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Issue 150 - 3 September 2010

Newly released NZNO report

Clarifying Nursing Education Funding Issues, August 2010
NZNO put forward an abridged version of this document earlier this year so that nurses, and others, could gain insight into the nursing education funding over the past two decades. This more detailed edition explores the nursing education context further. The aim is to gain perspective on the many decisions that have, or have not, been taken that affect the outcomes for nursing education and, ultimately, patient care. We trust this document will add to the ongoing discussions by shedding more light on our forward path. As well, the suggested principled model for nursing education is designed to provide a framework that makes a difference to that  process.
To download this report:

Free Medical Journals 

This database contains details of medical journals that make their articles freely available via the web after a certain period e.g 6 months; 12 months; 36 months.

Australian Research Online 

You can search 470,929 Australian research outputs, including theses; preprints; postprints; journal articles; book chapters; music recordings and pictures. Australian Research Online searches simultaneously across the contents of Australian university and government research repositories in addition to several other collections of Australian research. The list of currently participating universities, and government departments with the number of outputs currently in each repository, is listed at the left.


JOURNAL: Journal of the American Geriatrics Society

1. Pharmacological Management of Persistent Pain in Older Persons.
Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1331-1346
The article deals with the pharmacological management of persistent pain in older people in the U.S. It discusses guidelines from the American Geriatric Society (AGS), general principles in implementing an effective pharmacological approach, and recommended drugs for treatment of persistent pain. Factors to consider in the use of nonopioid analgesics are considered.

2. The Overlap Syndrome of Depression and Delirium in Older Hospitalized Patients.
By Givens, Jane al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1347-1353
To measure the prevalence, predictors, and posthospitalization outcomes associated with the overlap syndrome of coexisting depression and incident delirium in older hospitalized patients.
DESIGN: Secondary analysis of prospective cohort data from the control group of the Delirium Prevention Trial.
SETTING: General medical service of an academic medical center. Follow-up interviews at 1 month and 1 year post-hospital discharge.
PARTICIPANTS: Four hundred fifty-nine patients aged 70 and older who were not delirious at hospital admission.
MEASUREMENTS: Depressive symptoms assessed at hospital admission using the 15-item Geriatric Depression Scale (cutoff score of 6 used to define depression), daily assessments of incident delirium from admission to discharge using the Confusion Assessment Method, activities of daily living at admission and 1 month postdischarge, and new nursing home placement and mortality determined at 1 year.
RESULTS: Of 459 participants, 23 (5.0%) had the overlap syndrome, 39 (8.5%) delirium alone, 121 (26.3%) depression alone, and 276 (60.1%) neither condition. In adjusted analysis, patients with the overlap syndrome had higher odds of new nursing home placement or death at 1 year (adjusted odds ratio (AOR)=5.38, 95% confidence interval (CI)=1.57–18.38) and 1-month functional decline (AOR=3.30, 95% CI=1.14–9.56) than patients with neither condition.
CONCLUSION: The overlap syndrome of depression and delirium is associated with significant risk of functional decline, institutionalization, and death. Efforts to identify, prevent, and treat this condition may reduce the risk of adverse outcomes in older hospitalized patients. [ABSTRACT FROM AUTHOR]

3. Risk Factors for Preoperative and Postoperative Delirium in Elderly Patients with Hip Fracture
By Juliebø, Vibeke et al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1354-1361
To evaluate risk factors for preoperative and postoperative delirium.
DESIGN: Prospective cohort study.
SETTING: Departments of orthopedic surgery in two Norwegian hospitals.
PARTICIPANTS: Three hundred sixty-four patients with and without cognitive impairment, aged 65 and older.
MEASUREMENTS: Patients were screened daily for delirium using the Confusion Assessment Method. Established risk factors and risk factors regarded as clinically important according to expert opinion were explored in univariate analyses. Variables associated with the outcomes ( P<.05) were entered into multivariate logistic regression models.
RESULTS: Delirium was present in 50 of 237 (21.1%) assessable patients preoperatively, whereas 68 of 187 (36.4%) patients developed delirium postoperatively (incident delirium). Multivariate logistic regression identified four risk factors for preoperative delirium: cognitive impairment (adjusted odds ratio (AOR)=4.7, 95% confidence interval (CI)=1.9–11.3), indoor injury (AOR=3.6, 95% CI=1.1–12.2), fever (AOR=3.4, 95% CI=1.5–7.7), and preoperative waiting time (AOR=1.05, 95% CI=1.0–1.1 per hour). Cognitive impairment (AOR=2.9, 95% CI=1.4–6.2), indoor injury (AOR=2.9, 95% CI=1.1–6.3), and body mass index (BMI) less than 20.0 (AOR=2.9, 95% CI=1.3–6.7) were independent and statistically significant risk factors for postoperative delirium.
CONCLUSION: Time from admission to operation is a risk factor for preoperative delirium, whereas low BMI is an important risk factor for postoperative delirium in hip fracture patients. Cognitive impairment and indoor injury are independent risk factors for preoperative and postoperative delirium. [ABSTRACT FROM AUTHOR]

4. Sexual Function and Aging in Racially and Ethnically Diverse Women
By Huang, Alison al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1362-1368
To examine factors influencing sexual activity and functioning in racially and ethnically diverse middle-aged and older women.
DESIGN: Cross-sectional cohort study.
SETTING: Integrated healthcare delivery system.
PARTICIPANTS: One thousand nine hundred seventy-seven women aged 45 to 80.
MEASUREMENTS: Self-administered questionnaires assessed sexual desire, activity, satisfaction, and problems.
RESULTS: Of the 1,977 participants (876 white, 388 African American, 347 Latina, and 351 Asian women), 43% reported at least moderate sexual desire, and 60% had been sexually active in the previous 3 months. Half of sexually active participants (n=969) described their overall sexual satisfaction as moderate to high. Among sexually inactive women, the most common reason for inactivity was lack of interest in sex (39%), followed by lack of a partner (36%), physical problem of partner (23%), and lack of interest by partner (11%); only 9% were inactive because of personal physical problems. In multivariable analysis, African-American women were more likely than white women to report at least moderate desire (odds ratio (OR)=1.65, 95% confidence interval (CI)=1.25–2.17) but less likely to report weekly sexual activity (OR=0.68, 95% CI=0.48–0.96); sexually active Latina women were more likely than white women to report at least moderate sexual satisfaction (OR=1.75, 95% CI=1.20–2.55).
CONCLUSION: A substantial proportion of community-dwelling women remain interested and engaged in sexual activity into older age. Lack of a partner capable of or interested in sex may contribute more to sexual inactivity than personal health problems in this population. Racial and ethnic differences in self-reported sexual desire, activity, and satisfaction may influence discussions about sexual difficulties in middle-aged and older women. [ABSTRACT FROM AUTHOR]

5. Disparities in Oral Health Status Between Older Adults in a Multiethnic Rural Community: The Rural Nutrition and Oral Health Study.
By Quandt, Sara al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1369-1375
To compare oral health status according to ethnicity and socioeconomic status in African-American, American-Indian, and white dentate and edentulous community-dwelling older adults.
DESIGN: Cross-sectional study; data from self-reports and oral examinations.
PARTICIPANTS: A multistage cluster sampling design was used to recruit 635 participants aged 60 and older from rural North Carolina counties with substantial African-American and American-Indian populations.
MEASUREMENTS: Participants completed in-home interviews and oral examinations. Self-reported data included sociodemographic indicators; self-rated oral health status; presence or absence of periodontal disease, bleeding gums, oral pain, dry mouth; and fit of prostheses. Oral examination data included number of teeth and numbers of anterior and posterior functional occlusal units.
RESULTS: African Americans and American Indians had significantly lower incomes and educational attainment than whites. Self-rated oral health was significantly better in whites than in African Americans and American Indians. Prevalence of self-reported periodontal disease and bleeding gums was lower in whites. Of dentate participants, African Americans were significantly more likely than whites to have 11 to 20 teeth and one or two posterior occlusal contacts. Oral health deficits remained associated with ethnicity when adjusted for socioeconomic variables.
CONCLUSION: Oral health disparities in older adults in a multiethnic rural area were largely associated with ethnicity and not socioeconomic status. Clinicians should be aware of these health disparities in oral health status and their possible role in disparities in chronic disease. Further research is necessary to understand whether these oral health disparities reflect current or lifetime access to care, diet, or attitudes toward oral health care. [ABSTRACT FROM AUTHOR]

6. Thirteen Dimensions of Health in Elderly Sri Lankans: Results from a National Sri Lanka Aging Survey.
By: Østbye, Truls et al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1376-1387
To explore age and sex differences in distribution of 13 health dimensions with a focus on self-rated health (SRH) and the association between SRH and other health dimensions in elderly Sri Lankans.
DESIGN: Sri Lanka Aging Survey, a nationally representative cross-sectional survey.
SETTING: Community based.
PARTICIPANTS: Inhabitants of 13 districts in Sri Lanka aged 60 and older (N=2,413).
MEASUREMENTS: Self-reported SRH, hearing, activities of daily living (ADLs), instrumental activities of daily living (IADLs), mobility, physical disability, chronic diseases, stress and worry, mood, cognition, social participation, social support, and financial health. RESULTS: The prevalence of being “healthy” in most health dimensions, including SRH, declined with age. Men were more likely to report better SRH; independence in ADLs, IADLs, and mobility; absence of physical disability and chronic diseases; and good mental health. Absence of chronic diseases, independence in ADLs and IADLs, freedom from stress and worry, and absence of depression were associated with positive (excellent/very good/good) SRH. The male SRH advantage was not significant in adjusted analyses, and sex did not modify the association between SRH and other health dimensions.
CONCLUSION: Several of the dimensions associated with positive SRH are to a certain extent modifiable and therefore provide a potential for improvement in SRH of elderly Sri Lankans. Differences between this study and studies from elsewhere in the associations between different health dimensions and SRH, and in how sex modifies these associations, suggest  that some of the associations may depend on cultural context. [ABSTRACT FROM AUTHOR]

7. Computerized Decision Support to Reduce Potentially Inappropriate Prescribing to Older Emergency Department Patients: A Randomized, Controlled Trial.
By: Terrell, Kevin al. Journal of the American Geriatrics Society, Aug2009, Vol. 57 Issue 8: p1388-1394
To evaluate the effectiveness of computer-assisted decision support in reducing potentially inappropriate prescribing to older adults. DESIGN: Randomized, controlled trial.
SETTING: An academic emergency department (ED) in Indianapolis, Indiana, where computerized physican order entry was used to write all medication prescriptions.
PARTICIPANTS: Sixty-three emergency physicians were randomized to the intervention (32 physicians) or control (31 physicians) group.
INTERVENTION: Decision support that advised against use of nine potentially inappropriate medications and recommended safer substitute therapies.
MEASUREMENTS: The primary outcome was the proportion of ED visits by seniors that resulted in one or more prescriptions for an inappropriate medication. The main secondary outcomes were the proportions of medications prescribed that were inappropriate and intervention physicians' reasons for rejecting the decision support. RESULTS: The average age of the patients was 74, two-thirds were female, and just over half were African American. Decision support was provided 114 times to intervention physicians, who accepted 49 (43%) of the recommendations. Intervention physicians prescribed one or more inappropriate medications during 2.6% of ED visits by seniors, compared with 3.9% of visits managed by control physicians ( P=.02; odds ratio=0.55, 95% confidence interval=0.34–0.89). The proportion of all prescribed medications that were inappropriate significantly decreased from 5.4% to 3.4%. The most common reason for rejecting decision support was that the patient had no prior problems with the medication.
CONCLUSION: Computerized physican order entry with decision support significantly reduced prescribing of potentially inappropriate medications for seniors. This approach might be used in other efforts to improve ED care. Trial Registration: Clinical Identifier: NCT00297869. [ABSTRACT FROM AUTHOR]

8. Disease-Specific, Versus Standard, Nutritional Support for the Treatment of Pressure Ulcers in Institutionalized Older Adults: A Randomized Controlled Trial.
By Cereda, Emanuele et al. Journal of the American Geriatrics Society, Aug 2009, Vol. 57 Issue 8: p1395-1402

OBJECTIVES: To investigate whether a disease-specific nutritional approach is more beneficial than a standard dietary approach to the healing of pressure ulcers (PUs) in institutionalized elderly patients.
DESIGN: Twelve-week follow-up randomized controlled trial (RCT). SETTING: Four long-term care facilities in the province of Como, Italy.
PARTICIPANTS: Twenty-eight elderly subjects with Stage II, III, and IV PUs of recent onset (<1-month history).
 INTERVENTION: All 28 patients received 30 kcal/kg per day nutritional support; of these, 15 received standard nutrition(hospital diet or standard enteral formula; 16% calories from protein), whereas 13 were administered a disease-specific nutrition treatment consisting of the standard diet plus a 400-mL oral supplement or specific enteral formula enriched with protein (20% of the total calories), arginine, zinc, and vitamin C ( P<.001 for all nutrients vs control).
MEASUREMENTS: Ulcer healing was evaluated using the Pressure Ulcer Scale for Healing (PUSH; 0=complete healing, 17=greatest severity) tool and area measurement (mm<sup>2</sup> and %).
RESULTS: The sampled groups were well matched for age, sex, nutritional status, oral intake, type of feeding, and ulcer severity. After 12 weeks, both groups showed significant improvement ( P<.001). The treatment produced a higher rate of healing, the PUSH score revealing a significant difference at Week 12 (-6.1±2.7 vs -3.3±2.4; P<.05) and the reduction in ulcer surface area significantly higher in the treated patients already by Week 8 (-1,140.9±669.2 mm<sup>2</sup> vs -571.7±391.3 mm<sup>2</sup>; P<.05 and ~57% vs ~33%; P<.02).
CONCLUSION: The rate of PU healing appears to accelerate when a nutrition formula enriched with protein, arginine, zinc, and vitamin C is administered, making such a formula preferable to a standardized one, but the present data require further confirmation by high-quality RCTs conducted on a larger scale.[ABSTRACT FROM AUTHOR]

JOURNAL: Dermatology Nursing

9. Absence of Wisdom.
By Hill, Marcia J. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p1
Webster’s New World Dictionary of the American Language(Guralnik, 1964) defines wisdom succinctly as “good judgment based on knowledge; learning; dis-cretion; sagacity.” Dermatology Nursing, the first journal for dermatology nurses, has continued to offer excellent manuscripts and learning opportunities online. A chat room is available for questions/ discussions and we are on Facebook and Twitter as well. The excellence and expertise you continue find in the journal is also available through the Dermatology Nursing Institute (DNI).

10. CNE series. Head Lice: Diagnosis and Therapy.
By Martinez-Diaz, Gabriel al. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p2-8
Children worldwide are commonly infected with head lice, or pediculosis capitis. The epidemiology, etiology, clinical manifestations, diagnosis, and preventive and treatment modalities for managing head lice in children are reviewed. [ABSTRACT FROM AUTHOR]

11. Management of Psychodermatologic Disorders.
By Shenefelt, Philip D. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p9-17
Management options for psychodermatologic disorders include standard psychotropic drugs, alternative herbs and supplements, biofeedback, cognitive-behavioral methods, hypnosis, meditation, placebo effect, suggestion, and yoga. When single approaches fail, combinations of drugs and/or non-pharmacologic therapies may produce better results. [ABSTRACT FROM AUTHOR]

12. What's Your Assessment?
By Gordon, Shirley Countryman. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p18-20
The “What’s Your Assessment?” series includes a short case presentation and differential diagnosis. It is followed by a discussion of the disease or condition and the rationale used in each step of the assessment.

13. Damaging Hair Care Techniques.
By Chiang, Charles; Samrao, Aman; Mirmirani, Paradi. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p21-25
Hair is an integral part of our physical appearance and caring for our hair is often a part of our daily routine. Hair care routines vary depending on age, sex, race, ethnicity, and religious practices among other factors. When these practices are excessive or inappropriate, damage can be done to the hair. By understanding the basic structure of the hair shaft, health care providers can assess whether hair care techniques have led to damage and can then counsel patients on proper treatment of hair. [ABSTRACT FROM AUTHOR]

14. Clinical Snapshot. Allergic Contact Dermatitis: Poison Ivy.
By Goodman, Rhonda & Hollimon, Deborah. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p26-28

15. Focus on Allergens. Allergic Contact Dermatitis to Gold.
By Douglas, J. Desiree. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4: p29-31

16. Medical Assistant Forum. Team Approach in Mohs' Surgery.
By Hinton, Donna. Dermatology Nursing, Jul/Aug2010, Vol. 22 Issue 4, p32-33
Many of our practices treat skin cancer. Skin cancer isby far the most commoncancer and certain typesare easily treated and most times cured. There are different treatment protocols used for each diagnosis. A specialized procedure for basal cell and squamous cell carcinomas is Mohs’ micrographic surgery

Journals Table of Contents

17. From Australian Nursing Journal, September 10 2010, Volume 18 Number 3
This month's ANJ brings you important news in health and nursing and midwifery. The focus section in this issue of the journal is dedicated to mental health nursing
National registration hiccups; Decade long plan on mental health promised
17C. e-Health launched at three sites nationally; Promoting the physical and psychosocial health of nurses
17D. Influenza vaccination update
17E. Passion for university nursing wins the day
17F. Nursing provided valuable lessons for top union role; Climate and health alliance: a united voice
17G. Australians in prime of life disadvantaged;Reprieve from unfair deportation for international nursing students
17H. QLD: New report to help nurses check their pay; TAS: Tas students blitz HESTA awards; SA: Nurses fight for safe staffing levels
17I. Fiji's plea: don't poach our nurses; US nurses disaster contingent hits more than 14,000
17J. A good result for collaborative arrangements [The Health legislation Amendment (Midwives and Nurse Practitioners) Act 2010; Nurse managers: a vital link in the wellness chain
17K. Mandatory reporting - a panacea for poor practice?
17L. Rural nurse specialist leads NZ's primary care reform
Development of HIV resource for aged care facilities
17N. Nursing migration: Issues of equity and balance
17O. Nurse-led interventions to reduce cardiac risk factors in adults
17P. Seeking a change in mental health; The impact of death and dying on critical care nurses
17Q. Walking the talk: Consumer participation in CQUniversity curriculum
17R. Meeting physical and educational needs of people with mental illness
17S. The changing face of private mental health; Physical health and mental illness - taking action to bridge the gap
17T. Mental health: every nurses business
17U. The arts and mental wellbeing: opportunities and challenges
17V. Reducing reliance on seclusion in acute psychiatry; Meeting workforce demand in mental health
17W. Mango, lamb and yam curry

18. Ministry of Health - What's New
August 2010

31 Aug: Guidelines for Tuberculosis Control in New Zealand 2010
Up-to-date information on the diagnosis, treatment and management of patients. Includes information on infection control and best practice for dealing with people who have Tuberculosis.

27 Aug: Living Standards and Health: New Zealand 2006/07
This report compares two measures of living standards that were included in the 2006/07 New Zealand Health Survey, and investigates the associations between living standards and health.

26 Aug: Health Targets end of year results

23 Aug: Unequal Impact II: Māori and Non-Māori Cancer Statistics by Deprivation and Rural-Urban Status
This publication provides specific information about the unequal distribution of cancer outcomes for Māori and Non-Māori

News - National

19. Health conferences to bring 400 to city
More than 400 delegates will converge on Dunedin this week to attend two national health conferences involving dietitians and disease-control nurses. About 230 people will attend Dietitians New Zealand's annual three-day conference, which starts today.

20. Research shows natural cancer therapies don't cure, says expert
Dominion Post - 1 September 2010
Cancer patients are being warned by a medical expert that some complementary therapies are not only useless, but could be dangerous. In a public lecture at Victoria University in Wellington last night, Professor Shaun Holt said there were no complementary natural therapies that could cure cancer.

News - International

21. Short Sleep And Chronic Insomnia Linked To Four-Fold Risk Of Early Death In Men
2 September 2010
US researchers found that short sleep and insomnia was linked to a four times higher risk of early death in men; they urged public health policy makers to emphasize earlier diagnosis and treament of chronic insomnia. You can read how researchers from the Pennsylvania State University College of Medicine, in Hershey, Pennsylvania, came to these findings in a paper they wrote that was published on 1 September in the journal SLEEP.

22. For teens, too little sleep may equal too many snacks
By Sarah Klein, September 2, 2010
All those late nights spent trolling Facebook, texting friends, and cramming for tests may be taking a toll on teenagers' diets, a new study suggests. Teens who average fewer than eight hours of sleep on weeknights tend to eat more fatty foods and high-calorie snacks than their better-rested peers, according to the study, which was published in the journal Sleep.

23. Pre-emptive surgery to beat cancer
AFP September 02, 2010 
WASHINGTON: Women with a genetic predisposition to breast or ovarian cancer can dramatically reduce their risk of developing either by having preventative surgeries, a study shows. The research tracked nearly 2500 women with certain genetic mutations. It found pre-emptive mastectomies or surgeries to remove the ovaries or fallopian tubes nearly eliminated the incidence of either cancer. 


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