Effectiveness of meatal cleaning in the prevention of catheter-associated urinary tract infections and bacteriuria: an updated systematic review and meta-analysis

Objective A systematic review on meatal cleaning prior to urinary catheterisation and post catheterisation and reduces the risk catheter-associated urinary tract infections (CAUTIs) and bacteriuria was published in 2017, with further studies undertaken since this time. The objective of this paper is to present an updated systematic review on the effectiveness of antiseptic cleaning of the meatal area for the prevention of CAUTIs and bacteriuria in patients who receive a urinary catheter.Design Systematic review.Data sources Electronic databases Cochrane Library, PubMed, Embase, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline and Academic Search Complete were searched from 1 January 2016 and 29 February 2020.Eligibility criteria Randomised controlled trials (RCTs) and quasi-experimental studies evaluating the use of antiseptic, antibacterial or non-medicated agents for cleaning the meatal, periurethral or perineal areas before indwelling catheter insertion or intermittent catheterisation or during routine meatal care.Data extraction and synthesis Data were extracted using the Cochrane Collaboration’s data collection form for RCTs and non-RCTs. Data were extracted by one researcher and then checked for accuracy by a second researcher.Results A total of 18 studies were included. Some potential benefit of using antiseptics, compared with non-antiseptics for meatal cleaning to prevent bacteriuria and or CAUTI was identified (OR 0.84, 95% CI 0.69 to 1.02; p=0.071). Antiseptics (chlorhexidine or povidine-iodine) may be of value for meatal cleaning on the incidence of CAUTI, compared with comparator agents (saline, soap or antimicrobial cloths) (OR=0.65, 95% CI 0.42 to 0.99; p=0.047).Conclusion There is emerging evidence of the role of some specific antiseptics (chlorhexidine) prior to urinary catheterisation, in reducing CAUTIs, and some potential benefit to the role of antiseptics more generally in reducing bacteriuria.PROSPERO registration number CRD42015023741

Prevalence and correlates of depression among Australian women: a systematic literature review, January 1999-January 2010

Background: Little is known about the prevalence and correlates of depression among Australian women. This systematic review of depression among women in Australia, the largest identified to date, highlights the prevalence and correlates of depression across the life span. Results: The report adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement (PRISMA). Six health related databases were selected: Medline, PsychInfo, SCOPUS, Cinhal, Informit and Cochrane Systematic Reviews. 1,888 initial articles were found, and 111 articles were considered relevant for review. Prevalence rates of depression among women ranged from 2.6% to 43.9%. Higher rates were reported for younger women, or specific population groups. Most significant correlates included, age, adverse life events, tobacco use, sole motherhood, and previous mental health problems. Conclusions: Limitations include the scope of the investigation's aims and inclusion criteria, and the failure to identify gender specific data in most studies. Publication bias was likely, given that only papers reported (or translated) in English were included. Despite the breadth of information available, there were noticeable gaps in the literature. Some studies reported on affective disorders, but did not specifically report on depression; it is concluded that each mental illness warrants separate investigation. It was also common for studies to report a total prevalence rate without separating gender. This report recommends that it is vital to separate male and female data. The report concludes that more research is needed among mid-age women, Indigenous women, non-heterosexual women and Culturally and Linguistically Diverse (CALD) women

Multidisciplinary palliative care team experiences when caring for people with intellectual disability who are dying

Introduction: In the state of New South Wales (NSW) Australia the legislation requires that deaths of people with disability living in, or temporarily absent from, a government assisted accommodation service are reportable to the Coroner. Collated data from this reporting requirement offers information about where people with disability die, details of the death, and accommodation and health conditions at the time of death. Methods: Using a de-identified version of the collated database we analysed the reported deaths for 599 people with intellectual disability who had died during 2012 to 2016 across NSW. Results: The data set will be described in terms of key variables, including number of deaths per year, place of death, expectancy of death, and associated health risks. Significant relationships between place of death and policy compliance will also be described; for example compliance with coronial death reporting, and presence of health care plans. Implications: Recommendations about future data collection will be presented with a focus on policy compliance, data fidelity, and data collection methods. The findings will be discussed in light of Australia’s current move from a state-based to national reporting system for out-of-home deaths

Good agreement between self-report and centralized hospitalizations data for arthritis-related surgeries

Objective: To examine the level of agreement between self-reported and hospital administration records of arthritis related surgeries for two large samples of community dwelling older women in Australia, born between 1921-1926 and 1946-1951. Study Design and Setting: Self-report survey data from the Australian Longitudinal Study on Women’s Health (ALSWH) was linked to inpatient hospital data from the New South Wales Admitted Patient Data Collection (NSW APDC). Levels of agreement were compared using Cohen’s kappa, sensitivity, specificity, and positive and negative predictive values. Reasons for false positives were examined. Results: This study found good agreement (kappa > 0.70; sensitivity and specificity > 0.80) between self-report and hospitalisations data for arthritis related surgeries. Conclusion: This study provides new evidence for good agreement between self-reported health survey data and administrative records of arthritis related joint procedures, and supports the use of self-report surveys in epidemiological studies of joint procedures where administrative data are not available or not readily accessible, or where more extensive contextual information is needed. The use of health survey data in conjunction with administrative data has an important role to play in public health planning and policy

Specialist palliative care staff's varying experiences of talking with people with intellectual disability about their dying and death : a thematic analysis of in-depth interviews

Background: The cognitive and communication challenges experienced by people with intellectual disability present difficulties for health professionals, particularly in the face of illness and dying. Aim: To explore the experiences of specialist palliative care staff in talking with people with intellectual disability about their dying and death, and factors that influence these conversations. Design: An inductive thematic analysis was conducted on data from a larger qualitative semi-structured interview study. Setting/participants: Twenty palliative care staff from health services across Australia were interviewed. Participants were employed in multidisciplinary specialist palliative care teams and had provided palliative care to dying persons with intellectual disability. Results: Specialist palliative care staff did not consistently talk with people with intellectual disability about their dying and death. Conversations were influenced by (a) the perceived capacity of the person with intellectual disability, (b) experience and expertise of palliative care staff, (c) the relationship between palliative care staff and dying person and (d) values of palliative care staff and other caregivers (namely family members and paid carers). Conclusions: Specialist palliative care staff experience difficulties in talking with people with intellectual disability about their dying. Development of communication guidelines, resources and training for palliative care teams are urgently required to improve palliative care for this patient group. A more comprehensive research agenda on the needs of people with intellectual disability and their caregivers in palliative care is needed, with a particular focus on strategies to effectively communicate about dying and deat

Transforming retirement : new definitions of life after work

This quantitative research study uses survey data of women born between 1946 and 1951 in Australia. It follows earlier work that identified the importance of transitions from work for women of the baby boomer generation. We provide important insights into the lives of women who have partially or fully retired and the changing nature of women’s work and retirement. For many women, retirement is characterized by newfound freedoms, opportunities, career change, and evolving identities, yet others view retirement as a continuation of previous occupational and gendered roles and commitments. This study has important implications for retirement policies for women

Adults with intellectual disability : choice and control in the context of family

This chapter about the experience of choice and control by adults with intellectual disability in the family context is offered against the background of the tripartite ecological theory of self-determination (Abery and Stancliffe, A tripartite-ecological theory of self-determination. In Wehmeyer et al. (Eds.), Theory in self-determination: Foundations for educational practice (pp. 43–78). Springfield, IL: Charles C. Thomas, 2003). The challenges in determining readiness for adult decision-making are discussed, as are the experiences of adults with intellectual disability when exercising choice and control within the family context. How families, including parents and siblings, influence decision-making by their family member with intellectual disability is summarized. The critical role of the family in supporting independent choice-making is also highlighted. The chapter ends with a call for research about skills and resources for families to become effective, knowledgeable, and confident supporters of their member with intellectual disability in the quest for adult self-determination