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AbstractObjectivesUp to 60% of people with dementia living in care homes will ‘wander’ at some point, which has typically been seen by staff as a problematic behaviour. A range of non-pharmacological interventions have been tested to either support or prevent wandering. However, even recent innovative practice continues to maintain a focus on reducing or preventing wandering. This study aimed to identify, for the first time, care home staff perspectives on home level factors that facilitate or hinder them supporting residents to wander safely.MethodSemi-structured qualitative interviews were conducted with 19 care home staff, working in the North of England. Framework analysis was used to analyse the data.ResultsA range of environmental considerations were identified by staff. Care home design influenced how residents were able to move safely around, and inclusion of points of interest encouraged walking to different locations, such as a garden. Staff worried about managing access to other residents’ rooms by people who wander. Within the care home culture, prioritising safe staffing levels, training and awareness, involving external healthcare professionals where required and mentorship from experienced staff members, all contributed towards safe wandering. Staff support for positive risk-taking within the care home was key to promote person-centred care, alongside careful oversight and management of relationships between residents.ConclusionWe identified a range of cultural and environmental factors that contribute towards safe wandering. A positive approach to risk-taking by staff is required to support residents to engage in wandering as an enjoyable activity, whilst acknowledging that there are inherent risks associated with this.

Study Design A single surgeon case series and meta-analysisof literatureObjective To evaluate the clinical outcome and patient satisfaction following coccygectomy for coccygodynia in adults and children using a curvilinear paramedian skin incision and to conduct a meta-analysis of the literature to determine the associated infection rate with different surgical factors.Methods 45 consecutive patients (40 adults and 5 children) underwent surgical coccygectomy for persistent coccygodynia symptoms using a paramedian curvilinear incision. Postoperative clinical outcome scores, patients’ satisfaction and wound complications were assessed. A systematic literature search using specific MesH terms was then conducted covering the period from 1980 to 2020. Only those studies reporting infection rates post coccygectomy were included in a meta-analysis.Results The average age of patients was 39 years with a mean duration of symptoms prior to surgery of 7.4 years. The mean Oswestry Disability Index improved from 29 to 7.7 (P< .001). The mean pain Visual analogue scale improved from 8 to 2 (P< .001) and the median patient satisfaction score was 8 (out of 10) suggesting good to excellent outcome. The clinical improvement was the same in children and adults. There was a total of 5 (11%) wound infections, 2 of which needed surgical debridement. Meta-analysis of the included studies showed that the use of prophylactic antibiotics for 24 hours, nonabsorbable skin sutures and glue were associated with low infection rate.Conclusions Coccygectomy using curvilinear paramedian skin incision for chronic coccygodynia is an effective procedure with similar or lower complication rates as reported in the literature.

This paper reviews and summarises the work that has been conducted and the technology used in exploring and developing the Northern Bowen and Galilee basins in Queensland. It examines the methods operators have used in drilling, completing and testing wells through the varying stages of exploration, appraisal and development in the different parts of the basins. It examines all the work conducted in the Betts Creek Beds and Aramac Coal Measures throughout the Galilee Basin; the Moranbah Coal Measures, Rangal Coal Measures and Fort Cooper Coal Measures in the Moranbah area of the Bowen Basin; the Rangal Coal Measures, Burngrove Formation and Fairhill Formation in the Blackwater area; the conventional and coal seam gas developments in the Rolleston area, including the Bandanna Formation plays near Injune; and the Baralaba Coal Measures in the Moura area. Wells have been completed both open and cased hole with techniques including vertical wells, both with and without hydraulic fracturing and cavitation, as well as a variety of horizontal well designs including surface to inseam wells with vertical intercept wells and multiple lateral sections, chevron wells and both heel and toe intercepts. Operators have also implemented multiple wells on one pad. Throughout the Northern Bowen Basin, horizontal well drilling has been a key technology in commercial development. Generally, activities within the Galilee Basin have not progressed as far as the Bowen Basin, but nevertheless, horizontal wells are also emerging as a key technology.

Research has the potential to inform and enhance the care and experiences of people living and working in care homes. While there is a growing interest in research relevant for care homes, there is also a need to ensure that staff, residents and their families and friends are supported when considering taking part in research; particularly in a type of research called a ‘trial’. Trials are a type of research study that can help guide decisions about the best treatment, care and support for both residents (and their families and friends) and care home staff. While potentially important, trials are demanding for both care homes and trial research teams. Before agreeing to support a trial, there are questions a care home manager, staff, residents and their families and friends can consider. These questions are outlined in this article, and the answers to these will help a care home to determine whether they have the capacity, readiness and relationships to support a trial. By taking the time to ‘pause’ and ask ‘are we ready?’, care teams can support both care and science.

AbstractAimsStudies show that people with severe mental illness (SMI) have a greater risk of dying from colorectal cancer (CRC). These studies mostly predate the introduction of national bowel cancer screening programmes (NBCSPs) and it is unknown if these have reduced disparity in CRC-related mortality for people with SMI.MethodsWe compared mortality rates following CRC diagnosis at colonoscopy between a nationally representative sample of people with and without SMI who participated in Australia’s NBCSP. Participation was defined as the return of a valid immunochemical faecal occult blood test (iFOBT). We also compared mortality rates between people with SMI who did and did not participate in the NBCSP. SMI was defined as receiving two or more Pharmaceutical Benefits Scheme prescriptions for second-generation antipsychotics or lithium.ResultsAmongst NBCSP participants, the incidence of CRC in the SMI cohort was lower than in the controls (hazard ratio [HR] 0.77, 95% confidence interval [CI] 0.61–0.98). In spite of this, their all-cause mortality rate was 1.84 times higher (95% CI 1.12–3.03), although there was only weak evidence of a difference in CRC-specific mortality (HR 1.82; 95% CI 0.93–3.57). People with SMI who participated in the NBCSP had better all-cause survival than those who were invited to participate but did not return a valid iFOBT (HR 0.67, 95% CI 0.50–0.88). The benefit of participation was strongest for males with SMI and included improved all-cause and CRC-specific survival.ConclusionsParticipation in the NBCSP may be associated with improved survival following a CRC diagnosis for people with SMI, especially males, although they still experienced greater mortality than the general population. Approaches to improving CRC outcomes in people with SMI should include targeted screening, and increased awareness about the benefits or participation.Trial registrationAustralian and New Zealand Clinical Trials Registry (Trial ID: ACTRN12620000781943).

Background: Debate exists as to whether anterior–posterior spinal fusion (APSF), rather than posterior-only spinal fusion (PSF), provides benefit for treating severe thoracic adolescent idiopathic scoliosis (AIS). This systematic review and meta-analysis compare (1) Cobb angle correction, (2) complication and reoperation rate, (3) pulmonary function, (4) number of fused segments, and 5) patient-reported outcome measures (PROMs) in both groups. Methods: Electronic databases were searched to identify studies that met the following inclusion criteria: comparative studies (level 3 or above), severe thoracic curves (≥ 70°), age ≤ 16, AIS aetiology, Lenke 1–4 curves and follow-up ≥ 1 year for ≥ 95% of patient population. Literature was graded for quality and bias using GRADE and MINORS criteria. Results: Eight studies were included, defined by GRADE as low or moderate level evidence. Three studies showed superior curve correction in the APSF group; however, the meta-analysis showed no significant difference in curve correction between groups (95% CI − 3.45–12.96, P= 0.26). There were more complications in the APSF group, without statistical significance (95% CI 0.53–3.39, P= 0.54; I2= 0%, P= 0.78). There were no re-operations in either group. Two studies reported pulmonary function; one showed better function in the APSF group, the other better function in the PSF group. One study showed fewer fused segments in the APSF group, however, no significance was observed in the meta-analysis (95%CI − 1.65–0.31, P= 0.18). Three studies reported PROMs with no differences reported between groups. Conclusions: APSF and PSF have been found to have comparable results. The present evidence cannot support recommendations for guidelines on future practice with regards to effect on curve correction, complications, re-operations, pulmonary function or PROMs. Level of evidence: Level III, Systematic review of Level-III studies.