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Chow, J. S. F., D'Souza, A., Lane, B., Descallar, J., Ford, M., Marshall, S., & Pennings, S. (2022). Health workers' Perceptions and REsponses in implementing COVID-19 Immunisation StratEgy in South Western Sydney (PRECISE): An observational study [Article]. BMJ Open, 12(4), Article e055034. https://doi.org/10.1136/bmjopen-2021-055034
Objectives To understand the views and motivations of healthcare workers at a vaccination hub who received a COVID-19 vaccination in March-May 2021. Study design This is an observational study via an anonymous electronic survey of seven questions focus on where survey recipients received information about the vaccine roll-out, their motivations for receiving the vaccine and their level of comfort in receiving the vaccine. Setting The Liverpool Vaccination Hub is located in South Western Sydney. Participants Participants were healthcare workers who received the first dose of a COVID-19 vaccine in the Australian Government's Phase 1a and 1b priority categories. The majority of survey respondents (70%) were female (median aged between 35 and 44 years). The majority of survey respondents were clinical workers, such as nurse, paramedics and doctors. Outcome measures χ 2 analysis was used for analysis of survey responses in univariate analysis. Logistic regression was used to analyse survey responses, adjusting for week, type of health worker and age. Results 4746 healthcare workers responded to the survey after receiving their first vaccine dose, a response rate of 23%. Over 90% of respondents said that COVID-19 vaccination information from their organisation was easily available. Most of them reported that they were comfortable receiving a COVID-19 vaccine. The majority of respondents were motivated to receive the vaccine due to concern about contracting COVID-19 themselves (75%), or concerns about transmitting it to other people such as patients (52%), family members (65%) or other community members (54%). Younger respondents were more likely to have preferred more information on vaccine safety (p<0.0001) and the effectiveness of the vaccine (p<0.0001). Conclusion The majority of healthcare workers who received a COVID-19 vaccine reported that it was easy to find useful information about the vaccination roll-out and they had a positive experience being vaccinated. © 2022 BMJ Publishing Group. All rights reserved.
He, S., Rolls, K., Stott, K., Shekhar, R., Vueti, V., Flowers, K., Moseley, M., Shepherd, B., Mayahi-Neysi, M., Chasle, B., Warner, B., Ni Chroinin, D., & Frost, S. A. (2022). Does delirium prevention reduce risk of in-patient falls among older adults? A systematic review and trial sequential meta-analysis [Article]. Australasian Journal on Ageing, 41(3), 396-406. https://doi.org/10.1111/ajag.13051
Objectives: To determine whether delirium prevention interventions reduce the risk of falls among older hospitalised patients. Methods: A systematic search of health-care databases was undertaken. Given the frequency of small sample sized trials, a trial sequential meta-analysis was conducted to present estimate summary effects to date. A Bayesian approach was used to estimate the posterior probability of the delirium prevention interventions reducing falls risk by various clinically relevant levels. Results: Five randomised controlled trials were included in our final meta-analysis. There was a 43% reduction in the risk of falls among participants in the delirium prevention intervention arm, compared to the control; however, confidence intervals were wide (RE RR = 0.57, 95% CI 0.32; 1.00, p = 0.05). This result was found to be statistically significant, according to traditional significance levels (z > 1.96) and the more conservative trial sequential analysis monitoring boundaries. The posterior probabilities of the delirium prevention intervention reducing the risk of falls by 10%, 20% and 30% were 0.86, 0.63 and 0.29 respectively. Conclusions: The results of this systematic review and trial sequential meta-analysis suggest that delirium prevention trials may reduce the risk of in-hospital falls among older patients by 43%. However, despite significant risk reduction found upon meta-analysis, the variation among study populations and intervention components raised questions around its application in clinical practice. Further research is required to investigate what the necessary components of a multifactorial intervention are to reduce both delirium and fall incidence among older adult in-patients. © 2022 AJA Inc.
Kabil, G., Frost, Steven. A., McNally, S., Hatcher, D., Saavedra, A., Suster, C. J. E., Moscova, M., & Shetty, A. (2022). Identifying factors associated with intravenous fluid administration in patients with sepsis presenting to the emergency department: a retrospective cohort study [Article]. BMC Emergency Medicine, 22(1), Article 98. https://doi.org/10.1186/s12873-022-00650-4
Background: Appropriate and timely administration of intravenous fluids to patients with sepsis-induced hypotension is one of the mainstays of sepsis management in the emergency department (ED), however, fluid resuscitation remains an ongoing challenge in ED. Our study has been undertaken with two specific aims: firstly, for patients with sepsis, to identify factors associated with receiving intravenous fluids while in the ED; and, secondly to identify determinants associated with the actual time to fluid administration. Methods: We conducted a retrospective multicentre cohort study of adult ED presentations between October 2018 and May 2019 in four metropolitan hospitals in Western Sydney, Australia. Patients meeting pre-specified criteria for sepsis and septic shock and treated with antibiotics within the first 24 h of presentation were included. Multivariable models were used to identify factors associated with fluid administration in sepsis. Results: Four thousand one hundred forty-six patients met the inclusion criteria, among these 2,300 (55.5%) patients with sepsis received intravenous fluids in ED. The median time to fluid administration from the time of diagnosis of sepsis was 1.6 h (Interquartile Range (IQR) 0.5 to 3.8), and the median volume of fluids administered was 1,100 mL (IQR 750 to 2058). Factors associated with patients receiving fluids were younger age (Odds Ratio (OR) 1.05, 95% Confidence Interval (CI (1.03 to 1.07), p < 0.001); lower systolic blood pressure (OR 1.11, 95% CI (1.08 to 1.13), p < 0.001); presenting to smaller hospital (OR 1.48, 95% CI (1.25 to 1.75, p < 0.001) and a Clinical Rapid Response alert activated (OR 1.64, 95% CI (1.28 to 2.11), p < 0.001). Patients with Triage Category 1 received fluids 101.22 min earlier (95% CI (59.3 to131.2), p < 0.001) and those with Category 2 received fluids 43.58 min earlier (95% CI (9.6 to 63.1), p < 0.001) compared to patients with Triage Category 3–5. Other factors associated with receiving fluids earlier included septic shock (-49.37 min (95% CI (-86.4 to -12.4), p < 0.001)); each mmol/L increase in serum lactate levels (-9.0 min, 95% CI (-15.7 to -2.3), p < 0.001) and presenting to smaller hospitals (-74.61 min, 95% CI (-94.0 to -55.3), p < 0.001). Conclusions: Younger age, greater severity of sepsis, and presenting to a smaller hospital increased the probability of receiving fluids and receiving it earlier. Recognition of these factors may assist in effective implementation of sepsis management guidelines which should translate into better patient outcomes. Future studies are needed to identify other associated factors that we have not explored. © 2022, The Author(s).
Clarke, K., & McErlean, G. (2022). A nursing primer: Immunoglobulin (Ig) therapy for secondary antibody deficiency (SAD) in haematological malignancies. The Australian Journal of Cancer Nursing, 23(2), 5-11. https://search.informit.org/doi/10.3316/informit.753996146904978
Immunoglobulin (Ig) therapy is increasingly being used for secondary antibody deficiency (SAD) in cancer patients with haematological malignancies. The aetiology of SAD can be attributed to the underlying condition or to the expanding range of treatments now available that target the immune system. Most often, immunodeficiency is clinically diagnosed as hypogammaglobulinaemia in patients with haematological malignancies and results in these patients being at a greater risk of acquiring an infection. The administration of Ig therapy to improve immunity in these patients has traditionally been intravenous and in hospital. However, subcutaneous Ig therapy is an innovative and alternative approach that can be more widely implemented in cancer centres and has the potential to allow home self-administration. This article reviews current Ig practice in adults with SAD and the subsequent implications on nurses and patients in Australia.
Ntelezos, K., Katsoulas, T., Mariolis-Sapsakos, T., Galanis, P., Alexandrou, Evan, & Konstantinou, E. (2022). Comparing Safety and Colonization Rates Between Octyl-Isocyanacrylate Glue and Standard Gauze Sponge Dressings for Patients with PICC-PORTs: A Pilot Randomized Controlled Trial. International Journal of Caring Sciences, 15(2). 43. ntelezos_2 (internationaljournalofcaringsciences.org)
Abstract Introduction: Bacterial colonization in patients with peripherally-inserted implantable ports (PICC-PORTs) is a serious complication that has attributable morbidity and mortality. Methods: We conducted a single center randomized controlled trial comparing safety and effectiveness of octyl-isocyanacrylate glue (GLUE) and standard gauze (SG) dressings for PICC PORT placement. Block randomization was used to allocate patients into the two groups. Swab cultures of the port site were obtained at the end of the procedure and five days after device placement. We assessed the safety of GLUE vs. SG dressings and measured the rate of skin colonization between the two groups. We also estimated the feasibility for conducting a full scale clinical trial. Results: Twenty six patients were randomly allocated to the GLUE group and 25 to the SG dressing group. We observed one case of localized bleeding (GLUE group). We found no cases of localized inflammation or infection at the exit site, no unscheduled dressing changes were reported, and no skin irritation related to either group. There was no difference in the rate of skin colonization post procedure or after five days (p=0.28). Feasibility analysis showed that 98.1% of patients screened were eligible and agreed to enroll in the study and all patients received allocated treatment. Only one patient denied his/her participation in the study. There were no losses to follow up. Conclusions: No difference was found in skin colonization rates between the uses of GLUE or SG dressings for PICC-PORT placement. The high eligibility, recruitment and retention rate show that a larger clinical trial would be feasible. Keywords: octyl-isocyanacrylate glue, PICC-PORTs, randomized trial, safety, feasibility study