Description:
A deficiency in the gene for endonuclease G (Endog) was recently described as a genetic determinant of cardiac hypertrophy. The mechanisms involved in the regulation of Endog, however, are still to be elucidated. Therefore we hypothesised that Endog, being regulated by small regulatory non-coding RNAs called microRNAs (miRNAs), could contribute to the cardiac hypertrophy of the Hypertrophic Heart Rat (HHR), a human polygenic model of cardiac hypertrophy. From birth the HHR has less and smaller cardiomyocytes, which leads to hypertrophy and cardiac failure later in life. In this study, we examined genome-wide miRNA expression by Agilent Rat miRNA Microarray Kit Release 16.0 and Endog mRNA levels by real-time PCR in the left ventricle of neonatal HHR compared to age-matched rats from its authentic control, the Normal Heart Rat (NHR). Endog mRNA was significantly under-expressed in the HHR (fold change=−4.7; P=0.0001). Sixty-seven miRNAs (FDR P<0.05 and fold change>1.1) were differentially expressed between HHR and NHR (n=16). We then performed an in silico analysis to predict the miRNAs that are able to bind to the 3′ untranslated region of Endog mRNA, and therefore could regulate Endog levels. We discovered that the miRNAs let-7b, miR-338 and miR-347 are predicted to bind to Endog mRNA. Functional studies are being undertaken to determine whether these miRNAs can regulate Endog mRNA levels in vitro and their role in the pathological processes leading to cardiac hypertrophy. These miRNAs could be a new target for the prevention and treatment of cardiac hypertrophy in humans
Description:
The publication of the Australasian Creatinine Consensus Working Group’s position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010.
Description:
Background: Nearly half to 60% of falls in community-dwelling older people aged 65+ years result in physical injuries and 20%–50% of these require medical attention, including emergency department visit and hospitalisation. Fallers who stay in hospital longer than would be expected based on the primary injury diagnosis create an excess financial burden on the health system and represent a priority target group for fall prevention. Objectives: To identify and characterise high-length-of-stay (HLOS) patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. Methods: We analysed hospital discharge data from Victoria, Australia, to identify and characterise HLOS patients among community-dwelling older people aged 65+ years hospitalised for fall-related injury. We defined an episode as HLOS if the length of stay (LOS) was more than three times the average LOS for a particular diagnosis-related group. Results: Between 2005/06 and 2007/08 6822 patients (14.2% of the study group of which 73.8% were women) had ≥1 episode classified as HLOS. The HLOS patients accounted for 19.9% of episodes and 39.9% of bed days. HLOS patients were similar to non-HLOS patients in terms of indigenous status, in-hospital mortality and ethnicity. However, HLOS patients were older, less likely to be married, less likely to have hospital insurance and more likely to have comorbidity than non-HLOS patients. Significance/Contribution to the Field: This study identifies priority groups for a targeted prevention approach.
Description:
Objectives: Well-developed physical qualities may protect against contact injuries. However, the potential contribution of physical qualities as risk or protective factors to contact injury risk is yet to be determined for rugby league. This study applied a frailty survival model that accounts for recurrent injury to identify risk factors for all physiotherapist-reported contact injury in professional rugby league players. Design: Prospective cohort study. Methods: Sixty-six professional rugby league players participated in this three successive year prospective study. At the start of each season, all players underwent measurements of standard anthropometry (height, body mass, and sum of seven skinfolds), speed (10 m and 40 m sprint), muscular strength (1 repetition maximum [RM] bench press, 1RM squat, 1RM weighted chin-ups), power (vertical jump, bench throw, 1RM power clean, jump squat), and endurance (maximum repetition bench press with 60 kg resistance), repeated-sprint ability (12 × 20 m sprints performed on a 20 s cycle), prolonged high-intensity intermittent running ability (8 × 12 s maximal effort shuttles performed on a 48 s cycle), and maximal aerobic power (multi-stage fitness test). Data was used to demonstrate the application of the frailty model extension of the Cox proportional regression model for recurrent events to identify factors associated with a high hazard ratio (HR) of injury. Results: Heavier (body mass, HR = 2.6, 95% CI = 1.2-5.7), and faster (40 m sprint, HR = 2.1, 95% CI = 1.0-4.2) players, and those with poorly developed prolonged high-intensity intermittent running ability (HR = 2.9, 95% CI = 1.7-5.0) and upper-body strength (chin-up, HR = 2.2, 95% CI = 1.3-3.7) had a higher incidence of contact injuries. Conclusions: This study demonstrates application of a novel statistical approach for the analysis of injury data that is recurrent in nature. This approach identified that the greater impact forces generated from heavier players with faster speed may result in an increase in recurrent contact injury rates. However, the development of prolonged high-intensity intermittent running ability and upper-body strength and power may assist to reduce the risk of contact injury in professional rugby league players.
Description:
Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.
Description:
Background: Studies comparing internally linked (person–identifying) and unlinked (episodes of care) hospital discharge data (HDD) on hip fractures have mainly focused on incidence overestimation by unlinked HDD, but little is known about the impact of overestimation on patient profiles such as comorbidity estimates. In view of the continuing use of unlinked HDD in hip fracture research and the desire to apply research results to hip fracture prevention, we concurrently assessed the accuracy of both incidence and comorbidity estimates derived from unlinked HDD compared to those estimated from internally linked HDD. Methods: We analysed unlinked and internally linked HDD between 01 July 2005 and 30 June 2008, inclusive, from Victoria, Australia to estimate the incidence of hospital admission for fall-related hip fracture in community-dwelling older people aged 65+ years and determine the prevalence of comorbidity in patients. Community-dwelling status was defined as living in private residence, supported residential facilities or special accommodation but not in nursing homes. We defined internally linked HDD as the reference standard and calculated measures of accuracy of fall-related hip fracture incidence by unlinked HDD using standard definitions. The extent to which comorbidity prevalence estimates by unlinked HDD differed from those by the reference standard was assessed in absolute terms. Results: The sensitivity and specificity of a standard approach for estimating fall-related hip fracture incidence using unlinked HDD (i.e. omitting records of in-hospital deaths, inter-hospital transfers and readmissions within 30 days of discharge) were 94.4% and 97.5%, respectively. The standard approach and its variants underestimated the prevalence of some comorbidities and altered their ranking. The use of more stringent selection criteria led to major improvements in all measures of accuracy as well as overall and specific comorbidity estimates. Conclusions: This study strongly supports the use of linked rather than unlinked HDD in injury research. In health systems where linked HDD are unavailable, current approaches for identifying incident hip fractures may be enhanced by incorporating additional evidence-based criteria.
Description:
Elderly people with a lower limb amputation impose a heavy burden on health resources, requiring extensive rehabilitation and long term care. Mobility is key to regaining independence; however, the impact of multiple comorbidities in this patient group can make regaining mobility a particularly challenging task. An evidence-based prognosis for mobility is needed for rehabilitation and long term care planning. This systematic review summarizes the prosthetic and nonprosthetic mobility outcomes achieved by elderly people with a lower limb amputation, to determine whether an accurate prognosis for mobility can be made. MEDLINE, EMBASE, and CINAHL were searched for studies published before May 2010 in English, German, Dutch, or French, using keywords and synonyms for elderly, mobility, rehabilitation, and amputation. Mobility focused on actual movement (moving from one place to another) and was limited to long-term measurements, 6 months after amputation or 3 months after discharge from rehabilitation. The 15 included studies featured a diversity of objective outcome measures and mobility grades that proved difficult to compare meaningfully. In general, studies that included selected populations of prosthetic walkers showed that advanced prosthetic mobility skills can be achieved by the elderly person with a lower limb amputation, including outdoor/community walking. Studies that included all subjects undergoing a lower limb amputation reported that less than half of the elderly population achieved a household level of prosthetic mobility. The predominant findings from the included studies were incomplete reporting of study populations and poor reporting of the reliability of the mobility measures used. The strength of conclusions from this review was therefore limited and the prognosis for mobility in elderly people after lower limb amputation remains unclear. Further research into mobility outcomes of this population is needed to provide evidence that enables more informed choices in rehabilitation and long term care.
Description:
In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique. RESULTS: The survey findings identified the respondents' top ranked challenges. These were organised into four categories: (1) workforce issues; (2) access, equity and opportunity; (3) resources; and (4) contextual issues. Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges. CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.
Description:
In Australia, as in many other developed countries, the current healthcare environment is characterised by increasing differentiation and patient acuity, aging of patients and workforce, staff shortages and a varied professional skills mix, and this is particularly so in rural areas. Rural healthcare clinicians are confronted with a broad range of challenges in their daily practice. Within this context, the challenges faced by rural acute care clinicians were explored and innovative strategies suggested. This article reports the findings of a study that explored these challenges across disciplines in acute healthcare facilities in rural New South Wales (NSW), Australia. METHODS: A mixed method approach, involving a consultative, participatory 3 stage data collection process was employed to engage with a range of healthcare clinicians from rural acute care facilities in NSW. Participants were invited to complete a survey, followed by focus group discussions and finally facilitated workshops using nominal group technique. RESULTS: The survey findings identified the respondents' top ranked challenges. These were organised into four categories: (1) workforce issues; (2) access, equity and opportunity; (3) resources; and (4) contextual issues. Participants in the focus groups were provided with a summary of the survey findings to prompt discussion about the challenges identified and impact of these on their professional and personal lives. The results of the final workshop stage of the study used nominal group process to focus the discussion on identifying strategies to address identified challenges. CONCLUSIONS: This study builds on research conducted in a large metropolitan tertiary referral hospital. While it was found that rural clinicians share some of the challenges identified by their metropolitan counterparts, some identified challenges and solutions were unique to the rural context and require the innovative solutions suggested by the participants. This article provides insight into the working world of rural healthcare clinicians and offers practical solutions to some of the identified issues. The findings of this study may assist rurally based healthcare services to attract and retain clinical staff.
Description:
Special Issue: ACMHN’s 38th International Mental Health Nursing Conference - The Fabric of Life, 3-5 October 2012, Darwin Convention Centre, Darwin, Australia Australia and the United Kingdom (UK) share concerns regarding the recruitment and retention of nurses to the field of mental health care. This study sought to uncover what UK and Australian students perceived as motivational factors toward working in the context of mental health care. Abstracts only
Description:
Special Issue: ACMHN’s 38th International Mental Health Nursing Conference - The Fabric of Life, 3-5 October 2012, Darwin Convention Centre, Darwin, Australia Australia and the United Kingdom (UK) share concerns regarding the recruitment and retention of nurses to the field of mental health care. This study sought to uncover what UK and Australian students perceived as motivational factors toward working in the context of mental health care.
Description:
Objective: To describe Australian midwifery academics' perceptions of the current barriers and enablers for simulation in midwifery education in Australia and the potential and resources required for simulation to be increased. Design: A series of 11 focus groups/interviews were held in all states and territories of Australia with 46 participating academics nominated by their heads of discipline from universities across the country. Findings: Three themes were identified relating to barriers to the extension of the use of simulated learning environments (SLEs) ('there are things that you can't simulate'; 'not having the appropriate resources'; and professional accreditation requirements) and three themes were identified to facilitate SLE use ('for the bits that you're not likely to see very often in clinical'; ['for students] to figure something out before [they] get to go out there and do it on the real person'; and good resources and support). Key conclusion: Although barriers exist to the adoption and spread of simulated learning in midwifery, there is a long history of simulation and a great willingness to enhance its use among midwifery academics in Australia. Implications for practice: While some aspects of midwifery practice may be impossible to simulate, more collaboration and sharing in the development and use of simulation scenarios, equipment, space and other physical and personnel resources would make the uptake of simulation in midwifery education more widespread. Students would therefore be exposed to the best available preparation for clinical practice contributing to the safety and quality of midwifery care.
Description:
Purpose. Although the family environment is a potentially important influence on children's physical activity (PA), prospective data investigating these associations are lacking. This study aimed to examine the longitudinal relationship between the family environment and PA among youth. Design. A 5-year prospective cohort study. Setting. Nineteen randomly selected public schools in Melbourne, Australia. Subjects. Families of 5- to 6-year-old (n = 190) and 10- to 12-year-old (n = 350) children. Measures. In 2001, parents reported their participation in PA, family-based PA, and support and reinforcement for their child's PA. In 2001, 2004, and 2006, moderate to vigorous intensity PA (MVPA) was assessed among youth using accelerometers. Weekend and "critical window" (after school until 6:00 P.M.) MVPA were examined because we hypothesized that the family environment would most likely influence these behaviors. Analysis. Generalized estimating equations predicted average change in MVPA over 5 years from baseline family environment factors. Results. Maternal role modeling was positively associated with boys' critical window and weekend (younger boys) MVPA. Paternal reinforcement of PA was positively associated with critical window and weekend MVPA among all boys, and paternal direct support was positively associated with weekend MVPA (older boys). Among girls, maternal coparticipation in PA predicted critical window MVPA, and sibling coparticipation in PA was directly associated with weekend MVPA (younger girls). Conclusions. Longitudinal relationships, although weak in magnitude, were observed between the family environment and MVPA among youth. Interventions promoting maternal role modeling, paternal reinforcement of and support for PA, and Maternal and sibling coparticipation in PA with youth are warranted
Description:
Objective: To determine the current level of knowledge of first aid for a burn injury and sources of this knowledge among the general population of New South Wales. Design, setting and participants: People aged 16 years or older were interviewed as part of the 2007 NSW Population Health Survey, a continuous telephone survey of NSW residents. Main outcome measure: Weighted proportion of the population with optimal first aid knowledge for burns. Results: In total, 7320 respondents were asked questions related to burn injuries and first aid. Of the surveyed population, 82% reported that they would cool a burn with water, and 9% reported that they would cool the burn for the recommended 20 minutes. Few respondents reported that they would remove the patient’s clothing and keep the injured person warm. The most common sources of first aid information were a first aid book (42%) and the internet (33%). Speaking a language other than English at home, and being over 65 years of age were associated with a lack of first aid knowledge. Conclusions: A minority of people living in NSW know the optimal time for cooling a burn injury and other appropriate first aid steps for burns. This study demonstrates a gap in the public’s knowledge, especially among non-English speaking people and older people, and highlights the need for a clear, consistent first aid message.
A protocol for evidence-based targeting and evaluation of statewide strategies for preventing falls among community-dwelling older people in Victoria, Australia
Description:
Background: Falls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver the most effective interventions efficiently at a population level, and for these interventions to be taken up by older people. Objective: To support the development, and evaluation of, effective falls prevention policy and practice in the state of Victoria, Australia. Methods: The RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective programme. Research objectives were developed to support the strategies. These include: (1) identification of subgroups of older people most frequently admitted to hospital for falls; (2) examining the acceptability of established falls interventions; (3) identification of factors that encourage and support relevant lifestyle changes; (4) identifying opportunities to incorporate confirmed interventions in existing programmes and services; (5) developing guidelines for sustainability. The research results will subsequently guide strategy details for the falls prevention plan. RE-AIM will provide the framework for the evaluation structure. Outcome measures: Measures to monitor the implementation of the selected interventions will be determined for each intervention, based on the five key factors of the RE-AIM model. The overall effect of the falls prevention plan will be monitored by time series analysis of fall-related hospital admission rates for community-dwelling older people.
Description:
Background: Falls are a significant threat to the safety, health and independence of older citizens. Despite the now substantial evidence about effective falls prevention interventions, translation into falls reductions has not yet been fully realised. While the hip fracture rate is decreasing, the number and rate of fall-related hospital admissions among older people is increasing. The challenge now is to deliver the most effective interventions efficiently at a population level, and for these interventions to be taken up by older people. Objective: To support the development, and evaluation of, effective falls prevention policy and practice in the state of Victoria, Australia. Methods: The RE-AIM model (Reach, Efficacy, Adoption, Implementation, Maintenance) was used to identify strategies for an effective programme. Research objectives were developed to support the strategies. These include: (1) identification of subgroups of older people most frequently admitted to hospital for falls; (2) examining the acceptability of established falls interventions; (3) identification of factors that encourage and support relevant lifestyle changes; (4) identifying opportunities to incorporate confirmed interventions in existing programmes and services; (5) developing guidelines for sustainability. The research results will subsequently guide strategy details for the falls prevention plan. RE-AIM will provide the framework for the evaluation structure. Outcome measures: Measures to monitor the implementation of the selected interventions will be determined for each intervention, based on the five key factors of the RE-AIM model. The overall effect of the falls prevention plan will be monitored by time series analysis of fall-related hospital admission rates for community-dwelling older people.