'Atawhai': a primary care provider-led response to family violence in Aotearoa New Zealand.

BACKGROUND: As a key determinant of ill-health, family violence is inadequately responded to within Aotearoa New Zealand health policy and practice. Without adequate system support, health professionals can often be unsure of what to do, or how to help. Developed in response to this system gap, 'Atawhai' aims to make it easier for primary care professionals to respond to family violence. METHODS: Underpinned by indigenous Maori customs, Atawhai combines complexity theory and participatory research methodologies to be responsive to the complexity involved in family violence. We worked with 14 primary care professionals across ten whakawhitiwhiti korero wananga (meetings for deliberate dialogue) to identify and develop primary care system pathways and tools for responding to family violence. This paper focuses on the development of Atawhai through wananga and observation methods. Methods used to capture change will be reported separately. FINDINGS: Atawhai is a relational response to family violence, focused on developing a network of trusted relationships between health and social care professionals to support safe responses to those accessing care. This study identified four key health system pathways to responsiveness and developed associated tools to support health care responsiveness to family violence. We found the quality of relationships, both among professionals and with those accessing care, coupled with critical reflection on the systems and structures that shape policy and practice are essential in generating change within primary care settings. CONCLUSIONS: Atawhai is a unique health care response to family violence evidenced on empirical knowledge of primary care professionals. Our theoretical lens calls attention to parts of the system often obscured by current health care responses to family violence. Atawhai presents an opportunity to develop a grassroots-informed, long-term response to family violence that evolves in response to needs.

A randomised controlled trial to determine the effectiveness of a radial arterial catheter dressing.

OBJECTIVE: To reduce radial arterial catheter failure in patients admitted to an adult intensive care unit (ICU). DESIGN: A randomised controlled trial. SETTING: A single site, large metropolitan tertiary referral public hospital. PARTICIPANTS: Three hundred participants admitted to an adult ICU were enrolled between 25 May and 13 September 2015. INTERVENTIONS: Participants were randomly assigned to one of two treatment groups (a polyurethane adhesive keyhole dressing or a polyurethane adhesive keyhole dressing together with a polyurethane semipermeable transparent dressing). MAIN OUTCOME MEASURE: Arterial catheter failure. RESULTS: Data were complete for 289 of the 300 adult participants, who were randomised to one of the two groups. There were 179 men (62%) with a median age of 61 years (IQR, 48-74). Overall, there were 109 arterial catheter failures (38%). There was a significantly higher catheter failure rate in the usual care group (65, 60%) compared with the intervention group (44, 40%; P = 0.05). Accidental catheter removal occurred in 87% of cases (n = 27) in the usual care group and in 13% of cases (n = 4) in the intervention group (P = 0.05). There was no significant difference between the two groups for time to catheter failure (P = 0.06). However, if patients were sedated, they were 54% less likely to experience arterial catheter failure (OR, 0.46; 95% CI, 0.31-0.67; P < 0.0001). CONCLUSION: This study showed a statistically significant reduction in arterial catheter failure using a radial arterial catheter dressing of a polyurethane adhesive keyhole dressing together with a polyurethane semipermeable transparent dressing. The nursing care technique of applying this dressing may improve dressing efficacy and patient safety and reduced costs.

The presence of vaginal Lactobacillus species does not contribute to a measureable difference in amniotic fluid lactate levels collected from the vaginal tract of laboring women.

INTRODUCTION: Amniotic fluid lactate research is based on the hypothesis that a relationship exists between fatigued uterine muscles and raised concentrations of the metabolite lactate, which is excreted into the amniotic fluid during labor. To assess potentially confounding effects of lactate-producing organisms on amniotic fluid lactate measurements, we aimed to determine if the presence of vaginal Lactobacillus species was associated with elevated levels of amniotic fluid lactate, measured from the vaginal tract of women in labor. MATERIAL AND METHODS: Results from this study contribute to a large prospective longitudinal study of amniotic fluid lactate at a teaching hospital in Sydney, Australia. Amniotic fluid lactate measurement was assessed at the time of routine vaginal examination, after membranes had ruptured, using a hand-held lactate meter StatStripXPress (Nova Biomedical). Vaginal swab samples were collected at the time of the first amniotic fluid lactate measurement and stored for later detection and quantification of Lactobacillus species using a TaqMan real-time PCR assay. Swab sample and amniotic fluid lactate results were paired and analyzed. RESULTS: The PCR assay detected Lactobacillus species in 48 of 388 (12%) vaginal swab specimens (8% positive, 4% low positive) collected from women in labor after membranes had ruptured. There was no significant difference in median and mean (respectively) amniotic fluid lactate levels with (8.35 mmol/L; 8.95 mmol/L) or without (8.5 mmol/L; 9.08 mmol/L) Lactobacillus species detected. CONCLUSION: There was no association between the presence or level of vaginal Lactobacillus species and the measurement of amniotic fluid lactate collected from the vaginal tract of women during labor.

Foreign body sexual assault complicated by rectovaginal fistula.

A case is discussed of an adolescent presenting with a rectovaginal fistula secondary to a sexual assault 2 years earlier. The fistula resulted from a retained foreign body (bottle cap) inserted into the vagina during the assault. The adolescent did not disclose the presence of the foreign body at the initial examination.