School of Clinical Sciences - Te Kura Mātai Haumanu

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https://hdl.handle.net/10292/1241

The School of Clinical Sciences plays an important role in specialist teaching and research conducted by its academic staff and postgraduate students. This places AUT students at the forefront of much of the ground-breaking research undertaken in New Zealand, especially in the fields of Midwifery, Nursing, Occupational Therapy, Oral Health, Paramedicine, Physiotherapy, Podiatry.

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A Historical Narrative of the Development of Midwifery Education in Indonesia
(Elsevier, 2022-06-20) Adnani, Qorinah Estiningtyas Sakilah; Gilkison, Andrea; McAra-Couper, Judith
AIM: To describe the history of midwifery education, present the current education programmes and explore the ways that have been undertaken to advance the midwifery profession in Indonesia. METHODS: Historical and contemporary government documents were reviewed. FINDINGS: The history of midwifery education in Indonesia shows a complex picture during and since colonisation with government, education institutes and association proposing different ways in which midwives were to be educated. Advocacy from the midwifery profession in Indonesia meant increasingly it is midwives who are determining how midwifery education is provided. Recent initiatives have resulted in a diploma, advanced diploma, bachelor's degree, and a master's degree in midwifery. The work of the midwifery profession advocating for midwifery education culminated in the Midwifery Act 2019. These changes in this Act will ensure that midwifery education meets the needs of women and their families but also lead to competent midwives who have the knowledge and skills to provide midwifery services at all levels of health provision. The history of midwifery in Indonesia illustrates the importance of the ICM pillars of association, regulation, and education. CONCLUSION: The history of midwifery education in Indonesia shows that for too long midwifery education was decided, determined and even regulated by authorities and disciplines other than midwifery. However, when the midwifery association and regulation inform and regulate midwifery education then there is an opportunity to provide care that will make a difference in outcomes for women and their families. The historical analysis of the story of Indonesia midwifery gives insight into what is required for quality education.
Analysis of Skin Condition Emergency Department Outcomes via the Free Healthline Service From Whakarongorau Aotearoa.
(Pasifika Medical Association Group, 2023-12) Wilson, Miriama K; Pienaar, Fiona; Large, Ruth; Wright, Matt; Howie, Graham; Foliaki, Siale; Mikaere, Martin; Davis, Rebecca; Todd, Verity
The aim of this research is to gain a deeper understanding of the ethnic and socio-demographic differences in the utilisation of the national 24/7 Healthline service in relation to skin condition calls and their outcomes. Healthline is one of the 39 free telehealth services that Whakarongorau Aotearoa | New Zealand Telehealth Services provides to New Zealanders. This is a retrospective observational study analysing Healthline data over a 4-year period: January 2019 through to December 2022. A total of 61,876 skin condition calls were analysed including demographics of service users: age group, ethnicity, area of residence and call outcome. Higher acuity skin condition calls resulting in an outcome of a recommendation for emergency department (ED) care accounted for 5.3% (n=3,294) of calls. This research found that Māori were over-represented in this ED recommendation data over four years (942 ED outcomes; 28.6%), and Pasifika were under-represented (203 ED outcomes; 5.9%). Wairarapa and West Coast were found to have the highest number of ED outcomes per capita. Our results support the theory that severe skin conditions positively correlate with smaller district populations and increased deprivation in access to services. This study highlights the potential that telehealth services have to help reduce the inequity of access to care.
Aotearoa New Zealand Deaf Women’s Perspectives on Breast and Cervical Cancer Screening
(2023-05-26) Payne, DA; Terraschke, A; Yoshida, K; Osasah, VA
AIMS: Since the introduction of both cervical and breast screening programmes in Aotearoa New Zealand, mortality rates have dropped. Both screening programmes track women's engagement, but neither capture the level of engagement of Deaf women who are New Zealand Sign Language users or their experiences in these screening programmes. Our paper addresses this knowledge deficit and provides insights that will benefit health practitioners when providing screening services to Deaf women. METHODS: We used qualitative interpretive descriptive methodology to investigate the experiences of Deaf women who are New Zealand Sign Language users. A total of 18 self-identified Deaf women were recruited to the study through advertisements in key Auckland Deaf organisations. The focus group interviews were audiotaped and transcribed. The data was then analysed using thematic analysis. RESULTS: Our analysis indicated that a woman's first screening experience may be made more comfortable when staff are Deaf aware and a New Zealand Sign Language interpreter is used. Our findings also showed that when an interpreter is present, extra time is required for effective communication, and that the woman's privacy needs to be ensured. CONCLUSION: This paper provides insights, as well as some communication guidelines and strategies, which may be useful to health providers when engaging with Deaf women who use New Zealand Sign Language to communicate. The use of New Zealand Sign Language interpreters in health settings is regarded as best practice, however their presence needs to be negotiated with each woman.
Are Two Shocks Better Than One? Aotearoa New Zealand Emergency Medical Services Implement a New Defibrillation Strategy: Implications for Around Nine Patients per Week
(Pasifika Medical Association Group, 2024-03-22) Dicker, B; Maessen, S; Swain, A; Garcia, E; Smith, T
ChatGPT for Automated Qualitative Research: Content Analysis
(JMIR Publications Inc., 2024-07-25) Bijker, R; Merkouris, SS; Dowling, NA; Rodda, SN
Background: Data analysis approaches such as qualitative content analysis are notoriously time and labor intensive because of the time to detect, assess, and code a large amount of data. Tools such as ChatGPT may have tremendous potential in automating at least some of the analysis. Objective: The aim of this study was to explore the utility of ChatGPT in conducting qualitative content analysis through the analysis of forum posts from people sharing their experiences on reducing their sugar consumption. Methods: Inductive and deductive content analysis were performed on 537 forum posts to detect mechanisms of behavior change. Thorough prompt engineering provided appropriate instructions for ChatGPT to execute data analysis tasks. Data identification involved extracting change mechanisms from a subset of forum posts. The precision of the extracted data was assessed through comparison with human coding. On the basis of the identified change mechanisms, coding schemes were developed with ChatGPT using data-driven (inductive) and theory-driven (deductive) content analysis approaches. The deductive approach was informed by the Theoretical Domains Framework using both an unconstrained coding scheme and a structured coding matrix. In total, 10 coding schemes were created from a subset of data and then applied to the full data set in 10 new conversations, resulting in 100 conversations each for inductive and unconstrained deductive analysis. A total of 10 further conversations coded the full data set into the structured coding matrix. Intercoder agreement was evaluated across and within coding schemes. ChatGPT output was also evaluated by the researchers to assess whether it reflected prompt instructions. Results: The precision of detecting change mechanisms in the data subset ranged from 66% to 88%. Overall κ scores for intercoder agreement ranged from 0.72 to 0.82 across inductive coding schemes and from 0.58 to 0.73 across unconstrained coding schemes and structured coding matrix. Coding into the best-performing coding scheme resulted in category-specific κ scores ranging from 0.67 to 0.95 for the inductive approach and from 0.13 to 0.87 for the deductive approaches. ChatGPT largely followed prompt instructions in producing a description of each coding scheme, although the wording for the inductively developed coding schemes was lengthier than specified. Conclusions: ChatGPT appears fairly reliable in assisting with qualitative analysis. ChatGPT performed better in developing an inductive coding scheme that emerged from the data than adapting an existing framework into an unconstrained coding scheme or coding directly into a structured matrix. The potential for ChatGPT to act as a second coder also appears promising, with almost perfect agreement in at least 1 coding scheme. The findings suggest that ChatGPT could prove useful as a tool to assist in each phase of qualitative content analysis, but multiple iterations are required to determine the reliability of each stage of analysis.
Community-Based Support to Improve Mental Health and Wellbeing in Older Sexually and Gender Diverse People: A Scoping Review
(Taylor and Francis Group, 2023-10-19) Gasteiger, Chiara; Collens, Paula; Du Preez, Elizabeth
Objectives This scoping review seeks to identify what community-based support is used by older sexually and gender diverse (SGD) people, that aims to improve mental health/wellbeing. Methods A scoping review was conducted using the Arksey and O’Malley framework. APA PsycInfo, Embase, MEDLINE, PubMed, and Scopus were searched. Key information was extracted and entered into a structured coding sheet before being summarized. Results Seventeen studies were included (41% observational qualitative and 35% observational quantitative). The most commonly used community-based support was lesbian, gay, bisexual and transgender (LGBT) social groups. A range of practices were reported in five studies, including in SGD affirming religious congregations and mind-body practices. Two studies reported the use of formal programmes, with one based on a group initiative. Positive outcomes included feeling connected, improved social support and mental health, and coping with illness. Five studies reported null or negative findings, including a lack of acceptance. Most studies used categories for sex and gender inaccurately, and lacked detail when describing community-based support. Conclusion The use of community-based support by older SGD people is underexplored. More interventions designed for and by this community are needed, along with experimental research to draw conclusions on effectiveness to improve mental health or wellbeing.
Comparing Post-concussion Symptom Reporting Between Adults with and Without a TBI History Within an Adult Male Correctional Facility
(Cambridge University Press (CUP), 2023-08-17) Theadom, Alice; Mitchell, Tracey; Shepherd, Daniel
Background: A higher proportion of people in prison have a history of traumatic brain injury (TBI) than the general population. However, little is known about potentially related persistent symptoms in this population. Aims: To compare symptom reporting in men with and without a history of TBI following admission to a correctional facility. Methods: All men transferred to the South Auckland Correctional Facility in New Zealand complete a lifetime TBI history and the Rivermead Post-Concussion Symptom Questionnaire (RPQ) as part of their routine health screen. Data collected between June 2020 and March 2021 were extracted and anonymised. Participants were classified as reporting at least one TBI in their lifetime or no TBI history. The underlying factor structure of the RPQ was determined using principal components analysis. Symptom scores between those with and without a TBI history were compared using Mann Whitney U tests. Results: Of the N = 363 adult male participants, 240 (66%) reported experiencing at least one TBI in their lifetime. The RPQ was found to have a two-factor structure (Factor 1: cognitive, emotional, behavioural; Factor 2: visual-ocular) explaining 61% of the variance. Men reporting a TBI history had significantly higher cognitive, emotional and behavioural (U = 50.4, p < 0.001) and visuo-ocular symptoms (U = 68.5, p < 0.001) in comparison to men reporting no TBI history. Conclusion: A history of TBI was associated with higher symptom burden on admission to a correctional facility. Screening for TBI history and current symptoms on admission may assist prisoners experiencing persistent effects of TBI to access rehabilitation.
Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial
(JMIR Publications Inc., 2019-12-03) Thabrew, H; D'Silva, S; Darragh, M; Goldfinch, M; Meads, J; Goodyear-Smith, F
Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet-based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly M ori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check.
Describing the Patient Journey Through Healthcare Pathways Following Mild Traumatic Brain Injury in New Zealand Using Novel Graph Analysis
(Taylor and Francis Group, 2023-07-04) Bastos Gottgtroy, Renata; Hume, Patria A; Theadom, Alice
AIM: To identify treatment provider sequences and healthcare pathway characteristics and outcomes for people with mild traumatic brain injury (mTBI) in New Zealand. METHODS: Total mTBI costs and key pathway characteristics were analysed using national healthcare data (patient's injury and services provided). Graph analysis produced sequences of treatment provider types for claims with more than one appointment and healthcare outcomes (costs and time to exit pathway) were compared. Key pathway characteristics' effect on healthcare outcomes were evaluated. RESULTS: In two years, 55,494 accepted mTBI claims cost ACC USD$93,647,261 over four years. For claims with more than one appointment (36%), healthcare pathways had a median 49 days (IQR, 12-185). The 89 treatment provider types resulted in 3,396 different provider sequences of which 25% were General Practitioners only (GP), 13% Emergency Department to GP (ED-GP) and 5% GP to Concussion Service (GP-CS). Pathways with shorter time to exit and lower costs had correct mTBI diagnosis at initial appointment. Income maintenance comprised 52% of costs but only occurred for 20% claims. CONCLUSIONS: Improving healthcare pathways for people with mTBI by investing in training of providers to enable correct mTBI diagnosis could yield longer term cost savings. Interventions to reduce income maintenance costs are recommended.
Engagement With Reservation-Based Head Start Teachers to Explore Their Stress and Coping: A Qualitative Study
(Elsevier, 2024-07-01) Wilson, Deborah H
Background Native Americans residing in remote reservation communities find strength in connection to place, culture, language, and sovereignty; they also face challenges as their communities struggle with historical and contemporary traumas that have resulted in poverty, high crime and suicide rates and drug misuse. The psychological well-being of Head Start teachers who teach and support the needs of Native American children, is overlooked. Methods Qualitative interviews (n = 18) and focus groups (n = 9) were conducted with Head Start teachers, supervisors, parents, and ancillary staff to identify risk and protective factors at each level of the socioecological model (individual, relationships, community, society). Using content analysis and F4 analyse software two coders identified recurring themes. Results Individually teachers are resilient, focused more on the children's well-being than their own. Family was both significant support and stressor. Community struggles with drug and alcohol misuse and homelessness were the most frequent stressors. Workplace support included their supervisors and the mentorship they provided each other. Spirituality in the form traditional cultural practices, prayer and Christen faith were important sources of support and well-being. Conclusions This paper provides insight into the stress and coping mechanisms of reservation-based Head Start teachers, identifying ways to protect and promote their health and well-being. It is important to provide support at all levels of the socioecological model to enable these teachers to strengthen their physical and psychological health and wellbeing so that they may support the children and families of Head Start to help strengthen Native American health overall.
Experience of mTBI-Like Symptoms in a Sample Without Brain Injury in Aotearoa/New Zealand
(CSIRO Publishing, 2024) Chua, Jason; Theadom, Alice
Background Post-mild traumatic brain injury (mTBI) symptoms are not specific to mTBI and are experienced in populations without brain injury. Understanding how people without brain injury experience mTBI-like symptoms and factors influencing symptom reporting is important to determine how symptom experience differs following an mTBI. Methods To understand how people without a history of brain injury experience mTBI-like symptoms, we conducted a cross-sectional survey comprising sociodemographic characteristics, the Brain Injury Screening Tool symptom scale, general health rating, Illness Attitude Scale, Positive and Negative Affect Scale and Perceived Stress Scale. The mean total symptom score and proportion of people experiencing moderate or severe symptoms (≥4) were reported. Associations between sociodemographic variables, stress, negative affect, illness attitudes, health status and symptoms were examined using regression models. Results One-hundred and seventy-three people completed the survey with a mean age of 40 years (s.d. = 15.8; n = 82, 47.4% male). The mean total symptom score was 34.5( ± 26.6). Commonly experienced symptoms were tiredness (n = 73, 42.2%), poor sleep (n = 64, 37.0%) and headaches (n = 56, 32.4%). Regression analysis revealed that on average higher levels of worry about illness and negative affect were associated with higher symptoms (β = 0.5, P = 0.027 and β = 0.9, P = 0.020 respectively) but there were no significant associations with other variables. Conclusions Cognitive and vestibular-ocular symptoms occur much less frequently than physical symptoms in the general population and may be more specific to mTBI. However, there is a need to consider vestibular-ocular symptoms alongside illness attitudes due to greater concerns about these symptoms by patients.
Fear Avoidance and Return to Work After Mild Traumatic Brain Injury
(Informa UK Limited, 2023-02-22) Snell, DL; Faulkner, JW; Williman, JA; Silverberg, ND; Theadom, A; Surgenor, LJ; Hackney, J; Siegert, RJ
Objectives: Fear avoidance is associated with symptom persistence after mild traumatic brain injury (mTBI). In this study, we investigated whether fear avoidance was associated with other outcomes such as return to work-related activity (RTW). Materials and Methods: We analyzed associations between fear avoidance and RTW 6–9 months after mTBI, in two merged prospective mTBI cohorts. Adult participants aged 16 or over (n=175), presenting to outpatient services in New Zealand within 3 months of their injury, who were engaged in work-related activity at the time of injury, were included. Participants completed the Fear Avoidance Behavior after Traumatic Brain Injury (FAB-TBI) questionnaire at enrollment and 6 months later. Associations between FAB-TBI scores and RTW outcome were analyzed using multivariate approaches. Results: Overall, 53% of participants had RTW by 6–9 months after mTBI. While early fear avoidance was weakly associated with RTW, persistent high fear avoidance between study assessments or increasing avoidance with time were associated with greater odds of still being off work 6–9 months after injury. Conclusions: Pervasive and increasing avoidance of symptom triggers after mTBI were associated with lower rates of RTW 6–9 months after mTBI. Further research is needed to better understand transition points along the recovery trajectory where fear avoidance behaviors fade or increase after mTBI.
Limited Conversations About Constrained Futures: Exploring Clinicians’ Conversations About Life After Stroke in Inpatient Settings
(CSIRO, 2024-02-17) Bright, Felicity; Kayes, Nicola; Soundy, Andrew; Drown, Juliet
Background After a stroke, people can find it challenging to look forward to the future. Hope, a critical resource for recovery, can be threatened and can be supported or diminished through interactions with clinicians. As such, understanding how conversations can support people embarking on life after a stroke is critical. Our study explored how clinicians talk about the future with patients and considered what factors shape how these conversations occur. Methods This study drew on the Interpretive Description methodology, informed by principles of ethnographic inquiry. We conducted 300 hours of observations and 76 interviews with five people with stroke and 37 clinicians. Data were analysed using the reflexive thematic analysis. Results We constructed three themes that reflect how clinicians talk about the future with people in inpatient stroke services: (1) constrained temporal horizons, (2) limited talk controlled by clinicians, and (3) opening some doors while closing others. Conclusions Conversations about the future after stroke were constrained and limited: constrained to short-term futures and limited in what aspects of life after stroke were discussed. Creating conversational and relational spaces where people are supported to look to the future with a sense of possibility, hope, and potential is vital for assisting people to move forward in their lives after their stroke. Given its role in supporting people to move forward in their lives, communication must be seen as a core clinical skill and a clinical intervention in its own right.
Midwife Led Randomised Controlled Trials in Australia and New Zealand: A Scoping Review
(Elsevier, 2023-03-07) Homer, Caroline; Neylon, Kim; Kennedy, Kate; Baird, Kathleen; Gilkison, Andrea; Keogh, Samantha; Middleton, Sandy; Gray, Richard; Whitehead, Lisa; Finn, Judith; Rickard, Claire; Sharplin, Greg; Neville, Stephen; Eckert, Marion
BACKGROUND: Midwives are the largest workforce involved in caring for pregnant women and their babies, and are well placed to translate research into practice and ensure midwifery priorities are appropriately targeted in researched. Currently, the number and focus of randomised controlled trials led by midwives in Australia and New Zealand is unknown. The Australasian Nursing and Midwifery Clinical Trials Network was established in 2020 to build nursing and midwifery research capacity. To aid this, scoping reviews of the quality and quantity of nurse and midwife led trials were undertaken. AIM: To identify midwife led trials conducted between 2000 and 2021 in Australia and New Zealand. METHODS: This review was informed by the JBI scoping review framework. Medline, Emcare, and Scopus were searched from 2000-August 2021. ANZCTR, NHMRC, MRFF, and HRC (NZ) registries were searched from inception to July 2021. FINDINGS: Of 26,467 randomised controlled trials registered on the Australian and New Zealand Clinical Trials Registry, 50 midwife led trials, and 35 peer-reviewed publications were identified. Publications were of moderate to high quality with scores limited due to an inability to blind participants or clinicians. Blinding of assessors was included in 19 published trials. DISCUSSION: Additional support for midwives to design and conduct trials and publish findings is required. Further support is needed to translate registration of trial protocols into peer reviewed publications. CONCLUSION: These findings will inform the Australasian Nursing and Midwifery Clinical Trials Network plans to promote quality midwife led trials.
Multiple Symptom Illness in New Zealand Contemporary Veterans
(Pasifika Medical Association, 2023-08-04) McBride, David Iain; Richardson, Amy; Gardner, Dianne; Wyeth, Emma; Shepherd, Daniel; Derrett, Sarah; Cameron, Claire
AIMS: To describe patterns of multiple symptom illness (MSI) in New Zealand military veterans, defined as clusters of "medically unexplained" symptoms not fitting within a specific medical diagnosis, and to investigate the relationship with exposure to traumatic events. METHODS: We designed an online cross-sectional survey. The participants of interest were the 3,874 currently serving veterans who had been deployed to a conflict zone, but all veterans were eligible to participate. A modified Centers for Disease Control (CDC) 54-item symptom checklist identified MSI, the post-traumatic checklist-military version (PCL-M) identified symptoms of post-traumatic stress disorder (PTSD) and the brief trauma scale assessed "war zone" service. Factor analysis was used to identify unobserved "latent factors" in the data, factor severity scores and the number of symptoms being calculated for each respondent. RESULTS: The CDC questionnaire was completed by 1,819 veterans, with 1,672 completing the PCL-M. The factor analysis revealed three factors, explaining 86% of the variation in the data. Factor 1 symptoms were of an arthro-neuromuscular nature, Factor 2 cognitive and Factor 3 psycho-physiological. Discriminant function analysis showed that the factors could discriminate between those with and without PTSD but could not discriminate between those who did and did not serve in a war zone. CONCLUSIONS: In veterans, multiple symptoms including pain, sleep disorders, cognitive problems and avoidance, especially when severe, may be worthy of further investigation by health professionals because of the possible association with PTSD.
Obesity as a Risk Factor for Musculoskeletal Injury During Manual Handling Tasks: A Systematic Review and Meta-Analysis
(Elsevier BV, 2024-08) Boocock, Mark; Naudé, Yanto; Saywell, Nicola; Mawston, Grant
Obesity is a growing health concern worldwide and musculoskeletal disorders (MSD) are the leading cause of injury, disability, and work-related sickness absence globally. A systematic literature review and meta-analysis was undertaken to investigate the effects of increased body weight on the biomechanical, physiological, and psychophysical responses to manual handling. Methods A literature search was conducted on five electronic databases (EBSCO Health, SCOPUS, OVID (AMED), ProQuest, Google Scholar) that followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Studies were included if they investigated a manual handling activity comparing responses of obese/overweight adults to those with a healthy body weight. Included studies had to report on at least one biomechanical, physiological, or psychophysical outcome measure. The Joanna Briggs Institute (JBI) Critical Appraisal Tool was used to assess risk of bias (RoB) and methodological quality. A narrative synthesis of the findings was conducted and where possible, a meta-analysis was performed using random-effects models. Results Eighteen cross-sectional studies met the inclusion criteria. Participants were predominately male (22% female) and were primarily classified into obese, overweight, or healthy body weight based on their body mass index (BMI). A task involving symmetrical box lifting was the most frequently performed activity. Pooled estimates of effect sizes suggest obesity increases the horizontal reach distance when lifting, and repetitive lifting leads to higher heart rates compared with healthy weight participants. There was moderate evidence of increased moments and compression forces in the lower spine. Factors unaffected by obesity were knee flexion and perceived estimates of the maximum acceptable weight of lift (MAWL). Conclusions Differences in the kinematics and kinetics of lifting between obese or overweight handlers and those of a healthier weight, suggest that approaches to preventing and managing work-related musculoskeletal conditions should consider a worker’s body weight when designing workplaces, work practices, and training. To develop appropriate interventions, more high-quality studies are needed involving a range of industry and service sector handling tasks.
Processes for Identifying and Managing Traumatic Brain Injury in the Justice Sector
(CSIRO Publishing, 2024) Wilson, Lara; Chua, Jason; Howard-Brown, Christine; Wilkinson, Michelle; Sloan, Kay; Fraser, Kirsty; Theadom, Alice
Background Individuals engaged with the justice sector have complex health needs, which often intersect with traumatic brain injury (TBI). Prior research suggests that the prevalence of TBI is high among offenders. However, it is unclear what processes are in place to support their TBI-related health needs. This study aimed to establish how TBIs are currently identified and managed across the justice sector and to identify opportunities improve access to healthcare services for individuals following TBI. Methods This study was conducted through semi-structured interviews with justice sector staff, underpinned by the interpretive description approach. Participants were asked about how TBIs were managed in their setting and what would improve how they supported people in their care. Results Nine interviews were conducted with clinical managers (n = 2), probation officers (n = 2), psychologists (n = 2), a mental health nurse (n = 1) and program coordinators (n = 2). Analysis identified one overarching theme, ‘The need for national standards to facilitate practice change’, which incorporated five sub-themes: (1) Need to know about current and historical TBIs, (2) Need to address factors affecting reporting of new injuries, (3) Need for clear healthcare pathways, (4) Need for communication across the justice and healthcare sectors, and (5) Need to upskill people across the justice sector. Conclusion Routine screening processes, clarifying professional roles, streamlining healthcare pathways, facilitating data sharing and upskilling workforce knowledge about managing people affected by TBI may help to improve identification and management of TBI across the justice sector.
Prolonged Disorders of Consciousness: Identification Using the UK FIM + FAM and Cohort Analysis of Outcomes from a UK National Clinical Database
(Taylor and Francis, 2022-02-15) Turner-Stokes, Lynne; Rose, Hilary; Knight, Alison; Williams, Heather; Siegert, Richard J; Ashford, Stephen A
PURPOSE: 1: To determine whether Total UK FIM + FAM scores can identify patients in VS/MCS. 2: Using the identified cut-off points, to examine outcomes from specialist rehabilitation. METHODS: Part 1: Retrospective analysis of a consecutive clinical cohort (n = 388) presenting to a single specialist PDOC evaluation programme 2007-2021. FIM + FAM scores were analysed by PDOC diagnosis to define cut-off points for vegetative (VS) and minimally conscious states (MCS). Part 2: Multicentre cohort analysis of prospectively-collected clinical outcomes data from the UK Rehabilitation Outcomes Collaborative database of adults in PDOC registered 2011-2020 (n = 2384 in 68 centres). RESULTS: Cut-off points of ≤31 and 32-35 in FIM + FAM total scores respectively identified patients in VS/MCS-Minus and MCS-Plus. Approximately 365 PDOC patients are admitted to specialist rehabilitation units in England each year. By discharge, 43% have emerged into consciousness and demonstrate a wide range of disability. A few reached full independence, but the majority remained severely dependent. Nevertheless, those who emerged generated mean net life-time savings of over £436,000 (£400 million for this cohort). CONCLUSION: In absence of a dedicated PDOC registry, FIM + FAM scores can identify patients in VS/MCS at population level. Identifying those who emerge and providing timely rehabilitation generates cost-savings well-exceeding the cost of the evaluation/rehabilitation programme. Implications for rehabilitation The UK National Health Service currently collects no systematic data to identify patients in PDOC, so we have no accurate information on how many patients there are, where they are managed or what their outcomes are. In the absence of more direct data, total FIM + FAM scores of < =31 and 32-35 respectively can be used to identify patients in vegetative and minimally conscious states. Of the 365 or so patients admitted to specialist rehabilitation units per year, 43% emerge into consciousness leaving about 150 patients per year in PDOC states that are likely to be permanent. Identifying those who emerge and providing timely rehabilitation generates cost-savings that pay for the entire PDOC evaluation/rehabilitation programme many times over.
Promoting Digital Inclusion for Enhanced Resident Wellbeing: An Examination of Aged Residential Care Facility Websites
(New Zealand Medical Association, 2024-08-23) Wrapson, Wendy; Gasteiger, Chiara
Objective: Little is known about the extent to which aged care operators in Aotearoa New Zealand support and promote residents’ use of digital technologies. The aim of the study was to undertake an assessment of aged residential care (ARC) facilities’ provision of digital technology devices/internet access and digital learning opportunities for residents and to determine any COVID-19 related impact. Methods: Information on technology and internet provision from 558 ARC facilities was extracted from facilities’ own or related websites in 2019, and repeated in 2021. ARC facilities were categorised according to whether they provided: (1) digital devices, (2) internet access, (3) internet-based leisure activities, or (4) made no reference to technology. Results: In 2019 (pre-COVID-19), 392 (70%) of the 558 ARC facilities included in the study publicised availability of internet-based technologies (primarily wifi) for resident use; however, only 46 (8%) mentioned providing access to computer devices. In 2021 (during the pandemic), there had been a small increase to 421 (76%) and 54 (10%) facilities respectively. The number of facilities providing internet-based leisure activities only was 63 (11%) in 2019 and 55 (10%) in 2021. Those not mentioning technology at all had reduced from 166 (30%) in 2019 to 137 (24%) in 2021. Conclusion: The findings suggest that ARC facilities could be more proactive in enabling residents to participate in the digital world. The periods of social isolation due to COVID-19 do not appear to have had a major impact on ARC facilities’ promotion of digital technology use by residents.
Psychosocial Care in DHB-Based Stroke Services in Aotearoa: A Survey of Current Practice
(New Zealand Medical Association, ) Bright, Felicity; Davison, John; Abernethy, Ginny
aim: Stroke has significant psychosocial impacts which contribute to burden for the person with stroke and affect stroke outcomes. The Psychosocial Working Group of the National Stroke Network (NSN) sought to survey current practices for assessing and supporting psychosocial needs within district health board (DHB) based stroke services to inform national service delivery initiatives. methods: The survey was conducted in 2021. It was distributed to senior clinicians in all DHBs via the NSN. results: Thirty-seven responses were received from stroke services, representing 90% of DHBs. Sixty-three percent of services reported some process for screening for psychosocial needs. Of these, only 11% used validated screens. Variability in the type of psychosocial support was evident. Seven percent of services had routine access to psychology, while 53% could access psychology on referral. There was limited evidence of specific screening and support processes for Māori, Pacific peoples, or those with communication impairments. Respondents identified training and resources needs to enable better psychosocial care. conclusion: Stroke services are not consistently meeting national guidelines which require all services have a process for screening for psychosocial needs. This survey has informed a work programme to support psychosocial care practices in stroke services in Aotearoa New Zealand.

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Browsing School of Clinical Sciences - Te Kura Mātai Haumanu by Subject "11 Medical and Health Sciences"

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