interventions to improve the quality of low back pain care in emergency departments: A systematic review and meta‑analysis

Low back pain (LBP) is a common reason people visit Emergency Departments (ED). However, the care provided is often not aligned with guideline recommendations. Despite increasing research aiming to promote guideline-based care in EDs, interventions to best implement recommendations are unknown. This study aimed to identify ED LBP implementation interventions that have been trialed and evaluate their effects on ED-relevant outcomes. A systematic review and meta-analysis, including studies that evaluated interventions to improve the quality of care provided to adults presenting to ED with LBP. Databases searched until May 2023 were Cochrane Library, CINAHL, EMBASE (via OVID), and PEDro. Interventions were categorized according to whether they had a patient, clinician, health service, or multiple-level focus. Where possible, meta-analysis was undertaken. Certainty around the results was assessed using the GRADE criteria. Twenty-eight studies were included. Interventions were categorized as patient (n = 2), clinician (n = 8), health service (n = 12), or multiple-level (n = 6) targeted. Overall, interventions successfully reduced the likelihood of receiving an opioid in ED (OR 0.65; 95% CI 0.55-0.75). However, no significant effect on lumbar imaging was demonstrated (OR 0.85; 95% CI 0.64-1.12). Subgroup analyses showed that studies reporting high baseline imaging rates ≥ 36% and those that included systems-based changes significantly reduced imaging (OR 0.60; 95% CI 0.39-0.93; and OR 0.65; 95% CI 0.45-0.94, respectively). A small reduction in ED length of stay was observed in the group exposed to the LBP interventions (mean difference - 0.38 h; 95% CI - 0.58 to - 0.17). Overall, certainty of evidence was deemed low to very low. Interventions were mostly single-system focused with a preference for education-based implementation strategies targeting patients or clinicians. The interventions reduced the use of opioid medication for LBP in ED, but the effects on lumbar imaging rates were uncertain. Further high-quality research is needed to improve LBP care in this setting

They start on the zero-alcohol and they wanna try the real thing : Parents\u27 views on zero-alcohol beverages and their use by adolescents

Objective: Zero-alcohol beverages containing 0.0-0.5% alcohol by volume may offer public health benefits if individuals use them to substitute for alcohol-containing products, thereby reducing alcohol use. There are, however, concerns that zero-alcohol beverages may encourage adolescents\u27 earlier interest in alcohol and increase exposure to alcohol company branding. As this poses a challenge for parents, we studied parents\u27 views on zero-alcohol beverages and their provision to adolescents. Methods: We interviewed n=38 parents of 12-17-year-olds and used reflexive thematic analysis to interpret interview data. Results: Parents considered zero-alcohol beverages to be \u27adult beverages\u27 that potentially supported reduced adult drinking but were unnecessary for adolescents. Parents were concerned that adolescent zero-alcohol beverage use could normalise alcohol consumption and be a precursor to alcohol initiation. There was a potential conflict between moderate provision in \u27appropriate\u27 contexts, and potential benefits, which were each supported by some parents. Uncertainty on health qualities was also reported. Conclusions: Parents reported conflicting and cautious views on zero-alcohol beverage provision to adolescents. Implications for public health: As evidence on the impacts of zero-alcohol beverage availability develops, parent-targeted messages highlighting the potential risk of normalisation of alcohol use for young people could be developed, in conjunction with broader policy responses

The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children: A comparative two-centre audit

BACKGROUND: The impact of sedation on the quality of initial skeletal surveys performed for suspected physical abuse in children is not known. OBJECTIVE: To assess whether sedation influenced the number of, reason for and effective dose of repeat radiographs obtained as part of initial skeletal surveys, and their mean examination times. MATERIALS AND METHODS: One hundred consecutive antemortem initial skeletal survey examinations performed for suspected physical abuse in children \u3c2 years were retrieved from two tertiary paediatric hospitals: Centre 1, where sedation is not used for initial skeletal survey imaging; and Centre 2, where sedation is used routinely. RESULTS: In total, 4055 radiographic projections were performed, of which 93 (2.3%) were repeats. Comparing centres, there was a significant difference in the total number of repeats (P¼0.001) and the number of repeats in children aged \u3c12 months (P¼0.008). Mean examination times were significantly shorter in unsedated children (P¼0.005), even after outliers were excluded (P¼0.002). There was no significant difference between the number of routine projections (P¼0.587), incompletely imaged body parts (P¼0.254), rotation/suboptimal positioning (P¼0.527), repeats in children aged \u3e12 months (P¼0.089), routine projections in children aged \u3c12 months (P¼0.642) or \u3e12 months (P¼0.979) or the effective doses of repeats (P¼0.286). CONCLUSION: There were fewer repeat projections in sedated children and those aged \u3c12 months but examination times were significantly longer. There was no difference in the effective doses of repeated projections. The routine use of sedation is not supported whe

Documentation and management of paediatric obesity: Evidence from a paediatric inpatient unit

Introduction: The obesity epidemic is a worldwide phenomenon.1 In Australia, the prevalence of paediatric overweight or obesity is 25%.2 Children with obesity present to medical services more frequently than children with a healthy weight.3 Therefore, any hospital admission is an opportunity for clinicians to identify and manage children with overweight or obesity. Previous research has not objectively measured how frequently clinicians document a child as being above the healthy weight range and initiate weight management strategies. This study addresses this gap in the literature by demonstrating the prevalence rate and clinical characteristics of children with overweight/obesity in a non-tertiary paediatric inpatient unit and measuring the rate of clinician recognition, documentation, and initiation of weight management strategies

A comprehensive analysis of well-being frameworks applied in Australia and their suitability for Indigenous peoples

Purpose: Well-being is a complex, multi-dimensional, dynamic, and evolving concept, covering social, economic, health, cultural and spiritual dimensions of human living, and often used synonymously with happiness, life satisfaction, prosperity, and quality of life. We review the existing key wellbeing frameworks applied in Australia both for the wider public and Indigenous peoples. The aim is to provide a comprehensive overview of various applied frameworks, along with a critical analysis of domains or dimensions comprising those frameworks, and to analyse the role of nature in those frameworks. Methodology: We conducted a critical analysis of the main frameworks applied in Australia to date to measure the well-being of the mainstream (mainly non-Indigenous) and Indigenous populations. This study is particularly timely given the Australian Government’s interest in revising the well-being frameworks as mentioned in the Government “Measuring What Matters” statement. Results: The existing well-being frameworks in Australia either overlook or hardly consider the role of nature and its services which are important to support human well-being. Likewise, for Indigenous peoples “Country” (Indigenous clan land) is vital for their well-being as their living is imbued with ”Country”. The role of nature/”Country” needs to be considered in revising the well- being frameworks, indicators and measures to inform and develop appropriate policies and programs in Australia. Conclusion: To develop appropriate welfare policies and programs for achieving socio- economic and other wellbeing outcomes, it is essential to evolve and conceptualize well-being frameworks (and related indicators and measures) in line with people’s contemporary values, particularly considering the role of nature and its services

Yawardani Jan-ga – How horses are writing a new story with Aboriginal young people in the Kimberley

Equine Assisted Learning (EAL) is an experiential learning approach that simultaneously engages sensory, neuromotor and cognitive systems to promote wellbeing outcomes. EAL is very different to office-based social and emotional wellbeing interventions and seems particularly suited to support the wellbeing of Aboriginal young people due to their flexibility, their non-confrontational non-verbal methods for feedback, and importantly, the historical ties to horses through working and living on country. The Yawardani Jan-ga (Horses doing Healing) EAL intervention responds to the urgent needs of Aboriginal young people across the Kimberley. This study aims to evaluate the impact of the EAL intervention on the social and emotional wellbeing of Aboriginal young people

University staff perspectives on determinants of high-quality health professions student placements in regional, rural and remote Australia: Protocol for a mixed-method study

Introduction: In rural areas, work-integrated learning in the form of health student placements has several potential benefits, including contributing to student learning, enhancing rural health service capacity and attracting future rural health workforce. Understanding what constitutes a high-quality rural placement experience is important for enhancing these outcomes. There is no current standardised definition of quality in the context of rural health placements, nor is there understanding of how this can be achieved across different rural contexts. This study is guided by one broad research question: what do university staff believe are the determinants of high-quality health professions student placements in regional, rural and remote Australia? Methods and analysis: This study will adopt a convergent mixed-method design with two components. Component A will use explanatory sequential mixed methods. The first phase of component A will use a survey to explore determinants that contribute to the development of highquality health student placements from the perspective of university staff who are not employed in University Departments of Rural Health and are involved in the delivery of health student education. The second phase will use semistructured interviews with the same stakeholder group (non-University Department of Rural Health university staff) to identify the determinants of high-quality health student placements. Component B will use a case study Employing COnceptUal schema for policy and Translation Engagement in Research mind mapping method to capture determinants that contribute to the development of highquality health student placements from the perspective of University Department of Rural Health university staff. Ethics and dissemination: The University of Melbourne Human Ethics Committee approved the study (2022-23201-33373-5). Following this, seven other Australian university human research ethics committees provided external approval to conduct the study. The results of the study will be presented in several peer-review publications and summary reports to key stakeholder groups