Isabelle Ellis

The current state of Indigenous and Aboriginal women with diabetes in pregnancy: A systematic review

UNLABELLED To undertake a systematic review of diabetes in pregnancy (DIP), determining prevalence and impact on maternal and child health outcomes for Indigenous and Aboriginal women. METHOD Electronic searches of MEDLINE, Embase, CINAHL, ERIC, DARE, CDSR, PsycINFO, Austhealth and HealthInfoNet were undertaken. Changes in diagnostic criteria for DIP and variability in methodology meant a qualitative synthesis of the data was undertaken. RESULTS From the 142 potential studies, 42 peer reviewed journal articles met the inclusion criteria. GDM prevalence in 65% of studies was greater for Indigenous and Aboriginal women than the comparison groups; Pacific Islander 8.1%, Canadian Aboriginal 11.5%, American Indian 7.9%, Australian Aboriginal 8.4% compared with 2-5% worldwide. Of studies reporting high birth weight (>4000 g) and DIP, 75% had a higher than expected prevalence, 86% had higher macrosomia prevalence and 63% had higher stillbirth rates. Studies with Alaskan, Australian Aboriginal and Pacific Islander women had GDM prevalence both greater and less than comparison groups. CONCLUSION Correcting the health disparity for Indigenous and Aboriginal women with DIP is a health priority. DIP prevalence is not the same for all Indigenous and Aboriginal women. Inconsistent study design without robust data is interfering with accurate prevalence of DIP. New international consensus guidelines provide opportunities for high quality studies of DIP for Indigenous and Aboriginal women.

Effective strategies for weight loss in post-partum women: a systematic review and meta-analysis.

Post‐partum weight loss is critical to preventing and managing obesity in women, but the results from lifestyle interventions are variable and the components associated with successful outcomes are not yet clearly identified. This study aimed to identify lifestyle intervention strategies associated with weight loss in post‐partum women. MEDLINE, EMBASE, PubMed, CINAHL and four other databases were searched for lifestyle intervention studies (diet or exercise or both) in post‐partum women (within 12 months of delivery) published up to July 2014. The primary outcome was weight loss. Subgroup analyses were conducted for self‐monitoring, individual or group setting, intervention duration, intervention types, the use of technology as a support, and home‐ or centre‐based interventions. From 12,673 studies, 46 studies were included in systematic review and 32 randomized controlled trials were eligible for meta‐analysis (1,892 women, age 24–36 years). Studies with self‐monitoring had significantly greater weight lost than those without (−4.61 kg [−7.08, −2.15] vs. −1.34 kg [−1.66, −1.02], P = 0.01 for subgroup differences). Diet and physical activity when combined were significantly more effective on weight loss compared with physical activity alone (−3.24 kg [−4.59, −1.90] vs. −1.63 kg [−2.16, −1.10], P < 0.001 for subgroup differences). Lifestyle interventions that use self‐monitoring and take a combined diet‐and‐exercise approach have significantly greater weight loss in post‐partum women.

Is telehealth the right tool for remote communities? Improving health status in rural Australia.

The health status of people in rural and remote areas, particularly of Indigenous Australians, has been widely reported to be poorer than their urban counterparts. Health care in rural and remote Australia has relied on the work of nurses, often in the absence of medical or allied health personnel other than via telecommunication. Over the last 5 years telehealth has been heavily promoted as an innovative and effective way of improving the health status of people in rural and remote areas by providing improved access to specialist care. Through national infrastructure development and funding for a vast array of pilot projects, telehealth provision has been promoted as progressive, effective, and modern. This Editorial reviews the literature and highlights a need for additional research around telehealth-mediated patient–practitioner relationships.

The clinical champion role in the development of a successful telehealth wound care project for remote Australia

The role of a clinical champion in a wound care project was examined in terms of an emancipatory processes framework. During the project the role changed significantly, as the needs of the project changed. In the early phase of the project, the clinical champions role was that of team leader. During the middle phase of the project, the clinical champions role changed to health services advocate and coach. During the final phase of the project, the clinical champions role changed again, to that of salesperson and academic. Experience with the clinical issue being addressed by the new service, and clear motivation to complete the project, thereby seeing the new service established, allowed the clinical champion to motivate the team to overcome the difficulties in the change process.

Monitoring of long-term cardiac complications in patients receiving clozapine

There is a need for the implementation of consistent guidelines for long-term cardiac monitoring in patients prescribed clozapine. Berk et al.1 recommend that an echocardiogram should be performed at baseline, six months and then annually. Ronaldson et al.2 recommend active monitoring for the emergence of myocarditis, particularly by monitoring troponin and C-reactive protein levels. Questions remain regarding long-term monitoring protocols for clozapine therapy.

Nursing competencies needed for electronic advance care planning in community

Advance care planning implementation occurs across the world using different legislative frameworks, different language to describe both the process and the outcome, and different models to develop these plans. Many countries are in the process of developing personally controlled electronic health records. Including advance care plans as part of this record is proposed in Australia. The Electronic Advance Care Plan (eACP) in Community project aimed to develop a model that will engage community dwelling older adults with chronic lifelimiting illnesses in the process of advance care planning that is person-centred, evidence-based and has a focus of dignity of life. A systematic review was conducted to identify models of advance care planning information sharing and to examine the nurses’ role. A realist review comprising a metasynthesis of 8 qualitative studies and 9 quantitative studies was conducted. Nursing competencies need to be developed to include the medico-legal framework around advance care plan development, as well as information technology competencies and communication competencies so that nurses around the world are better informed for end-of-life care planning and practice in a digital world. - See more at: http://dl4.globalstf.org/?wpsc-product=nursing-competencies-needed-for-electronic-advance-care-planning-in-community#sthash.S3cVvh6u.dpuf

Teaching Telenursing with the Charles Darwin University Virtual Hospital

The American Academy of Ambulatory Care Nursing defines telenursing as “the delivery, management, and coordination of care and services provided via telecommunications technology within the domain of nursing.”1 This ranges from telephone triage, digital imaging for wound management, to electronic discharge planning. Telenursing is not a new field in Australia. In 1912, the Australian Inland Mission established nursing posts where nurses in outback Australia were stationed in remote towns and communities to provide care to the community. This care covered midwifery and the immediate emergency care needs of people suffering from injuries and acute illnesses, and the public health functions of health assessment, immunization, monitoring, and health promotion. By 1929 the Traeger pedal radio was introduced in North Queensland to allow communication between the nursing post and the newly established Royal Flying Doctor Service (RFDS) physician, thereby establishing the first routine telenursing service (Fig. 2.1). Within the first year, the RFDS had made 50 flights and treated 225 people. By 1934 a radio was installed in the aircraft allowing communication to be maintained with the ground. This heralded the first telenursing consultation with the physician in flight from a nurse at the remote town of Innaminka.8 Today telenursing is widespread.

Tale of Two Courthouses: A Critique of the Underlying Assumptions in Chronic Disease Self-Management for Aboriginal People

This article reviews the assumptions that underpin the commonly implemented Chronic Disease Self-Management models. Namely that there are a clear set of instructions for patients to comply with, that all health care providers agree with; and that the health care provider and the patient agree with the chronic disease self-management plan that was developed as part of a consultation. These assumptions are evaluated for their validity in the remote health care context, particularly for Aboriginal people. These assumptions have been found to lack validity in this context, therefore an alternative model to enhance chronic disease care is proposed.

Reporting of non‐prescribed medication usage in remote Australia: health‐seeking habits in Port Headland

Studies have indicated that the emergency department is the third most common site of hospital adverse events – many attributed to negligence.1 Because the emergency department is their first point of contact, large numbers of people are potentially exposed to mostly preventable adverse events. Further studies have indicated that the phase in care where most adverse events occur is during the medical examination and history taking.2 Clinicians in the emergency department of Port Hedland Hospital reported concern that individuals attending the emergency department were not reporting use of nonprescribed medications. Given that non-prescribed medications have the potential to cause adverse drug reactions and complementary and alternative medicines are used extensively by patients who attend Australian emergency departments,3 we sought to determine the usage of non-prescribed medications and people’s willingness to report their use in a remote town. Non-prescribed medications included bush medicines, complementary and alternative therapies and over-thecounter medicines.

Improving health services via advanced ICT networks

This chapter describes an innovative broadband initiative that connects a group of general practices, medical specialists, hospitals, and other health providers in rural areas of Australia through a managed virtual private network. It provides secure connectivity for a variety of mission-critical healthcare delivery applications—for example, transmission of pathology and radiology test results direct to clinicians. The medical practices involved are small-medium enterprises (SMEs) and the key aspects of ICTs for them are the impact on costs, productivity, and customer service. The formal evaluation process examined the domains of appropriateness, efficiency, and cost-effectiveness. Being the first such health network of its kind in Australia, the project encountered challenges and, by overcoming these, has been guiding government policy in respect to e-health. Initially funded from March 2005 via a Commonwealth Government grant, the GoldHealth network moved into a sustainable mode in July 2006. This chapter provides insights into GoldHealth and should be a useful guide to any similar broadband network initiatives for the health sector elsewhere in the world.