Nurse Champions for Medication Reconciliation: Making a Difference

Background: Medication reconciliation creates a significant safety risk when patients transition from one care environment to another. This is especially true for older adults who may have multiple medications, poor health literacy, or multiple providers. During care transitions, collecting accurate information about previous medication regimens can be a challenge. If providers are unskilled at eliciting the needed information, discrepancies can result, leading to medication errors, poorer outcomes, or patient harm. These discrepancies, if unresolved, can follow the patient throughout hospitalization and back into the outpatient setting, leaving patients unable to manage their care at home safely. Purpose: The objective of this project was to determine if the use of dedicated, highly trained nurse champions to collect medication histories at the point of hospital admission had a significant impact on the number of medication history discrepancies. Design Methods: This project included in-class training of 18 nurse champions in best practice recommendations to collect the best possible medication history on high-risk patients admitted to the inpatient setting. After the training, chart reviews were conducted, with multiple source verification, to identify any discrepancies in the medication regimen resulting from errors of omission, addition, dosing, route, or frequency. Conclusion: Following training, the nurse champions decreased the average number of errors in the medication history from 4.38 errors per patient (SD = 2.94) to 1.28 errors per patient (SD = 1.85), far exceeding the project goal of a 15% reduction in discrepancies (p \u3c0.001). Implications for Nursing: In smaller hospitals with limited resources, the use of nurse champions provides an effective option for improving the medication reconciliation process and promoting medication safety

A theoretically grounded exploration of the social and emotional outcomes of transition to secondary school

Adolescent development involves a complex interplay between genetics, biology, and social and emotional relationships within multiple contexts of home, school and the broader community. The transition from primary to secondary school, coupled with the onset of puberty, can therefore be a difficult period for young people to negotiate at a critical period of their developmental pathway. Using a social ecological perspective, this article examines the impact of the transition experience on adolescent social and emotional health, both immediately following transition to secondary school and at the end of the first year in this new school environment. This 1-year prospective study involving 1,500 Australian Grade 8 secondary school students found that 31% of students in the sample experienced a \u27difficult\u27 or \u27somewhat difficult\u27 transition to their new school. This third of the student sample were consequently more likely to experience poorer social and emotional health, including higher levels of depression and anxiety at the end of their first year of secondary school, while controlling for these variables at the time of transition. A central message from this work exemplifies the urgent need for a longitudinal intervention trial to develop best practice guidelines for activities that help ameliorate the negative impact a change in education context can create for adolescents negotiating a rapid metamorphosis from childhood to adulthood

A randomised control trial to reduce bullying and other aggressive behaviours in secondary schools

In Australia bullying tends to peak twice in a school student\u27s life - firstly at age 1 0 to 12 and then during the two years following their transition to secondary school (Rigby, 1994; Slee, 1995b) This transition to secondary school is considered a critical period to intervene on bullying (Farrington, 1993; Rigby, 1997, 1999; Sharp, 1995; Stevens, Bourdeaudhuij, & Van Oost, 2000; Whitney & Smith, 1993). It is suggested that compared with primary schools, the change in friendship structures that accompanies the move to secondary school, large student numbers and the less consistent contact and fewer close relationships between students and staff are factors contributing to the increase in bullying at this age (Stevens, Bourdeaudhuij et al., 2000; Patton, 2000)..

An exploration of how social context and type of living arrangement are linked to alcohol consumption amongst older Australians

Despite the potential public health risks associated with alcohol use among old people, relatively little research in this area has been conducted in Australia. Research shows social connectedness is integral to the health of older people, yet the relationship between social connectedness and alcohol use is complex, with a dearth of research exploring the context in which older people socialise and drink alcohol. The project adopted a mixed-methods design, using both qualitative and quantitative approaches, to explore the links between social context and alcohol consumption among 42 Australians, aged 65-74 years inclusive. The research specifically explored: > socialisation and alcohol: the meanings older Australian ascribe to their alcohol consumption practices; > setting and alcohol use: use of alcohol by older people living in private dwellings versus retirement villages; and > risk and restraint: factors that lead to increased use of alcohol and factors that restrain consumption in different settings

Educational evaluation of Cybersmart Detectives: final report: presented to the Australian Communications and Media Authority (ACMA)

The aim of the Australian Communications and Media Authority‟s (ACMA) Cybersmart Detectives (CSD) activity is to teach children key Internet safety messages in a safe school environment. The activity brings together a number of agencies with an interest in promoting online safety for young people, including education, State and Federal Police, government and child welfare advocates. The activity has been played by over 28, 000 students in Australia since initial trials in 2004. Cybersmart Detectives is offered free to schools by the ACMA as part of the Australian Government‟s commitment to cyber-safety. Based on a real-world Internet safety scenario, the CSD activity is delivered to students in the classroom as a series of messages. Aided by the classroom teacher, students work in small teams, reading correspondence, voting on a series of poll questions and sending questions and suggestions to their „Cybersmart Guide‟ waiting online. As the scenario unfolds, students discuss the risks of certain online and offline behaviours and ways of managing those risks..

Preventing overweight and obesity in young children: synthesising the evidence for management and policy making

Today, 3.24 million Australians are estimated to be obese. Without effective preventative programs, particularly among young children, this figure could rise to 7.2 million by 2025. This review provides practical information on successful and/or promising interventions that strengthen the primary health care response, through the promotion of healthy weight among young children aged two to six years. It reviews the policy implications of implementing these in different settings.The research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Novel regulatory mechanisms of mutagenic translesion DNA synthesis : characterization of REV1 in Saccharomyces cerevisiae

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Biology, 2007.Includes bibliographical references.Cells are constantly subjected to DNA damage from endogenous and exogenous sources. Spontaneous DNA damage alone accounts for -30,000 DNA lesions per day in a mammalian cell. Cells are also exposed to an enormous variety of environmental agents that can cause a wide range of modified bases and aberrant DNA structures. To respond to the large diversity of DNA lesions that can be produced, cells possess a host of DNA repair and damage tolerance systems. The majority of these processes operate with exquisite accuracy to restore the correct DNA sequence and structure to maintain genomic stability. However, in some cases, DNA damage induces a mutagenic response and these mechanisms are responsible for the active introduction of mutations into the genomes of all organisms. Since the discovery in 1999 of a novel superfamily of error-prone translesion DNA polymerases, we have gained substantial insight into the biochemical mechanisms of DNA damage tolerance and mutagenesis. Translesion polymerases are specialized to insert a nucleotide opposite to DNA lesions and often produce mutations during the replication of undamaged DNA. It is now appreciated that the regulation of DNA damage tolerance systems at multiple levels is critical to the appropriate deployment of these potentially mutagenic translesion polymerases to prevent rampant mutagenesis.(cont.) In particular, this thesis has focused on determining the regulation of the translesion polymerase Revl in the model organism Saccharomyces cerevisiae. The REV1 gene is responsible for the vast majority of spontaneous and damage-induced mutagenesis in all eukaryotes, from unicellular yeast to multicellular humans. Thus, an understanding the regulation and molecular mechanisms of REV1 activity will provide critical insight into the processes of mutagenesis underlying disease and evolution. The studies described here provide evidence supporting a new model of translesion synthesis, based on the observation of the cell-cycle regulation of the Revs protein. Additionally, mutations in conserved motifs in Revl have allowed characterization of the protein-protein interactions critical for REV1 activity in survival and mutagenesis. Taken together, the data presented here argue for a cellular response mediated through Rev regulation which temporally and spatially restricts potentially mutagenic translesion synthesis such that it is employed only when necessary.by Lauren S. Waters.Ph.D

Impact of extra-curricular activities on adolescents\u27 connectedness and cigarette smoking: final report

In Australia, cigarette smoking is still the leading cause of preventable death and yet in the past 10 years, despite efforts that have been made in the classroom and through the media, there have been limited reductions in adolescent smoking. The Extra-curricular Project builds on the work of two other projects conducted by researchers from the Child Health Promotion Research Centre (CHPRC). The Smoking Cessation for Youth Project (SCYP), conducted by the Western Australian Centre for Health Promotion Research, led to the identification of connectedness as a key mediator of cigarette smoking. The role of extra-curricular activities in mediating school connectedness was explored in the subsequent formative evaluation (conducted by the CHPRC) which was used to inform the Extra-curricular Project, and identified a range of benefits for students who participate in extracurricular activities through increasing school connectedness

The Forms of Bullying Scale (FBS): Validity and reliability estimates for a measure of bullying victimization and perpetration in adolescence

The study of bullying behavior and its consequences for young people depends on valid and reliable measurement of bullying victimization and perpetration. Although numerous self-report bullying-related measures have been developed, robust evidence of their psychometric properties is scant, and several limitations inhibit their applicability. The Forms of Bullying Scale (FBS), with versions to measure bullying victimization (FBS-V) and perpetration (FBS-P), was developed on the basis of existing instruments, for use with 12-to 15-year-old adolescents to economically, yet comprehensively measure both bullying perpetration and victimization. Measurement properties were estimated. Scale validity was tested using data from 2 independent studies of 3,496 Grade 8 and 783 Grade 8-10 students, respectively. Construct validity of scores on the FBS was shown in confirmatory factor analysis. The factor structure was not invariant across gender. Strong associations between the FBS-V and FBS-P and separate single-item bullying items demonstrated adequate concurrent validity. Correlations, in directions as expected with social-emotional outcomes (i.e., depression, anxiety, conduct problems, and peer support), provided robust evidence of convergent and discriminant validity. Responses to the FBS items were found to be valid and concurrently reliable measures of self-reported frequency of bullying victimization and perpetration, as well as being useful to measure involvement in the different forms of bullying behaviors

Three year results of the Friendly Schools whole-of-school intervention on children\u27s bullying behaviour

A group randomized controlled trial tested the efficacy of the Friendly Schools program to reduce student bullying behaviour. This socio-ecological intervention targeted the whole school, classroom, family, and individual students to reduce bullying behaviour. Self-report data were collected in 29 schools over three years from a cohort of 1968 eight to nine-year-olds. Surveys measured frequency of being bullied, bullying others, telling if bullied and observing bullying. Results indicate that intervention students were significantly less likely to observe bullying at 12, 24 and 36 months and be bullied after 12 and 36 months, and significantly more likely to tell if bullied after 12 months than comparison students. No differences were found for self-reported perpetration of bullying. The findings suggest whole-of-school programs that engage students in their different social contexts appear to reduce their experiences of being bullied and increase their likelihood of telling someone if they are bullied