First year allied health student transition to a regional university.

OBJECTIVE: Students from regional and remote backgrounds are more likely to stay and work in regional and remote locations. Health students transition and retention at university impacts the retainment of a competent rural health workforce. This study aimed to examine the perceptions of allied health students as they reflected upon their first six weeks at university and identified strategies which enhanced these experiences. DESIGN: A cross-sectional study. Surveys were administered to students who then completed a reflection exercise. Data were analysed using Pearson correlation coefficient and chi-squares. SETTING: An Australian regional university. PARTICIPANTS: First year occupational therapy, physiotherapy and speech pathology students. MAIN OUTCOME MEASURES: Factors influencing the first 6 weeks at university. RESULTS: One hundred and forty-three students participated. Homesickness was the major challenge in transitioning to university life. Subthemes identified were adjusting to being away from home, adjusting to university culture and the mature-aged student. Specific issues included a lack of familiarity with university campuses and services, being unprepared for the workload and confusion while learning new skills. CONCLUSION: Orientation week activities assist students transition into university and age-appropriate and family-friendly activities should be considered for mature-age students. All students were found to benefit from support to address economic pressures and skill development focusing on coping with university workload. The development of regional university policy including these strategies is likely to enhance student success.

Advance care planning in the context of clinical deterioration: a systematic review of the literature.

BACKGROUND: A Rapid Response Team can respond to critically ill patients in hospital to prevent further deterioration and unexpected deaths. However, approximately one-third of reviews involve a patient approaching the end-of-life. It is not well understood whether patients have pre-existing advance care plans at the time of significant clinical deterioration requiring Rapid Response Team review. Nor is it understood whether such critical events prompt patients, their families and treating teams to discuss advance care planning and consider referral to specialist palliative care services. AIM AND DESIGN: This systematic review examined advance care planning with patients who experience significant clinical deterioration in hospital and require Rapid Response Team review. The prevalence of pre-existing advance directives, whether this event prompts end-of-life discussions, the provision of broader advance care planning and referral to specialist palliative care services was examined. DATA SOURCES: Three electronic databases up to August 2017 were searched, and a manual review of article reference lists conducted. Quality of studies was appraised by the first and fourth authors. RESULTS: Of the 324 articles identified through database searching, 31 met the inclusion criteria, generating data from 47,850 patients. There was a low prevalence of resuscitation orders and formal advance directives prior to Rapid Response Team review, with subsequent increases in resuscitation and limitations of medical treatment orders, but not advance directives. There was high short- and long-term mortality following review, and low rates of palliative care referral. CONCLUSIONS: The failure of patients, their families and medical teams to engage in advance care planning may result in inappropriate Rapid Response Team review that is not in line with patient and family priorities and preferences. Earlier engagement in advance care planning may result in improved person-centred care and referral to specialist palliative care services for ongoing management.

Postural effects when cycling in late pregnancy.

AIM: This study assessed if upright cycling is preferable to semi-recumbent cycling during pregnancy. METHOD: Healthy women with low risk singleton pregnancies were tested at 34-38 weeks gestation. They cycled for 12 min, either semi-recumbent (45 degrees, n = 27) or upright (n = 23), at 135-145 beats min(-1). RESULTS: When semi-recumbent, minute ventilation was greater (p<0.03) at rest and systolic blood pressure and pulse pressure were greater during exercise (p<0.05). Exercise maternal heart rate, oxygen consumption, oxygen consumption per kilogram, minute ventilation, cardiac output, stroke volume, mean and diastolic blood pressures and arterio-venous oxygen difference were posture-independent. All increased with exercise (p<0.01), except stroke volume when semi-recumbent (p>0.05). Small post-exercise fetal heart rate increases (by 8 beats min(-1), p<0.05) were similar in both postures (n = 11 in each sub-group), with no adverse changes. Fetal heart rate accelerations and uterine activity (n = 11 in each sub-group) were not influenced by posture or exercise. CONCLUSIONS: (1) Neither posture had a distinct advantage. (2) Both postures were safe for short duration cycling. (3) The same target maternal heart rates are suitable for both postures because they resulted in similar oxygen consumptions and fetal heart rates.

Long-term risk factor control after a cardiac rehabilitation programme.

This study examined the hypothesis that Phase II cardiac rehabilitation participants (CRP) had better long-term risk factor control, self-rated perception of health and return to work rates than non-participants (NP) between 18 and 36 months post myocardial infarction (MI). It was a comparative study in a 550 bed hospital. Approximately half of both groups did not achieve a total cholesterol (TC) of 5.5 mmol/L or less. Compared with NP, CRP were significantly more likely to have a TC < = 6.5 mmol/L (7% vs. 28%) (p = 0.006). NP with TC > 6.5 mmol/L were significantly less likely to be on treatment (p = 0.002). CRP were more likely to regularly exercise than NP (79% vs. 61%) (p = 0.038). The success rate for blood pressure targets, return to work rates and self-rated perception of health were similar in both groups. In conclusion, CRP had better long-term control of some risk factors than NP. The study provides comparative longer-term patient outcomes after an Australian cardiac rehabilitation (CR) programme and forms the basis for further outcome measurement.