Worry-YING and Worry-YANG: A Critical Feminist Study with Women Who Worry.

Gender is a critical determinant of mental health and well-being. Women are at greater risk of mental illness due to gender-based violence, economic disadvantage, and low social status. Women experience higher levels of acute and chronic stress and are twice as likely to be diagnosed with anxiety disorder. Anxiety disorder is a serious public health problem affecting 1:3 people worldwide, and according to WHO's International Classification of Diseases (ICD-10), a key symptom of anxiety is excessive worry. Few studies, however, have explored worry as a precursor to anxiety, and fewer have explored worry in relation to gender. This critical feminist study aimed to explore this phenomenon and identify the impact of worry on women and their mental health and well-being. Methods: Forty-five women living in Melbourne, Australia, participated in this qualitative study. They attended a 1-h semi-structured interview with the researcher to define and discuss worry and identify any impact or effect worry or worrying has had on their life as women. Results: The findings revealed that women worry about children, money, work, study, and violence against women. Conclusions: This study builds on the existing knowledge of the mental health and well-being of women, supports early intervention strategies to prevent anxiety disorder and long-term health risks; and meets the core objectives of the National Women's Health Strategy 2020-2030 to 'Improve the health and wellbeing of all women and girls in Australia'.

Phaeochromocytoma and paraganglioma.

Phaeochromocytomas and paragangliomas are rare catecholamine-producing neuroendocrine tumours which can potentially cause catastrophic crises with high morbidity and mortality. This best practice article considers the causes and presentation of such tumours, screening and diagnostic tests, management of these patients and consideration of family members at risk.

Three-year quantitative magnetic resonance imaging and phosphorus magnetic resonance spectroscopy study in lower limb muscle in dysferlinopathy.

BACKGROUND: Natural history studies in neuromuscular disorders are vital to understand the disease evolution and to find sensitive outcome measures. We performed a longitudinal assessment of quantitative magnetic resonance imaging (MRI) and phosphorus magnetic resonance spectroscopy (31 P MRS) outcome measures and evaluated their relationship with function in lower limb skeletal muscle of dysferlinopathy patients. METHODS: Quantitative MRI/31 P MRS data were obtained at 3 T in two different sites in 54 patients and 12 controls, at baseline, and three annual follow-up visits. Fat fraction (FF), contractile cross-sectional area (cCSA), and muscle water T2 in both global leg and thigh segments and individual muscles and 31 P MRS indices in the anterior leg compartment were assessed. Analysis included comparisons between patients and controls, assessments of annual changes using a linear mixed model, standardized response means (SRM), and correlations between MRI and 31 P MRS markers and functional markers. RESULTS: Posterior muscles in thigh and leg showed the highest FF values. FF at baseline was highly heterogeneous across patients. In ambulant patients, median annual increases in global thigh and leg segment FF values were 4.1% and 3.0%, respectively (P < 0.001). After 3 years, global thigh and leg FF increases were 9.6% and 8.4%, respectively (P < 0.001). SRM values for global thigh FF were over 0.8 for all years. Vastus lateralis muscle showed the highest SRM values across all time points. cCSA decreased significantly after 3 years with median values of 11.0% and 12.8% in global thigh and global leg, respectively (P < 0.001). Water T2 values in ambulant patients were significantly increased, as compared with control values (P < 0.001). The highest water T2 values were found in the anterior part of thigh and leg. Almost all 31 P MRS indices were significantly different in patients as compared with controls (P < 0.006), except for pHw , and remained, similar as to water T2 , abnormal for the whole study duration. Global thigh water T2 at baseline was significantly correlated to the change in FF after 3 years (ρ = 0.52, P < 0.001). There was also a significant relationship between the change in functional score and change in FF after 3 years in ambulant patients (ρ = -0.55, P = 0.010). CONCLUSIONS: This multi-centre study has shown that quantitative MRI/31 P MRS measurements in a heterogeneous group of dysferlinopathy patients can measure significant changes over the course of 3 years. These data can be used as reference values in view of future clinical trials in dysferlinopathy or comparisons with quantitative MRI/S data obtained in other limb-girdle muscular dystrophy subtypes.

Correlation of patient-reported routine assessment of patient index data with clinical measures of disease activity in psoriatic arthritis.

AIM: A treat-to-target strategy is recommended for management of psoriatic arthritis (PsA), although there is lack of agreement regarding the best measure of disease activity to target. Physician assessments included in traditional indices can be complex and time consuming to complete and cannot be readily conducted by telehealth. This study compares the routine assessment of patient index data 3 (RAPID3), an efficient tool comprising patient self-assessment, with traditional clinician-led composite measures in the PsA clinic setting. METHODS: Data were collected prospectively from July 2016 to March 2020 in 2 dedicated PsA clinics in Sydney, Australia. A receiver operating characteristic (ROC) curve was created for comparison of RAPID3 score with composite scores minimal disease activity (MDA), very low disease activity (VLDA) and disease activity in psoriatic arthritis (DAPSA) in low disease activity or remission. RESULTS: Ninety-three patients had simultaneous collection of RAPID3 and MDA measures. Mean (SD) age was 49.9 (13.5) years, 50.5% were male and 23 (24.7%) had erosive disease at baseline. RAPID3 scores ≤3.2 and ≤2.7 (range 0-30) had high sensitivity and specificity for VLDA and DAPSA remission respectively, with ROC curve area under the curve (95% CI) of 0.94 (0.91-0.97) and 0.96 (0.93-0.99). CONCLUSION: RAPID3 has good agreement with physician-led composite scores of MDA, VLDA and DAPSA, and provides a viable alternative to composite scores. This is particularly helpful in settings that do not allow for clinical examination, for example telehealth.

Design and implementation of flexible advanced training in rheumatology: report of a pilot programme.

BACKGROUND: Training in medicine is highly demanding and coincides with critical life tasks including relationship development, childbearing and rearing. The rigid requirements of training programmes risk precluding successful achievement of these extracurricular roles, forcing choices between work and other life commitments. Flexible employment structures that facilitate the development of high-quality physicians are needed. AIM: To assess the outcomes of 2 novel flexible training positions in Rheumatology. METHODS: The clinical department, trainees and senior administration designed flexible, part-time advanced training positions in rheumatology. We sought to deliver excellent training, supervision and support while ensuring safe, efficient clinical service delivery within existing systems and cultures. Barriers to implementation were actively identified. We rejected job share arrangements in favour of independent part-time positions anchored to departmental education, clinical and trainee needs. The outcomes of these positions have been determined through regular trainee meetings, clinic activity and costs. RESULTS: Trainees achieved all training requirements, reported high levels of job satisfaction, strong professional development, improved work-life balance and reduction of stress. Outpatient events increased and waiting times have decreased. We estimate that increased rebatable outpatient services have rendered the positions cost neutral. CONCLUSION: Flexible training positions can enhance clinical departments while enabling high-quality training for junior doctors. Further work should consider longer term outcomes and application to different clinical and training settings.

Participatory Action Research (PAR) - to better understand the experiences of nurse academics working in a team.

BACKGROUND: There is considerable literature outlining the high levels of occupational stress nurse academics experience, and the potential effect of workplace pressure on mental health and wellbeing. OBJECTIVES/AIMS/HYPOTHESES: To support the notion that to succeed in an academic environment, academics are more successful when working in a team, two academics conducted a Participation Action Research study. DESIGN: The PAR study was developed in line with a Clinical Skill Project to better understand the experiences of nurse academics working in a team. The Clinical Skills Project involved the write up of 40 nursing skills for publication. Twenty-seven academics were recruited into the project and allocated skills to write, in teams of 2-3, according to clinical expertise and interest. The Participatory Action Research (PAR) approach formed the framework for the project, as well as, provided an opportunity for the nurse academics to 'come together' at fortnightly team meetings to discuss the project and talk about their experience working in a team. METHODS: Using the PAR cyclical process of observing, reflecting, planning, and acting there was ongoing opportunity for the academic nurses to discuss, question and share knowledge about academic practices. These Interactive reflections were recorded in a team reflective diary during the meetings. Participants were also asked to reflect on their individual experience of working in the team, before, during and after the project. At the completion of the project all reflective comments were transcribed to form a combined narrative. RESULTS: Thematic and content analysis was then undertaken to identify any similarities and or differences in academic staff experience. CONCLUSIONS: The analysis revealed the following key themes. Working in a team creates better staff relationships, Working in a team can change workplace culture and Working in a team can Improve staff health and well-being.

A Functional Radiological and Soft Tissue Classification to Predict Outcomes in Orbital Fracture Surgery in a Multidisciplinary "Real-World" Setting.

Purpose: The decision for open reduction and internal fixation (ORIF) of orbital fractures is usually based on clinical severity and soft tissue and bony findings. This study aimed to identify prognostic factors for a successful surgical outcome. Materials and Methods: We included all orbital fractures treated by ORIF referred to the Ophthalmology clinic for assessment over a 12-year period. A successful outcome was defined as (i) a single operation, (ii) improved diplopia and globe position at 6 months, (iii) no surgical complications, and (iv) patient satisfaction. Data was collected on presenting symptoms, orthoptic measurements, time interval from injury to surgery, fracture geometry and involvement of internal, and external bony landmarks. Univariate and multivariate regression was used to identify predictive factors for success. Results: There were 143 cases with median age 35.4 years and 81.8% (117/143) male. 51% (73/143) were complex fractures involving multiple orbital walls. 63.6% (91/143) achieved significant improvement in both enophthalmos and diplopia at 6 months. 15.3% (22/143) had significant preoperative soft tissue or neurogenic injury. 11.8% (17/143) required orbital plate repositioning or removal. 1.4% (2/143) developed orbital haematoma and 4.2% (6/143) had cicatricial entropion. Pre-operative nerve or muscle damage (OR 0.05, p = 0.01) and infraorbital fissure fracture (OR 0.38, p = 0.04) were associated with poor outcomes, whereas an intact posterior ledge was associated with successful outcomes (OR 3.03, p = 0.02). Conclusion: Careful ocular motility evaluation to ascertain neurogenic injury and muscle compartment syndrome, and radiological analysis of the integrity of the posterior ledge and the inferior orbital fissure can facilitate management and expectations of ORIF surgery.

StARTalking: An Arts and Health Program to Support Undergraduate Mental Health Nursing Education.

Community arts and health programs are recognized as powerful contributors to mental health and wellbeing, reducing social isolation and strengthening community connection. They attract individuals with diverse lived experience and are invaluable learning environments for consumers and undergraduate mental health nursing students. This paper reports on the evaluation of StARTalking, a community arts and health program in Melbourne, Australia. The study aimed to better understand the consumer and student experience participating in the program. The themes, Finding connection/Taking time out, clearly indicate that embedding arts and health in mental health nursing education supports consumer and student learning, health and wellbeing.

A labour of love: Reward and satisfaction for nurses: Findings from a grounded theory study in dementia care.

AIM: To understand nurses' perceptions of quality nursing care in the dementia-specific care unit. As the world's population ages, the incidence of dementia is projected to rise in tandem. The requirement for skilled, dementia-trained registered nurses who can provide quality nursing care will need to increase accordingly to meet the needs of these individuals. Extensive research has been completed on dementia nursing care in a variety of settings; however, little research has been undertaken into nurses' perceptions of quality nursing care in the dementia-specific care unit. Understanding how registered nurses perceive quality nursing care in the dementia-specific care unit is important and provides valuable information about nursing practice in this environment for nurses and decision-makers. Gaining a better understanding of quality nursing care in this care unit may result in better nurse education and an improved patient experience. It may also assist nursing organisations, residential aged-care facilities, government bodies and nongovernment agencies that support, manage, and oversee dementia-specific care units. METHOD: A grounded theory study was conducted to understand nurses' perceptions of quality nursing care in dementia-specific care units. The study involved interviewing nine registered nurses working in two dementia-specific care units on the Gold Coast, Queensland. Data were collected during semi-structured interviews and analysed using both constant comparison and thematic analysis. FINDINGS: Three themes emerged from this study-Caring at the Coalface, Labour of love and the Business of Dementia Healthcare. The largest theme, Labour of love, represents the personal reward and feeling of satisfaction six nurses said they experienced when interacting with individuals living in the dementia-specific care unit. They identified and repeatedly discussed the joy and fulfilment they experienced when caring for them, and considered this to be an essential element of quality nursing care. It was evident from the data that the nurses cared very deeply about these individuals, and despite increased risks to personal safety at work, they did not want to work anywhere else. This article reports on the largest and key theme identified in the study Labour of Love.

The sum of us. Implementing a Person Centred Care Bundle - A narrative inquiry.

AIM: This study is a narrative inquiry that aims to better understand the experience of nurses implementing a Person-Centred Care (PCC) bundle onto an acute care ward in a large hospital in Melbourne, Australia. BACKGROUND: The PCC includes five key focus areas aimed at streamlining nursing practice 1) Nursing assessment and care planning, 2) bedside handover, 3) patient safety rounding, 4) patient whiteboards, and 5) safety huddles. The PCC bundle outlines a nursing care process that is interactional with the patient, focused on information sharing, safety and respect. METHOD: A narrative inquiry was used to explore the nurse's experiences implementing the PCC. Surveys and focus groups were used to collect data and thematic analysis was used to identify any key themes. RESULTS: The three themes were; Passing the baton; Keeping the cogs moving when time poor; and Deep interpersonal relating-The sum of us.

Learning how to SMILE. Improving physical and mental health through nurse education and creative practice.

The purpose of this pilot study was to explore how best to prepare and support nursing undergraduate students learning in a community/primary care setting through a Student Managed Initiatives in Lifestyle Education (SMILE) project. Further to this our intention was to evaluate the ways in which students were able to apply nursing theory to the practice of identifying and responding to the health needs of vulnerable people. Using a collaborative approach and a qualitative method, this pilot study used focus group discussions to explore both the experiences of community participants and undergraduate nursing students. This project found that students were able to draw on theoretical understandings and their simulated learning experiences to support their learning in a complex, non-clinical practice setting. It also illustrates the way in which community centres and other naturalistic environments where individuals and groups meet, can provide spontaneous and rewarding opportunities for nursing students to develop and apply health promoting knowledge and skills. Shaping nursing curricula with this in mind, creates the potential for nurses to make a significant contribution to improved health outcomes for vulnerable and/or marginalised people.

Do we need 30 min cortisol measurement in the short synacthen test: a retrospective study.

OBJECTIVE: The short synacthen test (SST) is widely used across the UK to assess adrenal reserve but there remains no consensus on the timing of cortisol sampling to help diagnose adrenal insufficiency. The main objective of our study was to see if both 30 and 60 min sample are required following administration of synacthen to investigate suspected adrenal insufficiency (AI). DESIGN: This was a single-centre retrospective study of 393 SSTs measuring 0, 30 and 60 min cortisol levels after administration of 250 µg of synacthen. PATIENTS AND METHODS: All the SSTs for patients suspected of primary or secondary AI between April 2016 and October 2018 were included in this study. The tests were performed as per our hospital protocol. A post-adrenocorticotropic hormone (ACTH) cortisol response of 420 nmol/L at any time point was considered adequate to rule out AI. The data were analysed to ascertain the proportion of patients who achieved this level at 30 and/or 60 min. RESULTS: A total of 393 SST results were included in this study. Patients were divided into two groups depending on whether (group A) or not (group B) they were on steroids. Overall, a total of 313 (79.6%) subjects achieved cortisol level of ≥420 nmol/L at 30 and 60 min while 19 (4.8%) had late response (ie, insufficient 30 min cortisol levels, rising to ≥420 nmol/L at 60 min). Another 61 subjects (15.5%) showed insufficient response at both 30 and 60 min (ie, failed to achieved level of ≥420 nmol/L). Importantly, there was no patient in either group who had adequate response at 30 min and then failed at 60 min. Patients in group A were more likely to have inadequate response at both 30 and 60 min while patients in group B were more likely to have normal response at both time points. CONCLUSIONS: Our results suggest that about 5% of people undergoing SST may be inappropriately diagnosed as having AI (and subjected to long-term unnecessary steroid treatment) if the 60 min sample is not maintained. We suggest that 30 min sample does not add any additional diagnostic utility and can be omitted thus simplifying SST even further and saving on cost and resources. We propose that single measurement after 60 min of administration of synthetic ACTH is a sufficient screening test for AI.

Implementation and evaluation of an education programme for nursing staff on recognising, reporting and managing resident-to-resident elder mistreatment in aged care facilities.

AIM: To implement an educational programme for nursing staff on recognising, reporting and managing resident-to-resident elder mistreatment in aged care facilities. BACKGROUND: The phenomenon of a growing ageing population increases the demand of optimum care for older people living in aged care facilities. Caring for older people is complex, but should include the management of aggressive interaction between them. Nursing staff play a vital role in identifying and managing those behaviours. However, many nurses may not recognise these aggressive interactions as abuse. Therefore, this study aims to manage and reduce this abuse through an educational programme. DESIGN: Cluster randomised trial registered on the Australia New Zealand Clinical Trial Registry (ACTRN 12617001618347). METHODS: This trial was undertaken in an aged care facility located in Melbourne, Australia and was funded in January 2017. Wards were randomly allocated (as the intervention and control group) by using sealed opaque envelopes. Nursing staff, who met eligibility, were consecutively recruited and supplied their informed consent. Nurses from the intervention group received an educational programme, while nurses from the control group continued with the usual standard care. Main outcomes included recognising, managing and reporting the abuse before and after the intervention and will be evaluated on an intention-to-treat analysis. DISCUSSION: It is vital to manage and reduce resident-to-resident elder mistreatment. This educational programme may assist nursing staff to protect vulnerable older people experiencing this abuse and may improve comprehensive evidence-based care for older people residing in aged care facilities.

A systematic review protocol of educational programs for nursing staff on management of resident-to-resident elder mistreatment in residential aged care homes.

AIM: To review evidence concerning educational programs for nursing staff on management of resident-to-resident elder mistreatment with the aim of preventing and reducing this abuse in residential aged care homes. BACKGROUND: Although elder abuse has received considerable attention, very little is known regarding resident-to-resident elder mistreatment in residential aged care homes and about interventions/programs to prevent and reduce this harm. Nurses play an essential role in identifying and managing aggressive interactions. However, many nurses may not recognize these behaviours as forms of abuse. Thus, it is important to ascertain if educational programs for nursing staff have been developed and implemented. DESIGN: Quantitative systematic review registered on PROSPERO (CRD42017080925). METHODS: A systematic search of English published studies between 1980 - 2017 will be conducted in CINAHL, Embase, MEDLINE, ProQuest, PsychInfo and Scopus. Risk of bias and quality of the studies will be evaluated by using the Cochrane Collaboration's tool and the Methodological Index for Nonrandomized studies. A meta-analysis will be performed, if sufficient homogeneity exists; otherwise, data will be summarized by using a narrative description. This study was funded in January 2017. DISCUSSION: Nursing staff should play a pivotal role in preventing and/or reducing resident-to-resident elder mistreatment. Therefore, it is important to identify available educational programs for nursing staff dealing with this abuse. Consequently, this review may provide evidence-based care for nursing staff to assist them in protecting older residents from experiencing abuse or being abused and in improving their well-being.

Muscle MRI in patients with dysferlinopathy: pattern recognition and implications for clinical trials.

BACKGROUND AND OBJECTIVE: Dysferlinopathies are a group of muscle disorders caused by mutations in the DYSF gene. Previous muscle imaging studies describe a selective pattern of muscle involvement in smaller patient cohorts, but a large imaging study across the entire spectrum of the dysferlinopathies had not been performed and previous imaging findings were not correlated with functional tests. METHODS: We present cross-sectional T1-weighted muscle MRI data from 182 patients with genetically confirmed dysferlinopathies. We have analysed the pattern of muscles involved in the disease using hierarchical analysis and presented it as heatmaps. Results of the MRI scans have been correlated with relevant functional tests for each region of the body analysed. RESULTS: In 181 of the 182 patients scanned, we observed muscle pathology on T1-weighted images, with the gastrocnemius medialis and the soleus being the most commonly affected muscles. A similar pattern of involvement was identified in most patients regardless of their clinical presentation. Increased muscle pathology on MRI correlated positively with disease duration and functional impairment. CONCLUSIONS: The information generated by this study is of high diagnostic value and important for clinical trial development. We have been able to describe a pattern that can be considered as characteristic of dysferlinopathy. We have defined the natural history of the disease from a radiological point of view. These results enabled the identification of the most relevant regions of interest for quantitative MRI in longitudinal studies, such as clinical trials. CLINICAL TRIAL REGISTRATION: NCT01676077.

The Mental health Master Class: An innovative approach to improving student learning in mental health nursing.

The Master Class was developed as an additional educational innovation designed to promote learning about mental health and illness and mental health nursing as a career option to 2nd-year undergraduate nursing students. A number of students had approached the mental health nursing academics expressing two polar views on mental health. They either expressed extreme interest in mental health nursing or significant distress and concern related to studying the core 2nd-year subject. It was considered that the Master Class could potentially provide students with additional support. It was thought the Master Class may either consolidate their interest in mental health or relieve their stress. This article presents the findings of a pre- and postevaluation which was employed to explore the effectiveness of the 5-day intensive mental health Master Class programme on student's mental health learning and their understanding of the role of a mental health nurse. The findings highlighted that prior to participating in the Master Class, there was a significant sense of uncertainty associated with perceived levels of competence required within the profession of mental health nursing. This was coupled with students expressing they wanted to disengage with the profession even before they had commenced any theory or clinical experience. The post-Master Class findings illustrated a significant improvement in students desire to consider mental health nursing.