ARATA’s response to the NDIA’s assistive technology discussion paper

The Australian Rehabilitation and Assistive Technology Association (ARATA) responds to the NDIA’s AT Discussion Paper, and advocates that roles for all stakeholders must be considered.  • Summary of ARATA\u27s key recommendations arising from the Discussion Paper: 1. Evaluate outcomes from AT provision in trial sites and other systems to inform in the development of procurement and service delivery policy, consumer supports, and continuing professional development. 2. Support practitioners and researchers to validate existing AT service models for use in Australia. 3. Assist ARATA and other key stakeholders to develop a national accreditation system for AT practitioners and suppliers. 4. Investigate and document the roles, activities, and scope of practice of suppliers and peer mentors in AT service delivery, and associated outcomes for AT users. 5. Ensure the coupling of AT devices with appropriate soft technology support for device selection, implementation and review. 6. Investigate the efficacy and potential expansion of existing peer and consumer networking channels. 7. Support research into consumer use of information and decision-making in AT provision. 8. Fund independent AT information services and explore options for facilitating consumer ratings of products and services. 9. Identify AT products not yet available on the Australian market. 10. Fund research into AT development and commercialisation in Australia.&nbsp

Patient and community nurse perspectives on recruitment to a randomized controlled trial of urinary catheter washout solutions

Aims To provide evidence around the acceptability of a proposed randomised controlled trial (RCT) of catheter washout solutions. Design: A sample of senior community nursing staff (n=7) were interviewed and four focus groups with a sample of community nurses were conducted. Eleven semi-structured face-to-face interviews were undertaken with patients using a long-term catheter. Methods: An in-depth qualitative study using a phenomenological approach was employed. This approach was suitable to explore the lived experiences of subjects and gain their viewpoints and experiences. Results: Nurse participants raised concerns regarding the removal of treatment or increased risk of infection in relation to which arm of the trial patients were randomised to. There was concern that patients could get used to the increased contact with nursing staff. Six patients who agreed to participate cited personal benefit, benefiting others, and a sense of indifference. Four patients were unsure about taking part and one declined

How does genetic risk information for Lynch syndrome translate to risk management behaviours?

Background  There is limited research on why some individuals who have undergone predictive genetic testing for Lynch syndrome do not adhere to screening recommendations. This study aimed to explore qualitatively how Lynch syndrome non-carriers and carriers translate genetic risk information and advice to decisions about risk managment behaviours in the Australian healthcare system.  Methods  Participants of the Australasian Colorectal Cancer Family Registry who had undergone predictive genetic testing for Lynch syndrome were interviewed on their risk management behaviours. Transcripts were analysed thematically using a comparative coding analysis.  Results  Thirty-three people were interviewed. Of the non-carriers (n = 16), 2 reported having apparently unnecessary colonoscopies, and 6 were unsure about what population-based colorectal cancer screening entails. Of the carriers (n = 17), 2 reported they had not had regular colonoscopies, and spoke about their discomfort with the screening process and a lack of faith in the procedure’s ability to reduce their risk of developing colorectal cancer. Of the female carriers (n = 9), 2 could not recall being informed about the associated risk of gynaecological cancers.  Conclusion  Non-carriers and female carriers of Lynch syndrome could benefit from further clarity and advice about appropriate risk management options. For those carriers who did not adhere to colonoscopy screening, a lack of faith in both genetic test results and screening were evident. It is essential that consistent advice is offered to both carriers and non-carriers of Lynch syndrome

Testing for SARS-CoV-2 infection in care home residents and staff in English care homes: A service evaluation

Context COVID-19 is especially dangerous to older adults living in residential care. Objective To evaluate the usefulness of a nurse-led Enhanced Care Home Team (ECHT) SARS-CoV-2 testing strategy to identify resident cases early, identify typical illness presentation residents, and correctly attribute cause of death in care home settings in Norfolk, UK. Method Residents and staff received nose and throat swab tests (7 April to 29 June 2020). Resident test results were linked with symptoms on days 0-14 after test and mortality to 13 July 2020. The data collected were used to evaluate service performance. Findings Residents (n=521) and staff (estimated n=340) in 44 care homes were tested in the ECHT service. SARS-CoV-2 positivity was identified in 103 residents in 14 homes and 49 staff in seven homes. Of 103 SARS-CoV-2+ residents, just 37 had what were understood to be typical COVID-19 symptom(s). Among 51 residents without symptoms when initially tested, 13 (25%) developed symptoms within 14 days. Many SARS-CoV-2+ residents lacked typical symptoms but presented rather as ‘generally unwell’ (n=16). Of 39 resident deaths during the monitoring period, 20 (51%) were initially attributed to SARS-CoV-2, all of whom tested SARS-CoV-2+. One deceased person not initially attributed to SARS-CoV-2 tested positive through a different monitoring programme. 9% of all staff tests were positive. Implications A locally designed and integrated joint nursing and social care team approach successfully identified asymptomatic and pre-symptomatic SARS-CoV-2+ residents and staff. Being ‘generally unwell’ was common amongst symptomatic residents and indicated SARS-CoV-2 infection in older people in the absence of more ‘typical’ symptoms. The service supported correct attribution of cause of death

Anthropogenic disturbance impacts stand structure and susceptibility of an iconic tree species to an endemic canker pathogen

Forest ecosystems characterised by higher tree species diversity have been linked to a reduced susceptibility to pathogens. Conversely, endemic pathogens contribute to forest ecosystem dynamics and process. In the face of global change, however, negative impacts arising from more frequent and severe forest disturbances are increasingly observed. An increase in the susceptibility of Corymbia calophylla, a keystone tree species of southwest Western Australia, to cankers caused by the endemic fungus Quambalaria coyrecup, has emerged in recent decades. Landscape scale assessment of disease incidence has implicated the predisposing role of anthropogenic disturbance, indicating a need for this to be examined at a finer resolution. We assessed the effects of anthropogenic disturbance on the incidence of canker disease caused by Q. coyrecup across a disturbance gradient at 17 forest sites. In addition, we determined the impact of disturbance on tree community composition and stand level structural traits including stem density and stand basal area, and investigated the role of these factors as drivers of canker presence. Canker incidence and associated mortality of C. calophylla increased with anthropogenic disturbance. Disturbed edges showed significantly different overstorey composition from the forest transects. Total stem density increased with increasing disturbance, and disturbed edges contained greater numbers of C. calophylla stems compared to forest transects. There was a much increased basal area of C. calophylla on disturbed edges. Regardless of transect position, an increased incidence of canker resulted on sites with increased C. calophylla basal area. Lastly, increased tree species diversity (as measured by species richness) was associated with decreased canker incidence. We demonstrate that anthropogenic disturbance has altered stand structure and led to an increased susceptibility of C. calophylla to Q. coyrecup, resulting in high disease incidence and mortality of trees on disturbed road edges. Our results highlight the complexity of addressing tree health issues in the presence of multiple global change factors.The Australian Research Council (Linkage Project 120200581) and conducted within the Western Australian State Centre of Excellence for Climate Change Woodland and Forest Health, which is a partnership between private industry, community groups, universities and the Government of Western Australia.http://www.elsevier.com/locate/foreco2019-10-01hj2018Forestry and Agricultural Biotechnology Institute (FABI)Microbiology and Plant Patholog

Does self-monitoring reduce blood pressure? Meta-analysis with meta-regression of randomized controlled trials

Introduction. Self-monitoring of blood pressure (BP) is an increasingly common part of hypertension management. The objectives of this systematic review were to evaluate the systolic and diastolic BP reduction, and achievement of target BP, associated with self-monitoring. Methods. MEDLINE, Embase, Cochrane database of systematic reviews, database of abstracts of clinical effectiveness, the health technology assessment database, the NHS economic evaluation database, and the TRIP database were searched for studies where the intervention included self-monitoring of BP and the outcome was change in office/ambulatory BP or proportion with controlled BP. Two reviewers independently extracted data. Meta-analysis using a random effects model was combined with meta-regression to investigate heterogeneity in effect sizes. Results. A total of 25 eligible randomized controlled trials (RCTs) (27 comparisons) were identified. Office systolic BP (20 RCTs, 21 comparisons, 5,898 patients) and diastolic BP (23 RCTs, 25 comparisons, 6,038 patients) were significantly reduced in those who self-monitored compared to usual care (weighted mean difference (WMD) systolic −3.82 mmHg (95% confidence interval −5.61 to −2.03), diastolic −1.45 mmHg (−1.95 to −0.94)). Self-monitoring increased the chance of meeting office BP targets (12 RCTs, 13 comparisons, 2,260 patients, relative risk = 1.09 (1.02 to 1.16)). There was significant heterogeneity between studies for all three comparisons, which could be partially accounted for by the use of additional co-interventions. Conclusion. Self-monitoring reduces blood pressure by a small but significant amount. Meta-regression could only account for part of the observed heterogeneity

iPrevent®: a tailored, web-based, decision support tool for breast cancer risk assessment and management

We aimed to develop a user-centered, web-based, decision support tool for breast cancer risk assessment and personalized risk management. Using a novel model choice algorithm, iPrevent® selects one of two validated breast cancer risk estimation models (IBIS or BOADICEA), based on risk factor data entered by the user. Resulting risk estimates are presented in simple language and graphic formats for easy comprehension. iPrevent® then presents risk-adapted, evidence-based, guideline-endorsed management options. Development was an iterative process with regular feedback from multidisciplinary experts and consumers. To verify iPrevent®, risk factor data for 127 cases derived from the Australian Breast Cancer Family Study were entered into iPrevent®, IBIS (v7.02), and BOADICEA (v3.0). Consistency of the model chosen by iPrevent® (i.e., IBIS or BOADICEA) with the programmed iPrevent® model choice algorithm was assessed. Estimated breast cancer risks from iPrevent® were compared with those attained directly from the chosen risk assessment model (IBIS or BOADICEA). Risk management interventions displayed by iPrevent® were assessed for appropriateness. Risk estimation model choice was 100% consistent with the programmed iPrevent®logic. Discrepant 10-year and residual lifetime risk estimates of >1% were found for 1 and 4 cases, respectively, none was clinically significant (maximal variation 1.4%). Risk management interventions suggested by iPrevent® were 100% appropriate. iPrevent® successfully integrates the IBIS and BOADICEA risk assessment models into a decision support tool that provides evidence-based, risk-adapted risk management advice. This may help to facilitate precision breast cancer prevention discussions between women and their healthcare providers

Population changes in a whale breeding ground revealed by citizen science noninvasive genetics

Historical exploitation, and a combination of current anthropogenic impacts, such as climate change and habitat degradation, impact the population dynamics of marine mammalian megafauna. Right whales (Eubalaena spp.) are large cetaceans recovering from hunting, whose reproductive and population growth rate appear to be impacted by climate change. We apply noninvasive genetic methods to monitor southern right whale (E. australis, SRW) and test the application of noninvasive genetics to minimise the observer effects on the population. Our aim is to describe population structure, and interdecadal and interannual changes to assess species status in the Great Acceleration period of Anthropocene. As a basis for population genetic analyses, we collected samples from sloughed skin during post-migration epidermal moult. Considering the exploration-exploitation dilemma, we collaborated with whale watching companies, as part of a citizen science approach and to reduce ad hoc logistic operations and biopsy equipment. We used mitochondrial and microsatellite data and population genetic tools. We report for the first time the genetic composition and differentiation of the Namibian portion of the range. Population genetic parameters suggest that South Africa hosts the largest population. This corresponds with higher estimates of current gene flow from Africa compared to older samples. We have observed considerable interannual variation in population density at the breeding ground and an interdecadal shift in genetic variability, evidenced by an increase in the point estimate inbreeding. Clustering analyses confirmed differentiation between the Atlantic and Indo-Pacific, presumably originating during the ice ages. We show that population monitoring of large whales, essential for their conservation management, is feasible using noninvasive sampling within non-scientific platforms. Observed patterns are concurrent to changes of movement ecology and decline in reproductive success of the South African population, probably reflecting a large-scale restructuring of pelagic marine food webs.Charles University Grant Agency, Czech Republic.https://www.elsevier.com/locate/geccoam2023Mammal Research InstituteZoology and Entomolog

Using contractual incentives in district nursing in the English NHS: results from a qualitative study

© 2018 The author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. Since 2008, health policy in England has been focusing increasingly on improving quality in healthcare services. To ensure quality improvements in community nursing, providers are required to meet several quality targets, including an incentive scheme known as Commissioning for Quality and Innovation (CQUIN). This paper reports on a study of how financial incentives are used in district nursing, an area of care which is particularly difficult to measure and monitor