in other groups. A two-stage postal distribution approach provided an opportunity to adapt sampling approaches to different demographic groups. Based on initial response rates, the sampling strategy was revised to send postal surveys to groups with higher response rates groups and focus field recruitment strategies on low response groups.

Background The Interpersonal-Psychological Theory of Suicide (IPTS) aims to elucidate the key antecedents of suicide deaths. Limited research has tested the IPTS in a community setting, and very little longitudinal research has been conducted. The current study longitudinally tested the predictions of the IPTS for suicidal ideation in a large population-based sample. Methods The PATH through Life study assesses three age cohorts (20's, 40's, 60's) every four years. Two interpersonal factors were estimated at the third wave of assessment: thwarted belongingness (TB) and perceived burdensomeness (PB). The roles of these factors in suicide ideation (active and passive) four years later were estimated using logistic regression models (n = 4545). Results A one SD increase in TB was associated with increased odds of 37% for passive ideation and 24% for active ideation. For PB, odds were increased 2.5-fold for passive ideation and 2.4-fold for active ideation. A significant negative PB × TB interaction was found for passive but not active ideation. Effects were not consistent by age group or gender. Limitations Proxy measures were used to assess the constructs. The extended timeframe and low prevalence of suicidal ideation limited power to find effects within subgroups. Conclusions Although TB and PB were individually associated with suicidal thoughts, little evidence was found for the key predictions of the IPTS longitudinally. Further investigation of the dynamic interplay between interpersonal factors over time is needed.

Background Depression and anxiety interfere with an individual's quality of life and result in substantial economic costs to the workplace through lost productivity. The internet offers an unparalleled opportunity for the large scale, cost-effective delivery of mental health awareness and destigmatisation programs in the workplace. However, to date high quality assessments of the effectiveness of such workplace programs have been confined to health professional settings. The current study reports the effectiveness of Mental Health Guru (MH-Guru), a two-module online mental health workplace induction program. Methods A total of 507 employees from a large multi-departmental government workplace were randomised to a 2-week online depression and anxiety educational program (Mental Health Guru; MH-Guru), or a Wait List Control condition. Participants completed online surveys at baseline, 1 week post-intervention and at 6-month follow-up. Primary outcome measures included depression and anxiety literacy, personal stigma about depression and anxiety, and help seeking intentions for anxiety and depression at post-test. Secondary measures included help-seeking attitudes and self-reported help seeking behaviour. Satisfaction measures were also collected. Results Dropout at post intervention was 26.7% and 21.0% for the MH-Guru and Control conditions respectively. Relative to Control, MH-Guru participants showed significantly greater improvements in depression and anxiety literacy at post intervention. Between group standardized effect sizes at post-test and 6-months were 0.78 and 0.81 for depression literacy and 0.80 and 0.79 for anxiety literacy. Compared to the Control participants, the MH-Guru group also showed significantly greater reductions in depression and anxiety personal stigma. Between group effect sizes in stigma for depression were − 0.56 and − 0.47 at post-test and 6-months respectively and − 0.42 at both time points for anxiety. The MH-Guru intervention was not associated with a differentially greater increase in anxiety or depression help-seeking intentions or improvement in help seeking attitudes compared to the Control group. However, self-reported help-seeking behaviour was significantly greater in the MH-Guru group at post-test. In addition, the MH-Guru group showed greater intentions to seek help for depression from the Internet at 6-month follow-up. Satisfaction items suggested that the program was acceptable to employees. Conclusions Brief online programs such as MH-Guru have the potential to play an important role in increasing mental health awareness and decreasing stigmatizing attitudes in the workplace, and by extension the general community., Highlights • First RCT in the workplace to demonstrate the effectiveness of an online intervention for anxiety and depression in staff without health credentials. • The intervention (MH-Guru) was associated with reductions in stigma and improvements in literacy for depression and anxiety, sustained over 6 months. • Intentions to seek help from the Internet were greater at 6 months among those receiving the workplace intervention.

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.

General practice has an important role within the Australian healthcare system to provide access to care and effective management of chronic health conditions. However, people with serious mental illness experience challenges associated with service access. The current paper seeks to examine drivers of access to general practice for people with common and serious mental disorders, compared with people who access care for type II diabetes, a common physical health problem managed in general practice. The Bettering the Evaluation and Care of Health (BEACH) programme provides the most comprehensive and objective measurement of general practitioner activity in Australia. Using BEACH data, this study compared general practice encounters for depression, anxiety, bipolar disorder, schizophrenia, and type II diabetes during a 10-year period between 2006 and 2016. Analysis revealed more frequent encounters for depression compared to anxiety, and a higher representation of women in encounters for bipolar disorder compared to men. The relationship between number of encounters and patient age was strongly associated with the life course and mortality characteristics associated with each disorder. The findings highlight specific challenges associated with access to primary care for people with serious mental illness, and suggest areas of focus to improve the ability of these patients to access and navigate the health system.

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.

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.