Penny Allen

Avastin as an adjunct to vitrectomy in the management of severe proliferative diabetic retinopathy: a prospective case series

Purpose:  Bevacizumab (Avastin) is a monoclonal antibody which targets all isoforms of vascular endothelial growth factor A. Its potent anti‐angiogenic effects have been shown to cause regression of neovascularization in proliferative diabetic retinopathy. The aim of this study is to investigate the role of Avastin as an adjunct to vitrectomy in the management of severe diabetic eye disease.

Nurses’ Use of Mobile Devices to Access Information in Health Care Environments in Australia: A Survey of Undergraduate Students

Background The growth of digital technology has created challenges for safe and appropriate use of mobile or portable devices during work-integrated learning (WIL) in health care environments. Personal and professional use of technology has outpaced the development of policy or codes of practice for guiding its use at the workplace. There is a perceived risk that portable devices may distract from provision of patient or client care if used by health professionals or students during employment or WIL. Objective This study aimed to identify differences in behavior of undergraduate nurses in accessing information, using a portable or mobile device, when undertaking WIL compared to other non-work situations. Methods A validated online survey was administered to students while on placement in a range of health care settings in two Australian states. Results There were 84 respondents, with 56% (n=47) reporting access to a mobile or portable device. Differences in use of a mobile device away from, compared with during WIL, were observed for non-work related activities such as messaging (P<.001), social networking (P<.001), shopping on the Internet (P=.01), conducting personal business online (P=.01), and checking or sending non-work related texts or emails to co-workers (P=.04). Study-related activities were conducted more regularly away from the workplace and included accessing University sites for information (P=.03) and checking or sending study-related text messages or emails to friends or co-workers (P=.01). Students continued to access nursing, medical, professional development, and study-related information away from the workplace. Conclusions Undergraduate nurses limit their access to non-work or non-patient centered information while undertaking WIL. Work-related mobile learning is being undertaken, in situ, by the next generation of nurses who expect easy access to mobile or portable devices at the workplace, to ensure safe and competent care is delivered to their patients.

Low acuity and general practice-type presentations to emergency departments: A rural perspective

To estimate the number of general practice (GP)‐type patients attending a rural ED and provide a comparative rural estimate to a metropolitan study.

Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES – Australia.

AIM To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas. METHODS Diabetes MILES--Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%). RESULTS Respondents from rural/regional (n=1574, 48%) and metropolitan areas were represented equally (n=1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83-0.97) and T2DM (RR 0.69, 95% CI 0.59-0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25-3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07-1.36) or dietician (RR 1.17, 95% CI 1.07-1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators. CONCLUSIONS Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.

Intraocular pressure during femtosecond laser pretreatment: Comparison of glaucomatous eyes and nonglaucomatous eyes

Purpose To compare changes in intraocular pressure (IOP) during femtosecond laser pretreatment of cataract between glaucomatous eyes and nonglaucomatous eyes. Setting Launceston Eye Institute and Launceston Eye Hospital, Launceston, Australia. Design Nonrandomized interventional prospective case series. Methods Patients with clinically stable primary open‐angle glaucoma (POAG) having femtosecond laser pretreatment were compared with a concurrent cohort of patients with healthy eyes having the same procedure. Pretreatment was performed using a fluid‐filled optical docking system (Liquid Optics Interface). With the patient supine, the IOP was measured at 4 time points using a rebound tonometer (Icare Pro). Results The study comprised 143 eyes of 97 patients. Forty‐three eyes (30.1%) had documented glaucoma. The mean baseline IOP was 20.2 mm Hg ± 4.2 (SD) in glaucomatous eyes and 18.9 ± 4.0 mm Hg in nonglaucomatous eyes (P = .06). The mean change in IOP values between each time frame and baseline was as follows: vacuum‐on, 13.8 ± 9.9 mm Hg and 11.1 ± 6.9 mm Hg, respectively (P = .06); after treatment, 17.4 ± 7.4 mm Hg and 14.1 ± 7.2 mm Hg, respectively (P = .014); after undocking of vacuum, 9.9 ± 5.4 mm Hg and 8.7 ± 5.7 mm Hg, respectively (P = .24). Conclusions Femtosecond pretreatment caused a greater transient rise in IOP after treatment and a higher residual IOP after vacuum undocking in glaucomatous eyes than in nonglaucomatous eyes. This is well tolerated short term; however, long‐term implications for eyes with glaucoma are unknown at present. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

“A golden opportunity”: Exploring interprofessional learning and practice in rural clinical settings

Abstract Little is known about interprofessional practice (IPP) and interprofessional learning (IPL) in rural health services, despite national funding and continuing emphasis on increasing students’ clinical placements in rural areas. This short paper outlines a study in Tasmania, Australia, which investigated how and under what contexts and conditions IPP and IPL occur in rural clinical settings, and the enabling factors and strategies that promote this learning and practice. This study employed a mixed method design comprising focus group discussions and a survey involving health professionals from two rural health services. The findings demonstrate that formal and informal arrangements, the collaborative nature of small, close-knit healthcare teams and patient-centred models of care employed in rural practice settings, provide ideal contexts for IPP and IPL. The study has implications for promoting organisational readiness for IPP and IPL and harnessing the potential of rural services to promote and develop students’ interprofessional capability.

Severity and duration of pain after colonoscopy and gastroscopy: a cohort study

AIMS AND OBJECTIVES This study aimed to determine the prevalence, severity, location and duration of pain post-colonoscopy, and to explore possible associations between pain, demographic variables and diagnostic findings. The study also sought to provide information to guide decision-making on CO2 insufflation. BACKGROUND Colonoscopy with sedation is a common day surgery procedure in Australia. Attendance for colonoscopy is influenced by patient expectations, particularly about pain. Research on post-colonoscopy pain has focussed on pain experienced immediately post-procedure, with few studies investigating pain beyond 24 hours. DESIGN Follow-up study using patient-completed Pain Numerical Rating Scales. METHODS Patients undergoing colonoscopy at a single hospital day surgery unit were invited to complete Pain Numerical Rating Scales (where 0 = no pain and 10 = worst possible pain) three times daily for three days post-colonoscopy. RESULTS Among the 277 participants, 124 (45%) reported pain at any time during follow-up. Twenty-one (8%) participants experienced pain on each of the three days. Pain was most commonly experienced in the hypogastric and iliac regions. The severity of pain was low, with only 33 participants self-administering analgesics (paracetamol or nonsteroidal anti-inflammatory drugs) during follow-up. Participants who had both colonoscopy and gastroscopy were not more likely to report pain overall. However, they were more likely to report pain on days 2 and 3 and were also more likely to take analgesics. Pain was not associated with procedure duration, abdominal pressurisation, removal of polyps, diverticulitis, inflammatory bowel disease or the presence of benign or malignant lesions. CONCLUSIONS This research indicates that fewer than half of the patients undergoing colonoscopy will experience post-procedure pain and that just over one in ten patients will require analgesics. Patients undergoing both gastroscopy and colonoscopy are more likely to experience pain for longer and require over-the-counter analgesics. The low prevalence of pain suggests that room air insufflation is an acceptable alternative to more expensive CO2 . RELEVANCE TO CLINICAL PRACTICE The findings provide evidence for nurses and clinicians to advise patients about the likelihood of experiencing pain post-colonoscopy, and the characteristics of this pain. Nurses may reassure patients that pain is not more likely among patients diagnosed with colorectal disease or malignancy. Patients who have persistent pain for longer than 24 hours post-colonoscopy should be advised to seek medical care to investigate the cause of their pain.

Opportunities in oral health policy for Timor-Leste

Timor-Leste faces an urgent set of challenges in oral health. The impact of oral diseases in terms of reduced quality of life and cost of treatment is considerable. This paper reviews progress on policy recommendations since the National Oral Health Survey in 2002, the first such national survey. Few proposals have been implemented to date, owing to (i) lack of local support for the recommendations, particularly on promotion of oral health; (ii) lack of financial and budgetary provisions for oral health; (iii) lack of focus on services, human resources and dental personnel; (iv) poor focus, design and implementation of policy and planning in oral health; and (v) lack of transport to facilitate health-care workers’ access to remote areas. Based on this assessment, the present paper presents a reconfigured set of policies and recommendations for oral health that take into consideration the reasons for low uptake of previous guidance. Key priorities are promotion of oral health, legislative interventions, education of the oral-health workforce, dental outreach programmes, targeted dental treatment, dental infrastructure programmes, and research and evaluation. Interventions include promotion of oral health for schoolchildren, salt fluoridation, fluoride toothpaste and banning sweet stalls and use of tobacco and betel nut in, or near, schools. Timor-Leste should strengthen the availability and quality of outreach programmes for oral health. Dental therapists and dental nurses who can supply preventive and atraumatic restorative dental care should continue to be trained, and the planned dentistry school should be established. Ongoing research and evaluation is needed to ensure that the approach being used in Timor-Leste is leading to improved outcomes in oral health.

Early intervention for children with autism: An Australian rural hub and spokes model

The North West Tasmania Autism Specific Early Learning and Care Centre offers early intervention to children with autism symptoms in an extended hours Child Care Centre. In this regional and rural area it operates as a hub and spokes model with children from outlying areas receiving intervention from educators at their local mainstream childcare centre supported by specialist staff at the North West Tasmania Autism Specific Early Learning and Care Centre. We analysed clinical assessments of all children over the period 2009–2014 at entry and follow-up and found children in the spokes centres were achieving similar outcomes to those in the hub centres. The outcomes appeared to be moderated by the limited attendance of children with a smaller effect sizes on the majority of measures compared to best practice. However, larger effect sizes on the measure of socialisation could reflect the emphasis of the program on the social skills needed for participation in mainstream school environments.

Tasmanian macular hole study: whole population based incidence of full thickness macular hole

To determine the incidence of full thickness macular hole in the Tasmanian population.