Perceptions and experiences of emergency department staff during the implementation of the four-hour rule/national emergency access target policy in Australia: A qualitative social dynamic perspective

Background: The Four-Hour Rule or National Emergency Access Target policy (4HR/NEAT) was implemented by Australian State and Federal Governments between 2009 and 2014 to address increased demand, overcrowding and access block (boarding) in Emergency Departments (EDs). This qualitative study aimed to assess the impact of 4HR/NEAT on ED staff attitudes and perceptions. This article is part of a series of manuscripts reporting the results of this project. Methods: The methodology has been published in this journal. As discussed in the methods paper, we interviewed 119 participants from 16 EDs across New South Wales (NSW), Queensland (QLD), Western Australia (WA) and the Australian Capital Territory (ACT), in 2015-2016. Interviews were recorded, transcribed, imported to NVivo 11 and analysed using content and thematic analysis. Results: Three key themes emerged: Stress and morale, Intergroup dynamics, and Interaction with patients. These provided insight into the psycho-social dimensions and organisational structure of EDs at the individual, peer-to-peer, inter-departmental, and staff-patient levels. Conclusion: Findings provide information on the social interactions associated with the introduction of the 4HR/NEAT policy and the intended and unintended consequences of its implementation across Australia. These themes allowed us to develop several hypotheses about the driving forces behind the social impact of this policy on ED staff and will allow for development of interventions that are rooted in the rich context of the staff\u27s experiences. © 2019 The Author(s)

Mental Health and Psychological Help-Seeking of Iranian International Students at UNSW Australia

This research aimed to determine the level of psychological distress and attitudes towards seeking professional psychological help in Iranian international students at UNSW Australia, and to compare these with results reported in other university student samples. The study also explored the factors associated with increased levels of psychological distress and positive attitudes towards seeking professional psychological help in this sample.A preliminary qualitative exploration provided information about major stressors and coping strategies among Iranian international students at UNSW. The main study involved a cross-sectional e-mail survey of 180 Iranian international students pursuing academic degrees during 2012/2013 at this university. The self-administered questionnaire included demographic and personal items, and five standardised scales: World Health Organisation Quality of Life Scale (WHOQOL—BREF), Kessler Psychological Distress Scale, Attitudes towards Seeking Professional Psychological Help Scale—Short Form, Multidimensional Scale for Perceived Social Support, and Duke Religion Index. Logistic and linear regression analyses were used to analyse the predictors of psychological distress and attitudes towards seeking professional psychological help, respectively.Compared to a sample of university students in Australia, a significantly smaller proportion of Iranian international students experienced moderate or severe psychological distress. However, their distress levels were unexceptional when located within a range of similar studies of university students. Iranian international students did not differ from a sample of Australian university students in their attitudes towards seeking professional psychological help. Their attitudes were unexceptional when located among other studies of university students. When different psycho-social and socio-demographic factors were considered together, experiencing high to very high levels of psychological distress was associated with being female (OR=3.92, p=0.004), worse physical health (OR=0.50, p<0.001), negative attitudes towards seeking professional psychological help (OR=0.91, p=0.022), lower levels of perceived social support (OR=0.96, p=0.016), and lower levels of religious involvement and spirituality (OR=0.91, p=0.006). Positive attitudes towards seeking professional psychological help were associated with higher scores on the environment domain of WHOQOL—BREF (B=0.62, p=0.001) and having previous experience with psychological counselling (B=4.22, p<0.001). Findings from this growing group of international university students can be used to support more culturally competent mental health promotion and service provision

Comorbidity of Leishmania major with cutaneous sarcoidosis

Background: leishmaniasis infection might manifest as sarcoidosis; on the other hand, some evidences propose an association between sarcoidosis and leishmaniasis. Most of the times, it is impossible to discriminate idiopathic sarcoidosis from leishmaniasis by conventional histopathologic exam. Aim: We performed a cross-sectional study to examine the association of sarcoidosis with leishmaniasis in histopathologically diagnosed sarcoidal granuloma biopsy samples by polymerase chain reaction (PCR). Materials and Methods: We examined paraffin-embedded skin biopsy samples obtained from patients with clinical and histopathological diagnosis as naked sarcoidal granuloma, referred to Skin Research Center of Shaheed Beheshti Medical University from January 2001 to March 2010, in order to isolate Leishmania parasite. The samples were reassessed by an independent dermatopathologist. DNA extracted from all specimens was analyzed by the commercially available PCR kits (DNPTM Kit, CinnaGen, Tehran, Iran) to detect endemic Leishmania species, namely leishmania major (L. major). Results: L. major was positive in PCR of Eight out of twenty-five examined samples. Conclusion: Cutaneous leishmaniasis may be misinterpreted as sarcoidosis; in endemic areas, when conventional methods fail to detect Leishmania parasite, PCR should be utilized in any granulomatous skin disease compatible with sarcoidosis, regardless of the clinical presentation or histopathological interpretation

Air travel in a COVID-19 world: Commercial airline passengers’ health concerns and attitudes towards infection prevention and disease control measures

Background COVID-19 and its associated travel bans have reduced international passenger traffic by over 80% below 2019 levels. If airlines are to resume flying at commercially sustainable levels, they must work to restore passengers confidence and sense of security. This study examined commercial airline passengers’ health concerns and attitudes towards infection prevention and control measures for travel health and safety in the current COVID-19 global pandemic. Methods A cross-sectional study was conducted inviting adult members of 39 frequent flyer groups across three social media platforms to participate in an online survey. Results A total of 205 respondents completed the survey. The majority (75.6%) reported feeling ‘somewhat’ to ‘extremely concerned’ about contracting an infectious disease while flying, particularly respiratory-related. Few (9.8%) reported perceiving their health as an ‘essential priority’ for their preferred airline. Most respondents agreed airlines should provide complimentary hand sanitisers (86.8%), sanitary wipes (82.9%) and masks (64.4%) for passengers to use while flying as well as more information about preventing the spread of infections (90.7%), which would make the majority feel safer to fly. Conclusions COVID-19 has extensively challenged the air travel industry. Passengers have signalled that they expect more from airlines, and that they would actively engage in additional infection prevention and disease control measures while flying. Airlines must ensure passengers about the steps taken to minimize travel-associated risks, and their commitment towards passengers’ health and wellbeing, in order to rebuild consumers’ confidence in the recovery of the air travel industry

Australian critical care nurses’ knowledge, preparedness and experiences of managing SARS-COV-2 and COVID-19 pandemic

Background COVID-19 has again highlighted the crucial role of healthcare workers in case management, disease surveillance, policy development, and healthcare education and training. The ongoing pandemic demonstrates the importance of having an emergency response plan that accounts for the safety of frontline healthcare workers, including those working in critical care settings. Objectives To explore Australian critical care nurses’ knowledge, preparedness and experiences of managing patients diagnosed with SARS-CoV-2 and COVID-19. Methods An exploratory cross-sectional study of Australian critical care nurses was conducted between June and September 2020. An anonymous online survey was sent to Australian College of Critical Care Nurses (ACCCN) members to collect information about their knowledge, preparedness and experiences during the COVID-19 pandemic. Descriptive statistics were used to summarise and report data. Results A total of 157 critical care nurses participated, with 138 fully complete surveys analysed. Most respondents reported ‘good’ to ‘very good’ level of knowledge about COVID-19, and obtained up-to-date COVID-19 information from international and local sources. To manage patients with COVID-19, 82.3% felt sufficiently prepared at the time of data collection, and 93.4% had received specific education, training or instruction. Most participants were involved in assessing (89.3%) and treating (92.4%) COVID-19 patients. Varying levels of concerns about contracting SARS-CoV-2 were expressed by respondents, and 55.7% thought the pandemic had increased their workload. The most frequent concerns expressed by participants were a lack of appropriate PPE and fear of the PPE shortage. Conclusions While most nurses expressed sufficient preparedness for managing COVID-19 patients, specific education had been undertaken and experiential learning was evident. Fears of insufficient or appropriate PPE made the response more difficult for nurses and the community. Preparedness and responsiveness are critical to successful management of the COVID-19 pandemic and future outbreaks of emerging infectious diseases

Identifying the priority challenges in trauma care delivery for Australian and New Zealand trauma clinicians

Introduction: Injury is a leading cause of death and disability world-wide. Little is known about the day-to-day challenges the trauma clinicians face in their practice that they feel could be improved through an increased evidence base. This study explored and ranked the trauma clinical practice research priorities of trauma care professionals across Australia and New Zealand. Methods: A modified-Delphi study was conducted between September 2019 and January 2020. The study employed two rounds of online survey of trauma professionals from relevant Australia and New Zealand professional organisations using snowballing method. Participants were asked to rank the importance of 29 recommendations, each corresponding to a key challenge in trauma care delivery. Decisions on the priorities of the challenges were determined by a consensus of \u3e70% of respondents ranking the challenge as important or very important. Results: One hundred and fifty-five participants completed Round One, and 106 participants completed Round Two. A total of 15 recommendations reached \u3e70% in Round One. Nine recommendations also reached \u3e70% consensus in Round Two. Recommendations ranked highest were ‘Caring for elderly trauma patients’, ‘Identifying and validating key performance indicators for trauma system benchmarking and improvement’, and ‘Management of traumatic brain injury’. Conclusion: This study identified the priority areas for trauma research as determined by clinician ranking of the most important for informing and improving their practice. Addressing these areas generates potential to improve the quality and safety of trauma care in Australian and New Zealand

Global Burden, Point Sources, and Outbreak Management of Healthcare-Associated Burkholderia Cepacia Infections: An Integrative Review

Objective: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). Design: Integrative review. Methods: A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). Results: In total, we reviewed 125 documented outbreaks of Burkholderia cepacia–related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. Conclusions: Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice