End-of-life decision-making in the emergency department and intensive care unit: Health professionals' perspectives on and knowledge of the law in Queensland Jayne Hewitt, Nemat Alsaba, Katya May, Evelyn Kang, Colleen Cartwright, et al. EMA Emergency Medicine Australasia, 2024 ObjectiveTo investigate ED and intensive care unit healthcare professionals' perspectives and knowledge of the law that underpins end‐of‐life decision‐making in Queensland, Australia.MethodsAn online survey with questions about perspectives, perceived, and actual, knowledge of the law was distributed by the professional organisations of medical practitioners, nurses and social workers who work in Queensland EDs and intensive care units.ResultsThe survey responses of 126 healthcare professionals were included in the final analysis. Most respondents agreed that the law was relevant to end‐of‐life decision‐making, but that clinician and family consensus mattered more than following the law. Generally, doctors' legal knowledge was higher than nurses'; however, there were significant gaps in the knowledge of all respondents about the operation of advance health directives in Queensland.ConclusionsThe legal framework that supports end‐of‐life decision‐making for adults who lack decision‐making capacity has been in place for more than two decades. Despite frequently being involved in making or enacting these decisions, gaps in the legal knowledge of healthcare professionals who work in EDs and intensive care units in Queensland are evident. Further research to better understand how to improve knowledge and application of the law is warranted.
Cost-effectiveness of closed incision negative pressure wound therapy in preventing surgical site infection among obese women giving birth by caesarean section: An economic evaluation (DRESSING trial) Jennifer A. Whitty, Adam P. Wagner, Evelyn Kang, David Ellwood, Wendy Chaboyer, et al. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2023 BackgroundThere is growing evidence regarding the potential of closed incision negative pressure wound therapy (ci‐NPWT) to prevent surgical site infections (SSIs) in healing wounds by primary closure following a caesarean section (CS).AimTo assess the cost‐effectiveness of ci‐NPWT compared to standard dressings for prevention of SSI in obese women giving birth by CS.Materials and MethodsCost‐effectiveness and cost‐utility analyses from a health service perspective were undertaken alongside a multicentre pragmatic randomised controlled trial, which recruited women with a pre‐pregnancy body mass index ≥30 kg/m2 giving birth by elective/semi‐urgent CS who received ci‐NPWT (n = 1017) or standard dressings (n = 1018). Resource use and health‐related quality of life (SF‐12v2) collected during admission and for four weeks post‐discharge were used to derive costs and quality‐adjusted life years (QALYs).Resultsci‐NPWT was associated with AUD$162 (95%CI −$170 to $494) higher cost per person and an additional $12 849 (95%CI −$62 138 to $133 378) per SSI avoided. There was no detectable difference in QALYs between groups; however, there are high levels of uncertainty around both cost and QALY estimates. There is a 20% likelihood that ci‐NPWT would be considered cost‐effective at a willingness‐to‐pay threshold of $50 000 per QALY. Per protocol and complete case analyses gave similar results, suggesting that findings are robust to protocol deviators and adjustments for missing data.Conclusionsci‐NPWT for the prevention of SSI in obese women undergoing CS is unlikely to be cost‐effective in terms of health service resources and is currently unjustified for routine use for this purpose.
Patient experiences of, and preferences for, surgical wound care education Georgia Tobiano, Rachel M. Walker, Wendy Chaboyer, Joan Carlini, Louise Webber, et al. International Wound Journal, 2023 The aim of this study was to describe patients' experiences of, and preferences for, surgical wound care discharge education and how these experiences predicted their ability to self‐manage their surgical wounds. A telephone survey of 270 surgical patients was conducted across two hospitals two weeks after discharge. Patients preferred verbal (n = 255, 94.8%) and written surgical wound education (n = 178, 66.2%) from medical (n = 229, 85.4%) and nursing staff (n = 211, 78.7%) at discharge. The most frequent education content that patients received was information about follow‐up appointments (n = 242, 89.6%) and who to contact in the community with wound care concerns (n = 233, 86.6%). Using logistic regression, patients who perceived that they participated in surgical wound care decisions were 6.5 times more likely to state that they were able to manage their wounds at home. Also, patients who agreed that medical and/or nursing staff discussed wound pain management were 3.1 times more likely to report being able to manage their surgical wounds at home. Only 40% (107/270) of patients actively participated in wound‐related decision‐making during discharge education. These results uncovered patient preferences, which could be used to optimise discharge education practices. Embedding patient participation into clinical workflows may enhance patients' self‐management practices once home.
Incidence and predictors of surgical site infection in women who are obese and give birth by elective caesarean section: A secondary analysis Wendy Chaboyer, David Ellwood, Lukman Thalib, Sailesh Kumar, Kassam Mahomed, et al. Australian and New Zealand Journal of Obstetrics and Gynaecology, 2022 Background:Surgical site infection (SSI) after a caesarean section is of concern (CS) is of concern to both clinicians and women themselves.Aims:The aim of this study is to identify the cumulative incidence and predictors of SSI in women who are obese and give birth by elective CS.Materials and Methods:The method used was planned secondary analysis of data from women with a pre‐pregnancy body mass index (BMI) ≥30 kg/m2 giving birth by elective CS in a multicentre randomised controlled trial of a prophylactic closed‐incision negative pressure wound therapy dressing. Data were collected from medical records, direct observations of the surgical site and self‐reported signs and symptoms from October 2015 to December 2019. The Centers for Disease Control and Prevention definition was used to identify SSI. Women were followed up once in hospital just before discharge and then weekly for four weeks after discharge. Blinded outcome assessors determined SSI. After the cumulative incidence of SSI was calculated, multiple variable logistic regression models were used to identify independent risk factors for SSI.Results:SSI incidence in 1459 women was 8.4% (122/1459). Multiple variable‐adjusted odds ratios (OR) for SSI were BMI ≥40 kg/m2 (OR 1.55, 95% confidence interval (CI) 1.30–1.86) as compared to BMI 30–34.9 0 kg/m2, ≥2 previous pregnancies (OR 1.38, 95% CI 1.00–1.80) as compared to no previous pregnancies and pre‐CS vaginal cleansing (OR 0.55, 95% CI 0.33–0.99).Conclusions:Our findings may inform preoperative counselling and shared decision‐making regarding planned elective CS for women with pre‐pregnancy BMI ≥30 kg/m2.
What are the non-technical skills used by scrub nurses? An integrated review Acorn, 2014
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