The Impact of Rural Clinical Placement on Student Nurses' Employment Intentions

Commonwealth Government health policy and professional organisations have indicated that successful recruitment and retention strategies are crucial to address the shortage of health professionals in rural and remote areas. This research study aimed to evaluate the effectiveness of a Clinical Placement Support Scheme for nursing students as a recruitment strategy for rural and remote health care services, and to develop an increased awareness of the employment opportunities available in these areas. The population consisted of final year Bachelor of Nursing students enrolled in either a rural or metropolitan clinical placement in 2000. A pre-post test survey design was used. Analysis of pre and post test data found a 12% increase (to 89%) in the number of students intending to seek employment in a rural setting, compared to a 5% increase (to 46%) in students who undertook a metropolitan placement. One-third of the students who chose a rural placement had no previous experience of a rural lifestyle and over half of these students indicated their intention to work in a rural setting following their clinical placement. These results support the theory that undergraduate rural clinical experience can have a positive influence on the recruitment of health professionals to rural area

Vitamins E and C in patients with end-stage renal disease undergoing hemodialysis

Patients with end-stage renal disease undergoing hemodialysis have a high incidence of oxidative stress-related diseases. This study evaluated oxidative stress and inflammatory markers in patients undergoing hemodialysis before and during vitamin E supplementation. Blood samples were obtained before and after dialysis during two separate dialysis sessions to establish baseline measurements. For the next two months, subjects consumed 400 IU RRR-α-tocopherol daily. At one month and two months of supplementation, blood samples were also obtained before and after dialysis. Circulating concentrations of α- and γ-tocopherols and their metabolites (carboxyethyl-hydroxychromans, α- and γ-CEHCs), vitamin C, and uric acid were determined by HPLC with electrochemical detection. C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), and interleukin-6 (IL-6) were measured using standard clinical assays. F₂-isoprostanes were evaluated using an enzyme immunoassay. Dietary vitamins E and C were assessed using two 24-hour recalls. In response to vitamin E supplementation, plasma α-tocopherol concentrations increased from 18 ± 1.7 μM to 31 ± 5.4 μM (p<0.0001), while γ-tocopherol concentrations decreased from 2.8 ±1.0 μM to 1.7 ± 0.6 μM (p=0.001). Additionally, serum vitamin E metabolites increased, α-CEHCs from 68 ± 20 pmol/ml to 771 ± 161 (p<0.0001) and γ-CEHC from 837 ± 161.8 pmol/ml to 1136 ± 225.9 (p=0.0083). Both CEHCs are well above reported normal values (p<0.0001). Dietary antioxidants (vitamins E and C) were low in most subjects; thus, plasma ascorbic acid levels were low in most subjects, but high in a few, resulting a wide range of responses (88 ± 84 μM). Nonetheless, ascorbic acid concentrations decreased significantly after dialysis to 33 ± 34 μM (p=0.0124), but were unaffected by vitamin E supplementation. Indeed, many parameters decreased significantly by dialysis but were unchanged by vitamin E supplementation, including plasma concentrations of uric acid and TNF-α. Both IL-6 and F₂-isoprostane concentrations were elevated in the subjects but were unaffected by either vitamin E supplementation or dialysis. CRP increased significantly after dialysis (p=0.0161, ANOVA main effect), but in the vitamin E supplemented subjects CRP concentrations were slightly lower before dialysis , but increased following dialysis (p=0.0041, ANOVA interaction). Taken together, the data suggest that there is a complex relationship between chronic inflammation and oxidative stress. Longer supplementation with vitamin E might be necessary in order to observe beneficial effects

Corporate governance, market valuation and dividend policy in Brazil

This study investigates the effects of the corporate governance structure on market valuation and dividend payout of Brazilian companies. The empirical results indicate a high degree of ownership and control concentration. We can also note a significant difference between the voting and total capital owned by the largest shareholders, mainly through the existence of non-voting shares, pyramidal structures, and shareholding agreements. These mechanisms seem to be used by controlling shareholders to keep the firm’s control without having to own 50% of the total capital. The evidence also reveals that there is a relationship between governance structure, market valuation, and dividend policy in Brazil.Indisponível

Behavioral Interventions Associated with Smoking Cessation in the Treatment of Tobacco Use

Tobacco smoke is the leading cause of preventable premature death worldwide. While the majority of smokers would like to stop, the habitual and addictive nature of smoking makes cessation difficult. Clinical guidelines suggest that smoking cessation interventions should include both behavioural support and pharmacotherapy (e.g. nicotine replacement therapy). This commentary paper focuses on the important role of behavioural interventions in encouraging and supporting smoking cessation attempts. Recent developments in the field are discussed, including ‘cut-down to quit’, the behaviour change techniques taxonomy (BCTT) and very brief advice (VBA) on smoking. The paper concludes with a discussion of the important role that health professionals can and should play in the delivery of smoking cessation intervention

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum. Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries. Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content. Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

Thoracic Society of Australia and New Zealand position statement on acute oxygen use in adults : 'swimming between the flags'

Oxygen is a life-saving therapy but, when given inappropriately, may also be hazardous. Therefore, in the acute medical setting, oxygen should only be given as treatment for hypoxaemia and requires appropriate prescription, monitoring and review. This update to the Thoracic Society of Australia and New Zealand (TSANZ) guidance on acute oxygen therapy is a brief and practical resource for all healthcare workers involved with administering oxygen therapy to adults in the acute medical setting. It does not apply to intubated or paediatric patients. Recommendations are made in the following six clinical areas: assessment of hypoxaemia (including use of arterial blood gases); prescription of oxygen; peripheral oxygen saturation targets; delivery, including non-invasive ventilation and humidified high-flow nasal cannulae; the significance of high oxygen requirements; and acute hypercapnic respiratory failure. There are three sections which provide (1) a brief summary, (2) recommendations in detail with practice points and (3) a detailed explanation of the reasoning and evidence behind the recommendations. It is anticipated that these recommendations will be disseminated widely in structured programmes across Australia and New Zealand

Does a 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine prevent respiratory exacerbations in children with recurrent protracted bacterial bronchitis, chronic suppurative lung disease and bronchiectasis: protocol for a randomised c

BackgroundRecurrent protracted bacterial bronchitis (PBB), chronic suppurative lung disease (CSLD) and bronchiectasis are characterised by a chronic wet cough and are important causes of childhood respiratory morbidity globally. Haemophilus influenzae and Streptococcus pneumoniae are the most commonly associated pathogens. As respiratory exacerbations impair quality of life and may be associated with disease progression, we will determine if the novel 10-valent pneumococcal-Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) reduces exacerbations in these children. MethodsA multi-centre, parallel group, double-blind, randomised controlled trial in tertiary paediatric centres from three Australian cities is planned. Two hundred six children aged 18 months to 14 years with recurrent PBB, CSLD or bronchiectasis will be randomised to receive either two doses of PHiD-CV or control meningococcal (ACYW135) conjugate vaccine 2 months apart and followed for 12 months after the second vaccine dose. Randomisation will be stratified by site, age (&lt;6 years and &ge;6 years) and aetiology (recurrent PBB or CSLD/bronchiectasis). Clinical histories, respiratory status (including spirometry in children aged &ge;6 years), nasopharyngeal and saliva swabs, and serum will be collected at baseline and at 2, 3, 8 and 14 months post-enrolment. Local and systemic reactions will be recorded on daily diaries for 7 and 30 days, respectively, following each vaccine dose and serious adverse events monitored throughout the trial. Fortnightly, parental contact will help record respiratory exacerbations. The primary outcome is the incidence of respiratory exacerbations in the 12 months following the second vaccine dose. Secondary outcomes include: nasopharyngeal carriage of H. influenzae and S. pneumoniae vaccine and vaccine- related serotypes; systemic and mucosal immune responses to H. influenzae proteins and S. pneumoniae vaccine and vaccine-related serotypes; impact upon lung function in children aged &ge;6 years; and vaccine safety. DiscussionAs H. influenzae is the most common bacterial pathogen associated with these chronic respiratory diseases in children, a novel pneumococcal conjugate vaccine that also impacts upon H. influenzae and helps prevent respiratory exacerbations would assist clinical management with potential short- and long-term health benefits. Our study will be the first to assess vaccine efficacy targeting H. influenzae in children with recurrent PBB, CSLD and bronchiectasis

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice

Need and baseline for harmonising nursing education in respiratory care: preliminary results of a global survey

Background: The COVID-19 pandemic confirmed that respiratory nurses are critical healthcare providers. Limited knowledge is available about appropriate education to prepare nurses to deliver high-quality respiratory care. A survey was developed by the International Coalition for Respiratory Nursing (ICRN) group to identify the need for a respiratory nursing core curriculum.Method: A 39-item survey was distributed to 33 respiratory nursing experts in 27 countries. Questions asked about current roles, perception of need, expectations for a core curriculum project and respiratory content in nursing education in their countries.Results: 30 responses from 25 countries were analysed; participants predominantly worked in academia (53.3%, 16/30) and clinical practice (40%, 12/30). In total, 97% (29/30) confirmed a need for a core respiratory nursing curriculum. Post-registration nursing programmes at bachelor (83.3%, 25/30) and masters (63.3%, 19/30) levels include internal/medical nursing care; less than half identified separate respiratory nursing content. The core educational programme developed should include knowledge (70%, 21/30), skills (60%, 18/30), and competencies (50%, 15/30), with separate paediatric and adult content.Conclusion: Survey results confirm a wide variation in nursing education and respiratory nursing education across the world, with many countries lacking any formal educational programmes to prepare nurses capable of providing enhanced quality respiratory care. These findings support the need for a core respiratory curriculum. To advance this significant work the ICRN group plans to conduct a Delphi study to identify core curriculum requirements for respiratory nursing education at pre-registration and advanced educational levels to flexibly meet each country's specific educational requirements for recognition of respiratory nursing speciality practice