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Associate Professor Phillip Newton

Biography

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Dr Phillip Newton is the Director of Research Students in the Faculty of Health at UTS, and a senior lecturer in the Centre for Cardiovascular and Chronic Care.

He is a registered nurse with an academic track record that demonstrates a strong interdisciplinary focus and an emphasis on the links between clinical research and translation into the health service.

The main focus of Phillip’s research has been on risk factor modification and symptom management. He is now leading a team investigating the impact of frailty on people with chronic heart failure as well as people referred for solid organ transplantation.

He is also a senior investigator for the Heart Failure Snapshot study, the largest point prevalence study of acute heart failure and investigation of clinical variation across institutions in Australia.

Phillip has a distinguished and consistent record of obtaining competitive funding, having been awarded over $3 million in support from a number of leading research councils and networks.

Image of Phillip Newton
Associate Professor, Faculty of Health
Senior Research Fellow, Centre for Cardiovascular and Chronic Care (CCCC)
Director of Research, Faculty of Health
Associate Member, Australian Research Centre in Complementary and Integrative Medicine (ARCCIM)
Core Member, CHSP - Health Services and Practice
BN(Hons), PhD, Doctor of Philosophy
Member, Australian College of Nursing
Fellow, European Society of Cardiology
Fellow, American Heart Association
Fellow, Cardiac Society of Australia and New Zealand
 
Phone
+61 2 9514 2858

Research Interests

Research expertise:

  • Heart failure
  • Frailty
  • Heat failure disease management
Can supervise: Yes

Areas of research supervision:

  • Heart failure
  • Clinical trials
  • Symptom management
  • Frailty

Apply for a research degree

Nursing – undergraduate/post-graduate research methods

Chapters

Phillips, J.L., Newton, P. & Davidson, P. 2015, 'Palliative Care Service Provision for People with Heart Failure, The view from Australia' in Heart failure, From Advanced Disease to Bereavement.
Davidson, P.M., Newton, P.J. & Macdonald, P. 2014, 'Chronic heart failure' in Chang, E. & Johnson, A. (eds), Chronic Illness & Disability 2nd edition, Elsevier, Australia, pp. 409-423.
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Several key principles underpin the structure of this chapter. Firstly, it is important to appreciate the pathophysiological and epidemiological basis of CHF to undertake informed clinical practice; secondly the role of the nurses in evidence-based practice strategies to prevent and manage CHF is emphasised; and thirdly the process of reflection in developing your clinical practice from prevention to palliation of CHF is emphasised.
Davidson, P.M. & Newton, P.J. 2012, 'End-of-life care' in Krum, H. & Lueder, T.V. (eds), Advances in Heart Failure Management, Future Medicine Ltd, London, UK, pp. 155-166.
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As many treatments decrease the risk of sudden death, individuals with chronic heart failure (CHF) live for an extended time with a high symptom burden and uncertainty of prognosis.
Davidson, P.M., Newton, P.J. & Macdonald, P. 2008, 'Dyspnoea' in Beattie, J. & Goodlin, S. (eds), Supportive Care in Heart Failure, Oxford University Press, Oxford, pp. 159-187.
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Supportive care in heart failure (HF) management is the multidisciplinary holistic care of patients and their families from the time of diagnosis, during treatment aimed at prolonging life, through to the end of life when palliative care is provided.' The management of dyspnoea is a key consideration in supportive care of HF. This chapter will describe the physiological basis of dyspnoea, present a conceptual model for perceiving and managing dyspnoea, outline pharmacological and non-pharmacological strategies, and summarize key considerations for clinicians, patients, and their families to manage this debilitating symptom. In spite of the frequency and severity of dyspnoea, sparse information exists on symptom management in a supportive model of HF care.
Davidson, P.M., Newton, P.J. & Macdonald, P. 2008, 'Chronic Heart Failure' in Chang Johnson (ed), Chronic Illness & Disability: Implications for nursing practice, Elsevier, Australia, pp. 312-332.
Chronic heart failure is a growing publish health problem, both in Australia and New Zealand, and globally. This condition is associated with significant morbidity, mortality and economic burden, particularly among those ages 65 years and older.

Conferences

McDonagh, J., Ferguson, C. & Newton, P. 2017, 'Frailty measurement in heart failure – latest developments', Australasian Cardiovascular Nursing College, Brisbane.
Introduction Reported rates of frailty in individuals with heart failure range from 15-74%, accordingly, the measurement of frailty now has increasing utility in clinical and research practice. Aim To present the latest developments regarding frailty measurement in heart failure from a recent systematic literature review. Method Key electronic databases (MEDLINE and CINAHL and the COCHRANE Central) were searched from 2001- 2016. Search terms included but not limited to 'frailty, heart failure and measurement'. Eligibility criteria consisted of; studies that included subjects with a diagnosis of heart failure and studies must have assessed frailty using a structured instrument. Results/Findings From twenty-four articles there was a total of eight frailty instruments identified, the most commonly used instrument was Fried's Frailty Phenotype (n= 11). The second most common instrument was the Comprehensive Geriatric Assessment (n=6), followed by the Deficit Accumulation Index (n=2). None of the instruments have been formally validated for use in heart failure. All instruments assessed physical functioning but only four instruments assessed cognition. Conclusion There are a range of frailty instruments being utilised in heart failure. However, there is currently no frailty instruments validated for use in a heart failure specific population. Current data are limited by focusing primarily on a physical definition of frailty, future studies might look to incorporate cognitive and psychosocial domains as part of a multi-domain frailty assessment.
McDonagh, J., Martin, L., Ferguson, C., Jha, S., Macdonald, P., Davidson, P. & Newton, P. 2017, 'How is frailty measured in individuals with heart failure? A systematic review', The Journal of Frailty and Aging, International Conference on Frailty & Sarcopenia Research, Barcelona, Spain, pp. 152-153.
Rao, A., DiGiacomo, M., Newton, P., Phillips, J., Davidson, P.M. & Hickman, L. 2016, 'Meditation as a secondary prevention strategy for heart disease: a systematic review', Australian Cardiac Rehabilitation Association Conference, Adelaide.
Ivynian, S., Newton, P. & DiGiacomo, M. 2016, 'Care-seeking decisions in heart failure: a mixed-methods study', Australian Cardiac Rehabilitation Association Conference, Adelaide.
Jha, S.R., Hannu, M.K., Wilhelm, K., Newton, P.J., Chang, S., Montgomery, E., Harkess, M., Tunnicliff, P., Smith, A., Hayward, C., Jabbour, A., Keogh, A., Kotlyar, E., Dhital, K., Granger, E., Jansz, P., Spratt, P. & Macdonald, P. 2016, 'Reversibility of Frailty in Advanced Heart Failure Patients Listed for Transplantation', JOURNAL OF HEART AND LUNG TRANSPLANTATION, pp. S29-S29.
Jha, S.R., Hannu, M.K., Wilhelm, K., Newton, P.J., Chang, S., Chang, S., Montgomery, E., Harkess, M., Tunnicliff, P., Smith, A., Hayward, C., Jabbour, A., Keogh, A., Kotlyar, E., Dhital, K., Granger, E., Jansz, P., Spratt, P. & Macdonald, P.S. 2016, 'Frailty Measures in Advanced Heart Failure Patients Listed for Transplantation', JOURNAL OF HEART AND LUNG TRANSPLANTATION, Elsevier, USA, pp. S27-S27.
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Purpose To identify if the addition of cognitive impairment, depression, or both, to the physical assessment of frailty provides better outcome prediction in advanced heart failure (AHF) patients listed for heart transplantation. Beginning in 2013, all patients with AHF referred to our Transplant Unit have undergone assessment of physical frailty using the Fried Phenotype (FP), cognition (Montreal Cognitive Assessment, MoCA) and depression (Depression in Medical Illness, DMI). We assessed the value of four composite frailty measures: physical frailty (PF 3/5 = frailty), 'cognitive frailty' (FP+MoCA 3/6 = frail), depressive frailty (FP+DMI 3/6 = frail) and cognitive-depressive frailty (FP+MoCA+DMI 3/7 = frail) in predicting outcomes. Results 145 patients (99M: 46F; age 53±13 years, range 16-73; LVEF 27±14%) underwent assessment of frailty. Of the four measures, 'cognitive frailty' provided the strongest predictor of survival. When categorised by PF, 96 (66%) were identified as non- or pre-frail (NPF) and 49 (34%) were identified as frail. The prevalence of 'cognitive frailty' was higher with 85 NPF (59%) and 60 (41%) frail. Frailty (either physical or cognitive) was associated with higher NYHA, lower cardiac index, anemia, hypoalbuminemia and lower BMI. Frailty was independent of LVEF, LV diameter, renal function (serum creatinine and eGFR), sex and age. Actuarial survival curves are shown in Figure 1 for both physical (a) and cognitive (b) frailty. Survival curves adjust for bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or transplantation are also shown in figure 1 (c)/(d). Frailty was associated with higher mortality, with cognitive frailty better capturing early mortality: physical frailty (20 NF; 20F) and cognitive frailty (17 NF; 25F). Conclusions Cognitive frailty was highly prevalent in this cohort. The addition of cognition to the physical assessment of frailty strengthened the capacity to identify those at risk of early...
Ferguson, C., Inglis, S., Newton, P., Middleton, S., Macdonald, P. & Davidson, P. 2016, 'Patient centered approaches to anticoagulation decision making with individuals with heart failure and concomitant atrial fibrillation', Joint International Shared-Decision Making and International Society for Evidence Based Healthcare Conference, Sydney.
McDonagh, J., Ferguson, C., Jha, S., Ivynian, S., Crossley, C., Montgomery, E., Hwang, C., Inglis, S., Singh, G., Davidson, P., Macdonald, P. & Newton, P. 2016, 'Frailty in hospitalized heart failure patients predicts death and rehospitalisation at 6 months', The Journal of frailty & aging, International Conference on Frailty & Sarcopenia Research, Philadelphia, USA.
Rao, A., Newton, P., DiGiacomo, M., Hickman, L.D., Hwang, C. & Davidson, P.M. 2016, 'Which gender specific cardiac rehabilitation models best reduce cardiovascular risk in women?', 21st International Council on Women's Health Issues (ICOWHI) Cogress. Scale and Sustainability: Moving Women's Health Issues Forward, Baltimore, Maryland, USA.
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Hickman, L., Phillips, J.L., Newton, P. & Davidson, P.M. 2015, 'Montreal cognitive assessment tool: feasibility in a heart failure population group', Australian Cardiac Nurses Conference, Sydney.
Ivynian, S., DiGiacomo, M., Jha, S., Crossley, C. & Newton, P. 2015, 'Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis', Heart Lung and Circulation, Cardiac Society of Australia and New Zealand, Elsevier, Melbourne, pp. 419-419.
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Purpose: Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF. Methods: Electronic databases searched were Medline, EMBASE and CINAHL. Studies were included if they were peer reviewed journal articles written in English, and reported perspectives of HF patients following qualitative data collection and analysis. Forty articles underwent analysis following the approach of Thomas and Harden. Leventhal's self-regulatory model (SRM) was used to organise the literature. Results: Much of the literature fit within the SRM, however this model did not account for all factors that influence patients' care-seeking for worsening symptoms. Factors not accounted for included patients' appraisals of previous care-seeking experiences, perceived system and provider barriers to accessing care, and the influence of external appraisals. When added to factors already represented in the model, such as misattribution of symptoms, not identifying with HF diagnosis, cognitive status, lack of understanding information provided, adaptation to symptoms, and emotional responses, a more comprehensive account of patients' decision-making was revealed. Implications: This metasynthesis identified factors, as yet unaccounted for, in a prominent model, and has suggested a more comprehensive framework for addressing care-seeking in HF patients. This information can be used to tailor education, communication, and service initiatives to improve HF patients' responses to worsening symptoms.
Ivynian, S.E., Hwang, C., McDonagh, J., Digiacomo, M., Inglis, S.C. & Newton, P.J. 2015, 'Impact of multiple symptoms on quality of life and event-free survival in chronic heart failure', EUROPEAN HEART JOURNAL, pp. 128-128.
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Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Perspectives Of Online Health Information And Support In Chronic Disease Respiratory Disease: Focus Group Study', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Technology Use In Patients Attending A Cardiopulmonary Clinic', AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE.
Ferguson, C., Inglis, S., Newton, P., Middleton, S., Macdonald, P. & Davidson, P. 2015, 'Education & Practice Gaps on Atrial Fibrillation: A Survey of Cardiovascular Nurses', Australasian Cardiovascular Nursing College, Sydney.
Ferguson, C., Inglis, S., Newton, P., Middleton, S., Macdonald, P. & Davidson, P. 2015, 'Multimorbidity, selfcare & frailty: Important considerations in anticoagulation decision making in heart failure with atrial fibrillation: Outcomes of the AFASTER Study', European Journal of Heart Failure, European Society of Cardiology: Heart Failure, Wiley: 12 months, Seville, Spain.
Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2014, 'PT453 Disease Management Interventions For Improving Self-Management In Lower-Limb Peripheral Arterial Disease: A Cochrane Review.', Global Heart Supplements, Elsevier, Melbourne, Australia, pp. e262-e262.
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Peripheral arterial disease (PAD) contributes to psychological burden, poor quality of life and an increased risk of cardiovascular events. Disease management strategies supporting behavioural change and long-term adherence may improve outcomes for people with PAD. However, to our knowledge the evidence relating to self-management interventions for people with PAD has not yet been systematically reviewed or meta-analysed
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2014, 'The caregiver role in thromboprophylaxis management in atrial fibrillation', 'Young at Heart' : Australian Cardiovascular Nursing College 8th Annual Scientific Meeting, Gold Coast, Australia.
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Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2014, 'The Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) cohort study: 90 day outcomes', European Journal of Heart Failure Supplements, European Society of Cardiology: Heart Failure Congress, Wiley-Blackwell, Athens, Greece, pp. 282-282.
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Ferguson, C., Inglis, S., Newton, P., Middleton, S., Macdonald, P. & Davidson, P. 2014, 'Thromboprophylaxis prescription in hospitalized patients with heart failure and concomitant atrial fibrillation: Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failure (AFASTER) cohort study', Global Heart Journal, World Congress of Cardiology, Melbourne, pp. 109-109.
Ferguson, C., Inglis, S., Newton, P., Middleton, S., Macdonald, P. & Davidson, P. 2014, 'Frailty and thromboprophylaxis prescription in heart failure and atrial fibrillation: Preliminary findings from the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failure (AFASTER) cohort study', Global Heart, World Congress of Cardiology, Elsevier, Melbourne, pp. 264-264.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., MacDonald, P.S. & Davidson, P.M. 2013, 'Stroke prevention in heart failure: time to rethink risk prediction schemes?', World Federation of Neuroscience Nurses Congress, Gifu, Japan.
Ferguson, C., Inglis, S., Newton, P.J., Davidson, P.M. & Middleton, S. 2012, 'Atrial fibrillation and thromboprophylaxis: methods in risk assessment and addressing barriers to adherence: A review.', 'The Aging Heart' - Australian Cardiovascular Nursing College 6th Annual Scientific Meeting, Crowne Plaza, Coogee, Sydney, Australia..
Background: Globally, stroke is one of the worldâs most prevalent, disabling and chronic conditions. Atrial fibrillation is a common arrhythmia in heart failure and presents a significant risk factor for thrombo-embolic, ischaemic stroke. Risk stratification schemata and therapies exist for the treatment of atrial fibrillation and the prophylaxis of stroke, however commonly these therapies are not applied in practice, even when advised in guidelines for numerous reasons. Objective: This presentation aims to identify available validated risk assessment tools for the prediction of stroke risk in patients with atrial fibrillation. Each tool will be evaluated for their benefits and limitations and their consequential implications for clinical practice. Barriers to adherence of available therapies will also be discussed in relation to stroke risk assessment tools and the World Health Organizationâs multidimensional adherence model (2003) Methods: A comprehensive electronic search of the following databases was undertaken: CINAHL, Medline, EBSCO Host, SCOPUS, and the Cochrane Library. Google and Google Scholar search engines were also used. Results: 6 risk prediction assessment tools featured heavily in the search results. Namely; AFI, SPAF, FRS, FGCRS, CHA2DS2 and CHA2DS2-VASc. Each are evaluated and discussed with regards to their advantage and limitations. Conclusions: Whilst valid risk assessment tools are available and their use recommended within practice guidelines their comprehensiveness and holistic patient assessment is questionable. To date, many risk prediction models focus on physical aspects of health and do not assess criteria related to psycho-social aspects of patientâs health and wellbeing such as the patientâs likeliness to adhere to anticoagulation therapy, their ability to take oral medications or assume responsibility for the safe monitoring of their INR. There is much scope for improvement in stroke risk prediction models in atrial fibrill...
Davidson, P.M., Paull, G., Rees, D.M., Newton, J. & Newton, P.J. 2006, 'Characteristics of patients dying while enrolled in a home based heart failure program', JOURNAL OF CARDIAC FAILURE, pp. S129-S129.
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Journal articles

Hunt, L., Frost, S.A., Newton, P.J., Salamonson, Y. & Davidson, P.M. 2017, 'A survey of critical care nurses' knowledge of intra-abdominal hypertension and absdominal compartment syndrome', Australian Critical Care, vol. 30, no. 1, pp. 21-27.
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Background Intra-abdominal hypertension and abdominal compartment syndrome are potentially life threatening conditions. Critical care nurses need to understand the factors that predispose patients to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Predicting and managing IAH and ACS are important to improve health outcomes. Aim The aim of this paper was to (1) assess the knowledge of Australian critical care nurses about current IAH and ACS practice guidelines, measurement techniques, predictors for the development of IAH and ACS and (2) identify barriers in recognizing IAH, ACS and measuring IAP. Methods Between October 2014 and April 2015 86 registered nurses employed in the area of critical care were recruited via the form to participate in an on-line, 19-item questionnaire. The survey was distributed to critical care nurses via the Australian College of Critical Care Nurses (ACCCN) mailing list and directly to intensive care units via The majority of participants were women (n = 62) all participants were registered nurses employed in critical care the response rate was 3.2%. The study design was used to establish demographic data, employment data, and individuals' knowledge related to IAH and ACS. Participants had the option to write hand written responses in addition to selecting a closed question response. Results The results showed that most survey participants were able to identify some obvious causes of IAH. However, less than 20% were able to recognize less apparent indices of risk. A lack of education related to IAP monitoring was identified by nearly half (44.2%) of respondents as the primary barrier to monitoring IAP.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2017, 'Multi-morbidity, frailty and self-care: important considerations in treatment with anticoagulation drugs. Outcomes of the AFASTER study.', European journal of cardiovascular nursing : journal of the Working Group on Cardiovascular Nursing of the European Society of Cardiology, vol. 16, no. 2, pp. 113-124.
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Chronic heart failure (CHF) and atrial fibrillation (AF) are complex cardiogeriatric syndromes mediated by physical, psychological and social factors. Thromboprophylaxis is an important part of avoiding adverse events in these syndromes, particularly stroke.This study sought to describe the clinical characteristics of a cohort of patients admitted to hospital with CHF and concomitant AF and to document the rate and type of thromboprophylaxis. We examined the practice patterns of the prescription of treatment and determined the predictors of adverse events.Prospective consecutive participants with CHF and concomitant AF were enrolled during the period April to October 2013. Outcomes were assessed at 12 months, including all-cause readmission to hospital and mortality, stroke or transient ischaemic attack, and bleeding.All-cause readmission to hospital was frequent (68%) and the 12-month all-cause mortality was high (29%). The prescription of anticoagulant drugs at discharge was statistically significantly associated with a lower mortality at 12 months (23 vs. 40%; p=0.037; hazards ratio 0.506; 95% confidence interval 0.267-0.956), but was not associated with lower rates of readmission to hospital among patients with CHF and AF. Sixty-six per cent of participants were prescribed anticoagulant drugs on discharge from hospital. Self-reported self-care behaviour and 'not for cardiopulmonary resuscitation' were associated with not receiving anticoagulant drugs at discharge. Although statistical significance was not achieved, those patients who were assessed as frail or having greater comorbidity were less likely to receive anticoagulant drugs at discharge.This study highlights multi-morbidity, frailty and self-care to be important considerations in thromboprophylaxis. Shared decision-making with patients and caregivers offers the potential to improve treatment knowledge, adherence and outcomes in this group of patients with complex care needs.
Rihari-Thomas, J., DiGiacomo, M., Phillips, J., Newton, P. & Davidson, P.M. 2017, 'Clinician Perspectives of Barriers to Effective Implementation of a Rapid Response System in an Academic Health Centre: A Focus Group Study', Int J Health Policy Manag, vol. 6, no. x, pp. 1-10.
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Background: Systemic and structural issues of rapid response system (RRS) models can hinder implementation. This study sought to understand the ways in which acute care clinicians (physicians and nurses) experience and negotiate care for deteriorating patients within the RRS. Methods: Physicians and nurses working within an Australian academic health centre within a jurisdictional-based model of clinical governance participated in focus group interviews. Verbatim transcripts were analysed using thematic content analysis. Results: Thirty-four participants (21 physicians and 13 registered nurses [RNs]) participated in six focus groups over five weeks in 2014. Implementing the RRS in daily practice was a process of informal communication and negotiation in spite of standardised protocols. Themes highlighted several systems or organisational-level barriers to an effective RRS, including (1) responsibility is inversely proportional to clinical experience; (2) actions around system flexibility contribute to deviation from protocol; (3) misdistribution of resources leads to perceptions of inadequate staffing levels inhibiting full optimisation of the RRS; and (4) poor communication and documentation of RRS increases clinician workloads. Conclusion: Implementing a RRS is complex and multifactorial, influenced by various inter- and intra-professional factors, staffing models and organisational culture. The RRS is not a static model; it is both reflexive and iterative, perpetually transforming to meet healthcare consumer and provider demands and local unit contexts and needs. Requiring more than just a strong initial implementation phase, new models of care such as a RRS demand good governance processes, ongoing support and regular evaluation and refinement. Cultural, organizational and professional factors, as well as systems-based processes, require consideration if RRSs are to achieve their intended outcomes in dynamic healthcare settings.
Rao, A., Newton, P., DiGiacomo, M., Hickman, L., Hwang, C. & Davidson, P. 2017, 'Optimal gender specific strategies for the secondary prevention of cardiovascular disease in women: a systematic review', Journal of Cardiopulmonary Rehabilitation and Prevention.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2017, 'Barriers and enablers to adherence to anticoagulation in heart failure with atrial fibrillation: patient and provider perspectives'.
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Aims & Objectives The purpose of this study was to elucidate the barriers and enablers to adherence to anticoagulation in individuals with chronic heart failure (CHF) with concomitant atrial fibrillation (AF) from the perspective of patients and providers. Background CHF and AF commonly coexist and are associated with increased stroke risk and mortality. Oral anticoagulation significantly reduces stroke risk and improves outcomes. Yet, in approximately 30% of cases anticoagulation is not commenced for a variety of reasons. Design Qualitative study using narrative inquiry. Methods Data from face to face individual interviews with patients and information retrieved from healthcare file note review documented the clinician perspective. This study is a synthesis of the two data sources, obtained during patient clinical assessments as part of the Atrial Fibrillation And Stroke Thromboprophylaxis in hEart failuRe (AFASTER) Study. Results Patient choice and preference were important factors in anticoagulation decisions, including treatment burden, unfavourable or intolerable side effects and patient refusal. Financial barriers included cost of travel, medication cost and reimbursement. Psychological factors included psychiatric illness, cognitive impairment and depression. Social barriers included homelessness and the absence of a caregiver or lack of caregiver assistance. Clinician reticence included fear of falls, frailty, age, fear of bleeding and the challenges of multi-morbidity. Facilitators to successful prescription and adherence were caregiver support, reminders and routine, self-testing and the use of technology. Conclusions Many barriers remain to high risk individuals being prescribed anticoagulation for stroke prevention. There are a number of enabling factors that facilitate prescription and optimize treatment adherence. Nurses should challenge these treatment barriers and seek enabling factors to optimise therapy. Relevance to clinical practice Nurs...
Jha, S., McDonagh, J., Ferguson, C., Macdonald, P. & Newton, P. 2017, 'Frailty, not just about old people: Reply to Smith GD & Kydd A (2017) Getting care of older people right: the need for appropriate frailty assessment?', Journal of Clinical Nursing.
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Mauthner, O., Claes, V., Deschodt, M., Jha, S.R., Engberg, S., Macdonald, P.S., Newton, P.J. & De Geest, S. 2017, 'Handle with care: A systematic review on frailty in cardiac care and its usefulness in heart transplantation.', Transplant Rev (Orlando).
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BACKGROUND: There is growing consensus that frailty, a state of vulnerability and a decline in functioning across multiple physiological body systems, is a valuable criterion to guide clinicians' risk prediction for poor outcomes in adult transplant candidates. In its 2016 listing criteria for heart transplantation the International Society for Heart Lung Transplantation recommends frailty assessment. We aimed to summarize the usefulness of frailty assessment in heart transplant candidates or recipients reported throughout the literature. METHODS: We performed a systematic literature search in PubMed to identify papers reporting on frailty in transplantation, chronic heart failure, and ventricualr assist device implantation published over the last 10 years in English. Additionally, a hand search was conducted, including manually searching the reference lists and a citation search of relevant papers. RESULTS: Eleven primary research articles were included in this systematic review. Frailty is a risk factor for morbidity, hospitalization, and mortality in patients with advanced heart failure and individuals being considered for ventricualr assist device implantation. Of the patients being considered for transplantation, 33% are frail. The Frailty Phenotype by Fried is a particularly useful tool to quickly identify higher risk patients for adverse outcomes. CONCLUSION: A lack of standardization and limited evidence on frailty in transplantation limit its use as a definitive listing criterion. Future research efforts should focus on systematic integration of frailty measures in transplant practice.
McDonagh, J., Martin, L., Ferguson, C., Jha, S., Macdonald, P., Davidson, P. & Newton, P. 2017, 'Frailty assessment instruments in heart failure: a systematic review.', European Journal of Cardiovascular Nursing.
Deek, H., Hamilton, S., Brown, N., Inglis, S.C., DiGiacomo, M., Newton, P., Noureddine, S., Macdonald, P. & Davidson, P.M. 2016, 'Family-centred approaches to healthcare interventions in chronic diseases in adults: a quantitative systematic review.', Journal of Advanced Nursing, vol. 72, no. 5, pp. 968-979.
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Increasingly there is a focus on self-care strategies for both malignant and non-malignant conditions. Models of self-care interventions have focussed on the individual and less on the broader context of family and society. In many societies, decision-making and health seeking behaviours, involve family members.To identify elements of effective family-centred self-care interventions that are likely to improve outcomes of adults living with chronic conditions.Review paper.MEDLINE (Ovid), CINAHL, Academic Search Complete, PsychInfo and Scopus between 2000-2014.Quantitative studies targeting patient outcomes through family-centred interventions in adults were retrieved using systematic methods in January, 2015. Search terms used were: 'family', 'spouse', 'carer', 'caregiver', 'chronic', 'chronic disease', 'self-care', 'self-management' and 'self-efficacy'. Reference lists were reviewed. Risk of bias assessment was performed using the Cochrane Collaboration's tool. Data were reported using a narrative summary approach.Ten studies were identified. Improvements were noted in readmission rates, emergency department presentations, and anxiety levels using family-centred interventions compared with controls. Elements of effective interventions used were a family-centred approach, active learning strategy and transitional care with appropriate follow-up.Involving the family in self-care has shown some positive results for patients with chronic conditions. The benefits of family-centred care may be more likely in specific socio-cultural contexts.The review has year limits and further research needs to identify support for both the patients and family caregivers.
Deek, H., Noureddine, S., Newton, P.J., Inglis, S.C., MacDonald, P.S. & Davidson, P.M. 2016, 'A family-focused intervention for heart failure self-care: conceptual underpinnings of a culturally appropriate intervention', Journal of Advanced Nursing, vol. 72, no. 2, pp. 434-450.
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Jha, S.R., Hannu, M.K., Chang, S., Montgomery, E., Harkess, M., Wilhelm, K., Hayward, C.S., Jabbour, A., Spratt, P.M., Newton, P., Davidson, P.M. & Macdonald, P.S. 2016, 'The Prevalence and Prognostic Significance of Frailty in Patients With Advanced Heart Failure Referred for Heart Transplantation.', Transplantation, vol. 100, no. 2, pp. 429-436.
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Frailty is a clinically recognized syndrome of decreased physiological reserve. The heightened state of vulnerability in these patients confers a greater risk of adverse outcomes after even minor stressors. Our aim was to assess the prevalence and prognostic significance of the frailty phenotype in patients referred for heart transplantation.Consecutive patients referred or on the waiting list for heart transplantation from March 2013 underwent frailty assessment. Frailty was defined as a positive response to 3 or more of the following 5 components: weak grip strength, slowed walking speed, poor appetite, physical inactivity, and exhaustion. In addition, markers of disease severity were obtained, and all patients underwent cognitive (Montreal Cognitive Assessment) and depression (Depression in Medical Illness-10) screening.One hundred twenty patients (83 men:37 women; age, 53 &plusmn; 12 years, range, 16-73 years; left ventricular ejection fraction, 27 &plusmn; 14%) underwent frailty assessment. Thirty-nine of 120 patients (33%) were assessed as frail. Frailty was associated with New York Heart Association class IV heart failure, lower body mass index, elevated intracardiac filling pressures, lower cardiac index, anemia, hypoalbuminemia, hyperbilirubinemia, cognitive impairment, and depression (all < 0.05). Frailty was independent of age, sex, heart failure duration, left ventricular ejection fraction, or renal function. Frailty was an independent predictor of increased all-cause mortality: 1 year actuarial survival was 79 &plusmn; 5% in the nonfrail group compared with only 54 &plusmn; 9% for the frail group (P < 0.005).Frailty is prevalent among patients with advanced symptomatic heart failure referred for heart transplantation and is associated with increased mortality.
Ferguson, C., Inglis, S.C., Newton, P.J., Middleton, S., Macdonald, P.S. & Davidson, P.M. 2016, 'Education and practice gaps on atrial fibrillation and anticoagulation: a survey of cardiovascular nurses', BMC Medical Education, vol. 16, no. 9.
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Background Patients' knowledge of their atrial fibrillation (AF) and anticoagulation therapy are determinants of the efficacy of thromboprophylaxis. Nurses may be well placed to provide counselling and education to patients on all aspects of anticoagulation, including self-management. It is important that nurses are well informed to provide optimal education to patients. Current practice and knowledge of cardiovascular nurses on AF and anticoagulation in the Australian and New Zealand (ANZ) context is not well reported. This study aimed to; 1) Explore the nurse's role in clinical decision making in anticoagulation in the setting of AF; 2) Describe perceived barriers and enablers to anticoagulation in AF; 3) Investigate practice patterns in the management of anticoagulation in the ANZ setting; 4) Assess cardiovascular nurses' knowledge of anticoagulation. Methods A paper-based survey on current practices and knowledge of AF and anticoagulation was distributed during the Australian Cardiovascular Nursing College (ACNC) Annual Scientific Meeting, February 2014. This survey was also emailed to Cardiovascular Trials Nurses throughout New South Wales, Australia and nursing members of the Cardiac Society of Australia and New Zealand (CSANZ). Results There were 41/73 (56 %) respondents to the paper-based survey. A further 14 surveys were completed online via nurse members of the CSANZ, and via an investigator developed NSW cardiovascular trials nurse email distribution list. A total of 55 surveys were completed and included in analyses. Prior education levels on AF, stroke risk, anticoagulation and health behaviour modification were mixed. The CHA2DS2VASc and HAS-BLED risk stratification tools were reported to be underused by this group of clinicians. Reported key barriers to anticoagulation included; fears of patients falling, fears of poor adherence to medication taking and routine monitoring. Patient self-monitoring and self-management were reported as underutilise...
Shehab, S., Macdonald, P.S., Keogh, A.M., Kotlyar, E., Jabbour, A., Robson, D., Newton, P.J., Rao, S., Wang, L., Allida, S., Connellan, M., Granger, E., Dhital, K., Spratt, P., Jansz, P.C. & Hayward, C.S. 2016, 'Long-term biventricular HeartWare ventricular assist device support-Case series of right atrial and right ventricular implantation outcomes.', Journal of Heart and Lung Transplantation, vol. 35, no. 4, pp. 466-473.
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There is limited information on outcomes using the HeartWare ventricular assist device (HVAD; HeartWare, Framington, MA) as a biventricular assist device, especially with respect to site of right ventricular assist device (RVAD) implantation.Outcomes in 13 patients with dilated cardiomyopathy and severe biventricular failure who underwent dual HVAD implantation as bridge to transplantation between August 2011 and October 2014 were reviewed.Of 13 patients, 10 were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) Level 1, and 3 were INTERMACS Level 2. Mean age was 45 &plusmn; 11 years, and mean body mass index was 26 &plusmn; 4 kg/m(2). There were 7 patients on temporary mechanical support pre-operatively (extracorporeal life support, n = 5; intra-aortic balloon pump, n = 2). The median hospital length of stay was 53 days (interquartile range [IQR] 33-70 days) with a median intensive care unit length of stay of 14 days (IQR 8-36 days). The median length of support on device was 269 days (IQR 93-426 days). The right HVAD was implanted in the right ventricular (RV) free wall in 6 patients and in the right atrial (RA) free wall in 7 patients. Transplantation was successfully performed in 5 patients, and overall survival for the entire cohort was 54%. RVAD pump thrombosis occurred in 3 of 6 RV pumps and 1 of 7 RA pumps. No left ventricular assist device pump thrombosis was observed. Bleeding tended to be higher in the RV implantation group (3 of 6 vs 0 of 7). During follow up, 6 patients died (4 of 7 in the RA group vs 2 of 6 in the RV group). Cause of death was multiple-organ failure in 3 patients, sepsis in 2 patients, and intracerebral hemorrhage in 1 patient.Critically ill patients who require biventricular support can be successfully bridged to transplant using 2 HVADs. RA implantation may allow right heart support with lower pump thrombosis and bleeding complications, although this was at the expense of a higher mortality in this cohort.
Newton, P.J., Davidson, P.M., Reid, C.M., Krum, H., Hayward, C., Sibbritt, D.W., Banks, E. & MacDonald, P.S. 2016, 'Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study.', The Medical journal of Australia, vol. 204, no. 3, pp. 113-113.
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The primary aim of the NSW Heart Failure (HF) Snapshot was to obtain a representative cross-sectional view of patients with acute HF and their management in New South Wales and Australian Capital Territory hospitals.A prospective audit of consecutive patients admitted to 24 participating hospitals in NSW and the ACT with a diagnosis of acute HF was conducted from 8 July 2013 to 8 August 2013.A total of 811 participants were recruited (mean age, 77 &plusmn; 13 years; 58% were men; 42% had a left ventricular ejection fraction 50%). The median Charlson Comorbidity Index score was 3, with ischaemic heart disease (56%), renal disease (55%), diabetes (38%) and chronic lung disease (32%) the most frequent comorbidities; 71% of patients were assessed as frail. Intercurrent infection (22%), non-adherence to prescribed medication (5%) or to dietary or fluid restrictions (16%), and atrial fibrillation/flutter (15%) were the most commonly identified precipitants of HF. Initial treatment included intravenous diuretics (81%), oxygen therapy (87%), and bimodal positive airways pressure or continuous positive airways pressure ventilation (17%). During the index admission, 6% of patients died. The median length of stay in hospital was 6 days, but ranged between 3 and 12 days at different hospitals. Just over half the patients (59%) were referred to a multidisciplinary HF service. Discharge medications included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59%), -blockers (66%) and loop diuretics (88%).Patients admitted to hospital with acute HF in NSW and the ACT were generally elderly and frail, with multiple comorbidities. Evidence-based therapies were underused, and there was substantial interhospital variation in the length of stay. We anticipate that the results of the HF Snapshot will inform the development of strategies for improving the uptake of evidence-based therapies, and hence outcomes, for HF patients.
Vongmany, J., Hickman, L.D., Lewis, J., Newton, P.J. & Phillips, J.L. 2016, 'Anxiety in chronic heart failure and the risk of increased hospitalisations and mortality: A systematic review.', European Journal of Cardiovascular Nursing.
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Anxiety is a serious affective mood disorder that affects many chronic heart failure patients. While there is ample evidence that depression increases hospitalisations and mortality in chronic heart failure patients, it is unclear whether this association also exists for anxiety.The purpose of this study was to report on prospective cohort studies investigating anxiety in chronic heart failure patients and its association with hospitalisations and mortality rates. This systematic review aims to improve the current knowledge of anxiety as a potential prognostic predictor in chronic heart failure populations.This systematic review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Studies were identified by accessing electronic databases Embase, Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO. Studies were included if they: employed a prospective cohort study design, included chronic heart failure participants with a confirmed clinical diagnosis plus anxiety confirmed by a validated anxiety assessment tool and/or clinical diagnosis and reported longitudinal hospitalisation rates and mortality data in chronic heart failure.Six studies were identified for inclusion. A study investigating hospitalisations and mortality rates found a significant (p<0.05) association solely between hospitalisation and anxiety. Of four studies reporting on hospitalisations alone, only two reported significant associations with anxiety. One study reported rates of mortality alone and identified no significant associations between mortality and anxiety. There was some variation in quality of the studies in regards to their methodology, analysis and reported measures/outcomes, which may have affected the results reported.It is possible that anxiety does predict hospitalisations in chronic heart failure populations, however further research is required to confirm this observation.
Deek, H.A., Newton, P.J., Inglis, S.C., Kabbani, S., Noureddine, S., Macdonald, P. & Davidson, P.M. 2016, 'Protocol for a block randomised controlled trial of an intervention to improve heart failure care', Nurse Researcher, vol. 23, no. 4, pp. 24-29.
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Aim To describe the design of a randomised controlled trial conducted to evaluate a culturally tailored, nurse-led educational intervention. Background Self-care strategies are critical to improving health outcomes in heart failure. The family unit is crucial in collectivist cultures, but little is known about involving the family in the self-care of patients with heart failure. Discussion Involving the family in the self-care of heart failure is a novel approach. To the authors' knowledge, no one has evaluated it using a randomised controlled trial. Conclusion A valid comparison of outcomes between the control group and the intervention group involved in the study was provided in this trial. The chosen design, randomised controlled trial, enabled the assessment of the intervention. Implications for practice The application of a family self-care intervention in a collectivist culture was shown to improve clinical and quality outcomes of patients with heart failure. Considering the individual and the community needs is vital in improving these outcomes.
Shehab, S., Newton, P.J., Allida, S., Jansz, P. & Hayward, S.C. 2016, 'Biventricular mechanical support decvices – clinical perspectives', Expert Review of Medical Devices, vol. 13, no. 4, pp. 353-365.
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Jha, S.R., Hannu, M.K., Gore, K., Chang, S., Newton, P., Wilhelm, K., Hayward, C.S., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Jansz, P., Spratt, P.M., Montgomery, E., Harkess, M., Tunicliff, P., Davidson, P.M. & Macdonald, P.S. 2016, 'Cognitive impairment improves the predictive validity of physical frailty for mortality in patients with advanced heart failure referred for heart transplantation', JOURNAL OF HEART AND LUNG TRANSPLANTATION, vol. 35, no. 9, pp. 1092-1100.
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Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S., Shehab, S. & Newton, P.J. 2016, 'A survey of views and opinions of health professionals managing thirst in chronic heart failure.', Contemporary nurse, pp. 1-16.
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Thirst is a common and burdensome symptom of chronic heart failure which affects adherence to self-care practices specifically fluid restriction. Despite this, there is no standard clinical practice for managing the symptom of thirst.The aim is to identify the current strategies recommended by health professionals to help relieve thirst in chronic heart failure patients and their perceived usefulness of these strategies.A survey was distributed to attendees of the 8(th) Annual Scientific Meeting of Australasian Cardiovascular Nursing College.There were 42/70 respondents to the survey. The majority (33/40; 82.5%) had recommended various strategies to alleviate thirst. The most recommended strategy was ice chips (36/38; 94.7%). Overall, the respondents reported 'some use' in all of the strategies.Various strategies are recommended to CHF patients to relieve thirst. Despite this, systematic evaluation of these methods is still limited. More research is needed to investigate the effectiveness of these interventions in relieving thirst. Information from this survey may help in the incorporation of thirst- relieving strategies into evidence based guidelines; further improving the quality of care of patients.
Ferguson, C., Hickman, L., Lal, S., Newton, P., Kneebone, I., McGowan, S. & Middleton, S. 2016, 'Addressing the stroke evidence-treatment gap', Contemporary Nurse.
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Rao, A., Hickman, L.D., Sibbritt, D., Newton, P.J. & Phillips, J.L. 2016, 'Is energy healing an effective non-pharmacological therapy for improving symptom management of chronic illnesses? A systematic review', Complementary Therapies in Clinical Practice, vol. 25, pp. 26-41.
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Deek, H., Chang, S., Noureddine, S., Newton, P.J., Inglis, S.C., Macdonald, P.S., Al Arab, G. & Davidson, P.M. 2016, 'Translation and validation of the Arabic version of the Self-care of Heart Failure Index.', Nurse Res, vol. 24, no. 2, pp. 34-40.
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Background Heart failure is a complex clinical syndrome with high demands for self-care. The Self-care of Heart Failure Index (SCHFI) was developed to measure self-care and has demonstrated robust psychometric properties across populations. Aim To assess the psychometric properties of the Arabic version of the SCHFI (A-SCHFI). Discussion The scores of the A-SCHFI administered to 223 Lebanese patients with heart failure were used to validate this instrument. Face and content validity, assessed by a panel of experts, were found sufficient. The three constructs of the A-SCHFI explained 37.5% of the variance when performing exploratory factor analysis. Adequate fit indices were achieved using the modification procedure of controlling error terms with the confirmatory factor analysis. The reliability coefficient was adequate in the maintenance, management and confidence scales. Conclusion Following adaptation, the modified A-SCHFI was shown to be a valid and reliable measure of self-care among the Lebanese population. Implications for practice Cross-cultural adaptation is a rigorous process involving complex procedures and analyses. The adaptation of the A-SCHFI should be further analysed, including sensitivity and test-retest analysis, with methods to assess the degree of agreement among the panel.
Newton, P.J., Davidson, P.M., Reid, C.M., Krum, H., Hayward, C., Sibbritt, D.W., Banks, E. & MacDonald, P.S. 2016, 'Acute heart failure admissions in New South Wales and the Australian Capital Territory: the NSW HF Snapshot Study', The Medical journal of Australia, vol. 204, no. 3.
OBJECTIVE: The primary aim of the NSW Heart Failure (HF) Snapshot was to obtain a representative cross-sectional view of patients with acute HF and their management in New South Wales and Australian Capital Territory hospitals.DESIGN AND SETTING: A prospective audit of consecutive patients admitted to 24 participating hospitals in NSW and the ACT with a diagnosis of acute HF was conducted from 8 July 2013 to 8 August 2013.RESULTS: A total of 811 participants were recruited (mean age, 77 &plusmn; 13 years; 58% were men; 42% had a left ventricular ejection fraction 50%). The median Charlson Comorbidity Index score was 3, with ischaemic heart disease (56%), renal disease (55%), diabetes (38%) and chronic lung disease (32%) the most frequent comorbidities; 71% of patients were assessed as frail. Intercurrent infection (22%), non-adherence to prescribed medication (5%) or to dietary or fluid restrictions (16%), and atrial fibrillation/flutter (15%) were the most commonly identified precipitants of HF. Initial treatment included intravenous diuretics (81%), oxygen therapy (87%), and bimodal positive airways pressure or continuous positive airways pressure ventilation (17%). During the index admission, 6% of patients died. The median length of stay in hospital was 6 days, but ranged between 3 and 12 days at different hospitals. Just over half the patients (59%) were referred to a multidisciplinary HF service. Discharge medications included angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (59%), -blockers (66%) and loop diuretics (88%).CONCLUSIONS: Patients admitted to hospital with acute HF in NSW and the ACT were generally elderly and frail, with multiple comorbidities. Evidence-based therapies were underused, and there was substantial interhospital variation in the length of stay. We anticipate that the results of the HF Snapshot will inform the development of strategies for improving the uptake of evidence-based therapies, and hence outcomes, for HF...
Shehab, S., Allida, S.M., Davidson, P.M., Newton, P.J., Robson, D., Jansz, P.C. & Hayward, C.S. 2016, 'Right Ventricular Failure Post LVAD Implantation Corrected with Biventricular Support: An In Vitro Model.', ASAIO J, vol. 63, no. 1, pp. 41-47.
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Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2015, 'The caregiver role in thromboprophylaxis management in atrial fibrillation: A literature review', European Journal of Cardiovascular Nursing, vol. 14, no. 2, pp. 98-107.
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Background: Atrial fibrillation is a common arrhythmia and a risk factor for adverse events including stroke. People living with atrial fibrillation are commonly elderly and have multiple comorbidities. The role of a caregiver in supporting the individual to manage a chronic and complex condition has received limited attention.
Deek, H.A., Newton, P.J., Inglis, S., Kabbani, S., Noureddine, S., Macdonald, P. & Davidson, P.M. 2015, 'Heart health in Lebanon and considerations for addressing the burden of cardiovascular disease.', Collegian, vol. 22, no. 3, pp. 333-339.
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To (1) aggregate and define the burden of cardiovascular disease in Lebanon and (2) describe implications for policy, practice and research to improve health outcomes in Lebanon.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2015, 'The caregiver role in thromboprophylaxis management in atrial fibrillation', European Journal of Cardiovascular Nursing, vol. 14, no. 2, pp. 98-107.
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Background: Atrial fibrillation is a common arrhythmia and a risk factor for adverse events including stroke. People living with atrial fibrillation are commonly elderly and have multiple comorbidities. The role of a caregiver in supporting the individual to manage a chronic and complex condition has received limited attention.
Allida, S.M., Inglis, S.C., Davidson, P.M., Lal, S., Hayward, C.S. & Newton, P.J. 2015, 'Thirst in chronic heart failure: a review.', Journal of clinical nursing, vol. 24, no. 7-8, pp. 916-926.
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This review will (1) explore factors related to thirst in chronic heart failure and (2) describe interventions to alleviate thirst in chronic heart failure patients.Thirst is a common and troublesome symptom of chronic heart failure. Despite the burden and prevalence of this symptom, there are limited strategies to assist in its management.This is a review of literature on the burden of thirst, contributors to thirst and potential management strategies of thirst in patients with chronic heart failure.Medline, Cumulative Index for Nursing and Allied Health, PubMed and Scopus were searched using the key words thirst, chronic heart failure, angiotensin II, fluid restriction and intervention. Of the 165 citations yielded, nine studies (n = 9) were included. The eligibility criteria included participants with confirmed diagnosis of chronic heart failure, randomised controlled studies or any studies with thirst as primary or secondary outcome, in humans and in English. There was no limit to the years searched.Factors related to thirst in chronic heart failure were condition; prolonged neurohormonal activation, treatment; pharmacological interventions and fluid restriction and emotion. No intervention studies were found in chronic heart failure patients. Interventions such as artificial saliva and chewing gum have been investigated for their effectiveness as a thirst reliever in haemodialysis patients.Thirst is a frequent and troublesome symptom for individuals with chronic heart failure. It is highly likely that this contributes to poor adherence with fluid restrictions. Chewing gum can help alleviate thirst, but investigation in people with heart failure is needed.Increasing awareness of thirst and interventions to relieve it in clinical practice is likely to improve the quality of care for people with chronic heart failure.
Hunt, L., Frost, S.A., Alexandrou, E., Hillman, K., Newton, P.J. & Davidson, P.M. 2015, 'Reliability of intra-abdominal pressure measurements using the modified Kron technique.', Acta Clinica Belgica, vol. 70, no. 2, pp. 116-120.
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OBJECTIVES: Assessment of intra-abdominal pressure (IAP) and the likelihood of abdominal compartment syndrome using valid and reliable measures is an important tool in the assessment of critically ill patients. The current method of relying on a single IAP per measurement period to determine patient clinical status raises the question: is a single intermittent IAP measurement an accurate indicator of clinical status or should more than one measurement be taken per measurement period? METHODS: This study sought to assess the reliability of IAP measurements. Measurements were taken using the modified Kron technique. A total of two transvesical intra-abdominal pressure measurements were undertaken per patient using a standardized protocol. Recordings were taken at intervals of 5 minutes. RESULTS: The majority of participants (58%) were surgical patients. Thirty-two were males and the mean age was 58 years (SD: 167 years). The concordance correlation coefficient between the two measurements was 095. Both the scatter and Bland-Altman plots demonstrate that the comparisons of two measurements are highly reproducible. CONCLUSION: The findings of this study suggest that conducting two IAP measurements on single patient produce comparable results; therefore, there appears to be no advantage in doing two IAP measurements on a single patient. The measurement of an IAP requires the implementation of a standardized protocol and competent and credentialed assessors trained in the procedure.
Chang, S., Davidson, P.M., Newton, P.J., Macdonald, P., Carrington, M.J., Marwick, T.H., Horowitz, J.D., Krum, H., Reid, C.M., Chan, Y.K., Scuffham, P.A., Sibbritt, D. & Stewart, S. 2015, 'Composite outcome measures in a pragmatic clinical trial of chronic heart failure management: A comparative assessment', International Journal of Cardiology, vol. 185, pp. 62-68.
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Disler, R.T., Inglis, S.C., Newton, P.J., Currow, D.C., Macdonald, P.S., Glanville, A.R., Donesky, D., Carrieri-Kohlman, V. & Davidson, P.M. 2015, 'Patterns of Technology Use in Patients Attending a Cardiopulmonary Outpatient Clinic: A Self-Report Survey', Interactive journal of medical research, vol. 4, no. 1, pp. e5-e5.
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Sibbritt, D., Davidson, P., DiGiacomo, M., Newton, P. & Adams, J. 2015, 'Use of Complementary and Alternative Medicine in Women With Heart Disease, Hypertension and Diabetes (from the Australian Longitudinal Study on Women's Health)', AMERICAN JOURNAL OF CARDIOLOGY, vol. 115, no. 12, pp. 1691-1695.
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Jha, S.R., Ha, H.S.K., Hickman, L.D., Hannu, M., Davidson, P.M., Macdonald, P.S. & Newton, P.J. 2015, 'Frailty in advanced heart failure: a systematic review', Heart Failure Reviews, vol. 20, no. 5, pp. 553-560.
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Disler, R., Inglis, S., Newton, P., Currow, D., Macdonald, P., Glanville, A., Donesky, D., Carrieri-Kohlman, V. & Davidson, P. 2015, 'ATTITUDES TO ONLINE DELIVERY OF HEALTH INFORMATION AND CHRONIC DISEASE MANAGEMENT IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE: FOCUS GROUP STUDY', RESPIROLOGY, vol. 20, pp. 105-105.
Hickman, L.D., Phillips, J.L., Newton, P.J., Halcomb, E.J., Al Abed, N. & Davidson, P.M. 2015, 'Multidisciplinary team interventions to optimise health outcomes for older people in acute care settings: A systematic review', Archives of Gerontology and Geriatrics, vol. 61, no. 3, pp. 322-329.
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Ivynian, S., DiGiacomo, M. & Newton, P. 2015, 'Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis', Heart Failure Reviews, vol. 20, no. 6, pp. 655-671.
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Over 50% of heart failure (HF) patients delay seeking help for worsening symptoms until these reach acute levels and require emergency hospitalisation. This metasynthesis aimed to identify and explore factors influencing timely care-seeking in patients with HF.
Betihavas, V., Frost, S.A., Newton, P.J., Macdonald, P., Stewart, S., Carrington, M.J., Chan, Y.K. & Davidson, P.M. 2015, 'An Absolute Risk Prediction Model to Determine Unplanned Cardiovascular Readmissions for Adults with Chronic Heart Failure.', Heart Lung and Circulation, vol. 24, no. 11, pp. 1068-1073.
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Frequent readmissions are a hallmark of chronic heart failure (CHF). We sought to develop an absolute risk prediction model for unplanned cardiovascular readmissions following hospitalisation for CHF.An inception cohort was obtained from the WHICH? trial, a prospective, multi-centre randomised controlled trial which was a head-to-head comparison of the efficacy of a home-based intervention versus clinic-based intervention for adults with CHF. A Cox's proportional hazards model (taking into account the competing risk of death) was used to develop a prediction model. Bootstrap methods were used to identify factors for the final model. Based on these data a nomogram was developed.Of the 280 participants in the WHICH? trial 37 (13%) were readmitted for a cardiovascular event (including CHF) within 28 days, and a further 149 (53%) were readmitted within 18 months for a cardiovascular event. In the proposed competing risk model, factors associated with an increased risk of hospitalisation for CHF were: age (HR 1.07, 95% CI 0.90-1.26) for each 10-year increase in age; living alone (HR 1.09, 95% CI 0.74-1.59); those with a sedentary lifestyle (HR 1.44, 95% CI, 0.92-2.25) and the presence of multiple co-morbid conditions (HR 1.69, 95% CI 0.38-7.58) for five or more co-morbid conditions (compared to individuals with one documented co-morbidity). The C-statistic of the final model was 0.80.We have developed a practical model for individualising the risk of short-term readmission for CHF. This model may provide additional information for targeting and tailoring interventions and requires future prospective evaluation.
Davidson, P.M., Newton, P.J., Tankumpuan, T., Paull, G. & Dennison-Himmelfarb, C. 2015, 'Multidisciplinary Management of Chronic Heart Failure: Principles and Future Trends', Clinical Therapeutics, vol. 37, no. 10, pp. 2225-2233.
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Jha, S.R., Hannu, M., Newton, P., Wilhelm, K., Hayward, C., Jabbour, A., Kotlyar, E., Keogh, A., Dhital, K., Granger, E., Jansz, P., Spratt, P., Montgomery, E., Tunnicilff, P., Shaw, S. & MacDonald, P. 2015, 'Frailty as a Predictor of Outcomes in Heart Transplant-Eligible Patients With Advanced Heart Failure', JOURNAL OF HEART AND LUNG TRANSPLANTATION, vol. 34, no. 4, pp. S187-S188.
Deek, H.A., Newton, P.J., Inglis, S.C., Kabbani, S., Noureddine, S., Macdonald, P. & Davidson, P.M. 2015, 'Family focused Approach to iMprove Heart Failure care InLebanon QualitY (FAMILY) Intervention: A RandomizedControlled Trial', Nurse Researcher.
Hunt, L.M., Frost, S., Hillman, K., Newton, P.J. & Davidson, P.M. 2014, 'Management of intra-abdominal hypertension and abdominal compartment syndrome: a review', Journal of Trauma Management and Outcomes, vol. 8, no. 2, pp. 1-8.
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Patients in the intensive care unit (ICU) are at risk of developing of intra abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Aim: This review seeks to define IAH and ACS, identify the aetiology and presentation of IAH and ACS, identify IAP measurement techniques, identify current management and discuss the implications of IAH and ACS for nursing practice. A search of the electronic databases was supervised by a health librarian. The electronic data bases Cumulative Index of Nursing and Allied Health Literature (CINAHL); Medline, EMBASE, and the World Wide Web was undertaken from 1996- January 2011 using MeSH and key words which included but not limited to: abdominal compartment syndrome, intra -abdominal hypertension, intra-abdominal pressure in adult populations met the search criteria and were reviewed by three authors using a critical appraisal tool. Data derived from the retrieved material are discussed under the following themes: (1) etiology of intra-abdominal hypertension; (2) strategies for measuring intra-abdominal pressure (3) the manifestation of abdominal compartment syndrome; and (4) the importance of nursing assessment, observation and interventions. Intra-abdominal pressure (IAP) and abdominal compartment syndrome (ACS) have the potential to alter organ perfusion and compromise organ function.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., MacDonald, P.S. & Davidson, P.M. 2014, 'Atrial Fibrillation: Stroke Prevention in Focus', Australian Critical Care, vol. 27, no. 2, pp. 92-98.
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Introduction: Atrial fibrillation (AF) is a common arrhythmia and a risk factor for stroke and other adverse events. Internationally there have been recent advancements in the therapies available for stroke prevention in AF. Nurses will care for individuals with AF across a variety of primary and acute care settings and should be familiar with evidence based therapies. Aim: This paper provides a review of the epidemiology of AF and stroke, stroke and bleeding risk assessment tools and evidence based treatments for the prevention of stroke in AF including the use of novel anti-thrombin agents. Method: A review of key databases was conducted from 2002 - 2012 using the key search terms 'atrial fibrillation' 'anticoagulation' 'risk assessment' and 'clinical management'. The following electronic databases were searched: CINAHL, Medline, Scopus, the Cochrane Library and Google Scholar. Reference lists were manually hand searched. Key clinical guidelines from National Institute for Clinical Excellence (NICE, UK), American Heart Association (AHA, USA), American College of Cardiology (ACC, USA) and the European Society of Cardiology (ESC) and key government policy documents were also included. Articles were included in the review if they addressed nursing management with a focus on Australia. Results: Many treatment options exist for AF. Best practice guidelines make a variety of recommendations which include cardioversion, ablation, pulmonary vein isolation, pharmacological agents for rate or rhythm control approaches, and antithrombotic therapy (including anticoagulation and antiplatelet therapy). Treatment should be patient centred and individualised based upon persistency of the rhythm, causal nature, risk and co-morbid conditions. Conclusion: AF is a common and burdensome condition where treatment is complex and not without risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas understanding the risk of AF and appropriate...
Davidson, P.M., Newton, P.J., Ferguson, C., Daly, J., Elliott, D., Homer, C.S., Duffield, C.M. & Jackson, D.E. 2014, 'Rating and Ranking the Role of Bibliometrics and Webometrics in Nursing and Midwifery', The Scientific World Journal, vol. 2014.
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Background. Bibliometrics are an essential aspect of measuring academic and organizational performance. Aim. This review seeks to describe methods for measuring bibliometrics, identify the strengths and limitations of methodologies, outline strategies for interpretation, summarise evaluation of nursing and midwifery performance, identify implications for metric of evaluation, and specify the implications for nursing and midwifery and implications of social networking for bibliometrics and measures of individual performance.
Ferguson, C., Inglis, S., Newton, P.J., Cripps, P.J., Macdonald, P. & Davidson, P.M. 2014, 'Social media: A tool to spread information: A case study analysis of Twitter conversation at the Cardiac Society of Australia & New Zealand 61st Annual Scientific Meeting 2013', Collegian, vol. 21, no. 2, pp. 89-93.
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Background The World Wide Web has changed the way in which people communicate and consume information. More importantly, this innovation has increased the speed and spread of information. There has been recent increase in the percentage of cardiovascular professionals, including journals and associations using Twitter to engage with others and exchange ideas. Evaluating the reach and impact in scientific meetings is important in promoting the use of social media. Objective This study evaluated Twitter use during the recent 61st Annual Scientific Meeting at the Cardiac Society of Australia and New Zealand. Methods During the Cardiac Society of Australia and New Zealand 2013 61st Annual Scientific Meeting Symplur was used to curate conversations that were publicly posted with the hashtag #CSANZ2013. The hashtag was monitored with analysis focused on the influencers, latest tweets, tweet statistics, activity comparisons, and tweet activity during the conference. Additionally, Radian6 social media listening software was used to collect data. A summary is provided. Results There were 669 total tweets sent from 107 unique Twitter accounts during 8th August 9 a.m. to 11th August 1 p.m. This averaged nine tweets per hour and six tweets per participant. This assisted in the sharing of ideas and disseminating the findings and conclusions from presenters at the conference with a total 1,432,573 potential impressions in Twitter users tweet streams. Conclusion This analysis of Twitter conversations during a recent scientific meeting highlights the significance and place of social media within research dissemination and collaboration. Researchers and clinicians should consider using this technology to enhance timely communication of findings. The potential to engage with consumers and enhance shared decision-making should be explored further.
Sheerin, N.J., Newton, P.J., MacDonald, P.S., Leung, D., Sibbritt, D., Spicer, T., Johnson, K., Krum, H. & Davidson, P.M. 2014, 'Worsening renal function in heart failure: The need for a consensus definition', International Journal of Cardiology, vol. 174, no. 3, pp. 484-491.
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Acute decompensated heart failure is a common cause of hospitalisation. This is a period of vulnerability both in altered pathophysiology and also the potential for iatrogenesis due to therapeutic interventions. Renal dysfunction is often associatedwith heart failure and portends adverse outcomes. Identifying heart failure patients at risk of renal dysfunction is important in preventing progression to chronic kidney disease or worsening renal function, informing adjustment to medication management and potentially preventing adverse events. However, there is no working or consensus definition in international heart failure management guidelines for worsening renal function. In addition, there appears to be no concordance or adaptation of chronic kidney disease guidelines by heart failure guideline development groups for the monitoring of chronic kidney disease in heart failure. Our aim is to encourage the debate for an agreed definition given the prognostic impact of worsening renal function in heart failure. Wepresent the case for the uptake of the Acute Kidney Injury Network criteria for acute kidney injurywith some minor alterations. This has the potential to inform study design and meta-analysis thereby building the knowledgebase for guideline development. Definition consensus supports data element, clinical registry and electronic algorithm innovation as instruments for quality improvement and clinical research for better patient outcomes. In addition, we recommend all community managed heart failure patients have their baseline renal function classified and routinely monitored in accordance with established renal guidelines to help identify those at increased risk for worsening renal function or progression to chronic kidney disease.
Stewart, S., Carrington, M.J., Horowitz, J.D., Marwick, T.H., Newton, P.J., Davidson, P.M., MacDonald, P.S., Thompson, D.R., Chan, Y., Krum, H., Reid, C. & Scuffham, P.A. 2014, 'Prolonged impact of home versus clinic-based management of heart failure on all-cause hospitalization and mortality: results from a pragmatic, multicentre randomized trial', International Journal of Cardiology, vol. 174, no. 3, pp. 600-610.
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We compared the longer-term impact of the two most commonly applied forms of post-discharge management designed to minimize recurrent hospitalization and prolong survival in typically older patients with chronic heart failure (CHF). Methods We followed a multi-center randomized controlled trial cohort of Australian patients hospitalized with CHF and initially allocated to home-based or specialized CHF clinic-based intervention for 1368 &plusmn; 216 days. Blinded endpoints included event-free survival from all-cause emergency hospitalization or death, all-cause mortality and rate of all-cause hospitalization and stay. Results 280 patients (73% male, aged 71 &plusmn; 14 years and 73% left ventricular systolic dysfunction) were initially randomized to home-based (n = 143) or clinic-based (n = 137) intervention. During extended follow-up (complete for 274 patients), 1139 all-cause hospitalizations (7477 days of hospital stay) and 121 (43.2%) deaths occurred. There was no difference in the primary endpoint; 20 (14.0%) home-based versus 13 (7.4%) clinic-based patients remained event-free (adjusted HR 0.89, 95% CI 0.70 to 1.15; p = 0.378). Significantly fewer home-based (51/143, 35.7%) than clinic-based intervention (71/137, 51.8%) patients died (adjusted HR 0.62, 95% CI 0.42 to 0.90: p = 0.012). Home-based versus clinic-based intervention patients accumulated 592 and 547 all-cause hospitalizations (p = 0.087) associated with 3067 (median 4.0, IQR 2.0 to 6.8) versus 4410 (6.0, IQR 3.0 to 12.0) days of hospital stay (p < 0.01 for rate and duration of hospital stay). Conclusions Relative to clinic-based intervention, home-based intervention was not associated with prolonged event-free survival. Home-based intervention was, however, associated with significantly fewer all-cause deaths and significantly fewer days of hospital stay in the longer-term.
Close, G.R., Newton, P.J., Fung, S.C., Denniss, A.R., Halcomb, E., Kovoor, P., Stewart, S. & Davidson, P.M. 2014, 'Socioeconomic status and heart failure in Sydney', Heart Lung and Circulation, vol. 23, no. 4, pp. 320-324.
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Socioeconomic disadvantage is associated with an increased risk of developing heart failure and with inferior health outcomes following diagnosis. Methods Data for hospitalisations and deaths due to heart failure in the Sydney metropolitan region were extracted from New South Wales hospital records and Australian Bureau of Statistics databases for 19992003. Standardised rates were analysed according to patients residential local government area and correlated with an index of socioeconomic disadvantage. Results Eight of the 13 local government areas with standardised separation rate ratios significantly higher than all NSW, and those with the six highest standardised separation rate ratios, were in Greater Western Sydney. Rates of heart failure hospitalisations per local government area were inversely correlated with level of socioeconomic status. Conclusions Higher rates of heart failure hospitalisations among residents of socioeconomically disadvantaged regions within Sydney highlight the need for strategies to lessen the impact of disadvantage and strategies to improve cardiovascular health.
Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D. & Davidson, P.M. 2014, 'Experience of advanced chronic obstructive pulmonary disease: Metasynthesis of qualitative data.', Journal of Pain and Symptom Management, vol. 48, no. 6, pp. 1182-1199.
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Context. Chronic obstructive pulmonary disease (COPD) is a life-limiting illness. Despite best available treatments, individuals continue to experience symptom burden and have high health-care utilization. Objectives. To increase understanding of the experience and ongoing needs of individuals living with COPD.
Chang, S., Newton, P.J., Inglis, S., Luckett, T., Krum, H., MacDonald, P.S. & Davidson, P.M. 2014, 'Are all outcomes in chronic heart failure rated equally? An argument for a patient-centred approach to outcome assessment', Heart Failure Reviews, vol. 19, no. 2, pp. 153-162.
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Chronic heart failure (CHF) is a multi-dimensional and complex syndrome. Outcome measures are important for determining both the efficacy and quality of care and capturing the patient's perspective in evaluating the outcomes of health care delivery. Capturing the patient's perspective via patient-reported outcomes is increasingly important; however, including objective measures such as mortality would provide more complete account of outcomes important to patients. Currently, no single measure for CHF outcomes captures all dimensions of the quality of care from the patient's perspective.
Johnson, M.J., Bland, J.M., Davidson, P.M., Newton, P.J., Oxberry, S.G., Abernethy, A.P. & Currow, D.C. 2014, 'The Relationship Between Two Performance Scales: New York Heart Association Classification and Karnofsky Performance Status Scale', Journal of Pain and Symptom Management, vol. 47, no. 3, pp. 652-658.
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Deek, H., Newton, P., Sheerin, N., Noureddine, S. & Davidson, P.M. 2014, 'Contrast media induced nephropathy: A literature review of the available evidence and recommendations for practice', Australian Critical Care, vol. 27, no. 4, pp. 166-171.
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Allida, S.M., Inglis, S.C., Davidson, P.M., Hayward, C.S. & Newton, P.J. 2014, 'Measurement of thirst in chronic heart failure - A review.', Contemporary Nurse, vol. 48, no. 1, pp. 2-9.
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Abstract Background: Thirst is a bothersome symptom of chronic heart failure (CHF) which impacts adversely on quality of life. Despite this, limited work has been done to investigate thirst as a symptom or to develop reliable and valid measures of thirst in CHF. The purpose of this manuscript is to establish which tools have been used in research to measure thirst in CHF.Medline, PubMed, Cumulative Index for Nursing and Allied Health, and Scopus were searched using following key words thirst, heart failure, measure, scale, randomised controlled trials and multicentre studies.The search discovered 37 studies of which 6 studies met the inclusion criteria. One study was a research abstract and five were full-text studies. To date, there are only three measurement tools utilised in studies examining thirst in CHF patients [Visual Analogue Scale (VAS), Numeric Rating Scale and Thirst Distress Scale].Thirst in CHF is measured in a non-systematic way. In recent studies, the VAS has been used to measure thirst intensity. While this measurement tool is very easy and quick to administer, using a uni-dimensional tool in conjunction with a multi-dimensional tool may be beneficial to capture all dimensions of thirst. In order to manage thirst efficiently, consistent measurement of thirst in CHF is vital.
Ferguson, C., Inglis, S., Newton, P.J., Middleton, S., Macdonald, P. & Davidson, P.M. 2013, 'Atrial fibrillation and thromboprophylaxis in heart failure: The need for patient centered approaches to address adherence', Vascular Health and Risk Management, vol. 9, pp. 3-11.
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Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision-making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for AF and emphasises the importance of addressing both tailoring individual risk for stroke and weighing the benefits of treatment. Further, this review provides details of innovative and patient centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy a comprehensive risk assessment should include evaluation of associated cardio-geriatric conditions, potential for adherence to prescribed therapy, frailty, functional and cognitive ability.
Waller, A., Girgis, A., Davidson, P.M., Newton, P.J., Lecathelinais, C., Macdonald, P., Hayward, C. & Currow, D. 2013, 'Facilitating needs-based support and palliative care for people with chronic heart failure: preliminary evidence for the acceptability, inter-rater reliability and validity of a needs assessment tool', Journal of Pain and Symptom Management, vol. 45, no. 5, pp. 912-925.
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Context. Understanding the types and extent of need is critical to informing needs-based care for people with chronic heart failure (CHF). Objectives. To explore the psychometric quality of a newly developed rapid screening measure to assess the supportive and palliative care needs of people with CHF.
Saltman, D., Jackson, D.E., Newton, P.J. & Davidson, P.M. 2013, 'In pursuit of certainty: can the systematic review process deliver?', BMC Medical Informatics and Decision Making, vol. 13, no. 25.
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There has been increasing emphasis on evidence-based approaches to improve patient outcomes through rigorous, standardised and well-validated approaches. Clinical guidelines drive this process and are largely developed based on the findings of systematic reviews (SRs). This paper presents a discussion of the SR process in providing decisive information to shape and guide clinical practice, using a purpose-built review database: the Cochrane reviews; and focussing on a highly prevalent medical condition: hypertension. Methods We searched the Cochrane database and identified 25 relevant SRs incorporating 443 clinical trials. Reviews with the terms `blood pressure or `hypertension in the title were included. Once selected for inclusion, the abstracts were assessed independently by two authors for their capacity to inform and influence clinical decision-making. The inclusions were independently audited by a third author. Results Of the 25 SRs that formed the sample, 12 provided conclusive findings to inform a particular treatment pathway. The evidence-based approaches offer the promise of assisting clinical decision-making through clarity, but in the case of management of blood pressure, half of the SRs in our sample highlight gaps in evidence and methodological limitations. Thirteen reviews were inconclusive, and eight, including four of the 12 conclusive SRs, noted the lack of adequate reporting of potential adverse effects or incidence of harm. Conclusions These findings emphasise the importance of distillation, interpretation and synthesis of information to assist clinicians. This study questions the utility of evidence-based approaches as a uni-dimensional approach to improving clinical care and underscores the importance of standardised approaches to include adverse events, incidence of harm, patients needs and preferences and clinicians expertise and discretion.
Betihavas, V., Newton, P.J., Frost, S., MacDonald, P.S. & Davidson, P.M. 2013, 'Patient, provider and system factors influencing rehospitalisation in adults with heart failure', Contemporary Nurse, vol. 43, no. 2, pp. 244-256.
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Objectives: To identify patient, provider and system factors predicting rehospitalisation in adults with heart failure (HF).
Chang, S., Davidson, P.M., Newton, P.J., Krum, H., Salamonson, Y. & MacDonald, P.S. 2013, 'What is the methodological and reporting quality of health related quality of life in chronic heart failure clinical trials?', International Journal of Cardiology, vol. 164, no. 2, pp. 133-140.
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Background: Although the number of clinical trials assessing health related quality of life (HRQoL) in chronic heart failure (CHF) has increased exponentially over the last decade, little is known about the quality of reporting. The purpose of this review was to assess the methodological and reporting rigor of HRQoL in RCTs of pharmacological therapy in CHF.
Davidson, P.M., Inglis, S. & Newton, P.J. 2013, 'Self-care In Patients With Chronic Heart Failure', Expert Review of Pharmacoeconomics & Outcomes Research, vol. 13, no. 3, pp. 351-359.
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Globally, chronic heart failure is a common, complex syndrome characterized by high levels of healthcare utilization, reduced quality of life and premature mortality. Self-care is a complex decision-making process involving symptom recognition, action and evaluation.
Inglis, S., Hermis, A., Shehab, S., Newton, P.J., Lal, S. & Davidson, P.M. 2013, 'Peripheral arterial disease and chronic heart failure: a dangerous mix', Heart Failure Reviews, vol. 18, no. 4, pp. 457-464.
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Chronic heart failure (CHF) is associated with a high comorbidity burden, adverse impact on quality of life and high health care utilisation. Peripheral arterial disease (PAD) and CHF share many risk, pathophysiological and prognostic features, and each has been associated with increased morbidity and mortality. PAD often goes undetected, and yet in spite of the availability of screening tools, this is not commonly considered in CHF care. A review of the electronic databases Medline, CINAHL and Cochrane CENTRAL was undertaken using the MeSH terms peripheral arterial disease, peripheral vascular disease, intermittent claudication and heart failure to identify studies examining the prevalence and clinical outcomes of coexisting PAD in patients with CHF. Five studies were identified. There are limited data describing the impact of PAD on CHF outcomes. As PAD may contribute to decreased capacity to exercise and other self-care behaviours, identifying those at risk and providing appropriate therapy are important. Based on this review, patients who are smokers and those with diagnosed coronary heart disease and diabetes should be targeted for the screening of PAD.
Macdonald, P., Newton, P.J. & Davidson, P.M. 2013, 'The SNAPSHOT ACS study: getting the big picture on acute coronary syndrome', Medical Journal Of Australia, vol. 199, no. 3, pp. 147-148.
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Betihavas, V., Newton, P.J., Frost, S., Alexandrou, E., MacDonald, P.S. & Davidson, P.M. 2013, 'Importance of Predictors of Rehospitalisation in Heart Failure: A Survey of Heart Failure Experts', Heart Lung and Circulation, vol. 22, no. 3, pp. 179-183.
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Aims: We investigated the opinion of clinical experts and researchers involved in chronic heart failure disease management regarding the ranking of patient, provider and system factors that predict the risk of rehospitalisation.
Davidson, P.M., Abernethy, A.P., Newton, P.J., Clark, K. & Currow, D.C. 2013, 'The caregiving perspective in heart failure: a population based study', BMC Health Services Research, vol. 13, no. 342.
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Sekar, B., Newton, P.J., Williams, S.G. & Shaw, S.M. 2013, 'Should we consider patients with coexistent hepatitis B or C infection for orthotopic heart transplantation?', Journal of transplantation, vol. 2013, p. 748578.
Heart transplantation (HTX) is the gold standard surgical treatment for patients with advanced heart failure. The prevalence of hepatitis B and hepatitis C infection in HTX recipients is over 10%. Despite its increased prevalence, the long-term outcome in this cohort is still not clear. There is a reluctance to place these patients on transplant waiting list given the increased incidence of viral reactivation and chronic liver disease after transplant. The emergence of new antiviral therapies to treat this cohort seems promising but their long-term outcome is yet to be established. The aim of this paper is to review the literature and explore whether it is justifiable to list advanced heart failure patients with coexistent hepatitis B/C infection for HTX.
Stewart, S., Carrington, M.J., Marwick, T., Davidson, P.M., Macdonald, P., Horowitz, J.D., Krum, H., Newton, P.J., Reid, C., Chan, Y. & Scuffham, P.A. 2012, 'Impact of Home Versus Clinic-Based Management of Chronic Heart Failure: The WHICH? (Which Heart Failure Intervention Is Most Cost-Effective & Consumer Friendly in Reducing Hospital Care) Multicenter, Randomized Trial', Journal Of The American College Of Cardiology, vol. 60, no. 14, pp. 1239-1248.
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Although direct patient contact appears to be best in delivering CHF management overall, the precise form to optimize health outcomes is less clear.
Davidson, P.M., Mitchell, J., DiGiacomo, M., Inglis, S., Newton, P.J., Harman, J. & Daly, J. 2012, 'Cardiovascular disease in women: implications for improving health outcomes', Collegian, vol. 19, no. 1, pp. 5-13.
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This literature review collated data on women and cardiovascular disease in Australia and globally to inform public health campaigns and health care interventions. If found that women with acute coronary syndromes show consistently poorer outcomes than men, independent of comorbidity and management, despite less anatomical obstruction of coronary arteries and relatively preserved left ventricular function. Higher mortality and complication rates are best documented amongst younger women and those with STsegment-elevation myocardial infarction. Sex differences in atherogenesis and cardiovascular adaptation have been hypothesised, but not proven. Atrial fibrillation carries a relatively greater risk of stroke in women than in men, and anticoagulation therapy is associated with higher risk of bleeding complications. The degree of risk conferred by single cardiovascular risk factors and combinations of risk factors may differ between the sexes, and marked postmenopausal changes are seen in some risk factors. Sociocultural factors, delays in seeking care and differences in self-management behaviours may contribute to poorer outcomes in women. Differences in clinical management for women, including higher rates of misdiagnosis and less aggressive treatment, have been reported, but there is a lack of evidence to determine their effects on outcomes, especially in angina. Although enrolment of women in randomised clinical trials has increased since the 1970s, women remain underrepresented in cardiovascular clinical trials. Improvement in the prevention and management of CVD in women will require a deeper understanding of women&acirc;s needs by the community, health care professionals, researchers and government.
Du, H., Everett, B., Newton, P.J., Salamonson, Y. & Davidson, P.M. 2012, 'Self-efficacy: a useful construct to promote physical activity in people with stable chronic heart failure', Journal of Clinical Nursing, vol. 21, no. 3-4, pp. 301-310.
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Aim. To explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and propose a model of intervention. Background. The benefits of physical activity in reducing cardiovascular risk have led to evidence-based recommendations for patients with heart disease, including those with chronic heart failure. However, adherence to best practice recommendations is often suboptimal, particularly in those individuals who experience high symptom burden and feel less confident to undertake physical activity. Self-efficacy is the degree of confidence an individual has in his/her ability to perform behaviour under several specific circumstances. Four factors influence an individual&acirc;s level of self-efficacy: (1) past performance, (2) vicarious experience, (3) verbal persuasion and (4) physiological arousal. Design. Discursive. Methods. Using the method of a discursive paper, this article seeks to explore the conceptual underpinnings of self-efficacy to address the barriers to participating in physical activity and proposes a model of intervention, the Home-Heart-Walk, to promote physical activity and monitor functional status. Conclusions. Implementing effective interventions to promote physical activities require appreciation of factors impacting on behaviour change. Addressing concepts relating to self-efficacy in physical activity interventions may promote participation and adherence in the longer term.
Jiwa, M., Davidson, P.M., Newton, P.J., DiGiacomo, M., McGrath, S. & Lotriet, C. 2012, 'Patient, Provider and System Factors Impacting on the Diagnosis and Management of Lung Cancer Care in Australia', Journal of Cancer Therapy, vol. 3, pp. 406-411.
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Background: Lung cancer is the leading cause of cancer death in Australia, with only modest improvements in survival. This study aims to identify factors impacting on diagnosis and management of lung cancer with particular reference to Australian primary care. Methods: A sequential mixed method modified approach employing interview and a two- phased survey technique. Following telephonic interviews with 31 health professionals (individuals representing general practitioners, specialized physicians, nurses and allied health practitioners), interview data was analysed using qualita-tive thematic analysis, and surveys using descriptive statistics. Emergent themes were organised under patient, provider and system factors. Interviews ceased upon saturation of data. Results: Multiple patient, provider and systems issues were seen to contribute to adverse health outcomes. There is a strong relationship between smoking and outcomes, and factors related to higher smoking rates such as a lower socioeconomic status. For smokers, guilt and/or denial was con-sidered a reason for delay in the decision to seek medical care for cough or shortness of breath. Aboriginal people un-der-report morbidity related to smoking and chronic obstructive pulmonary disease; other patients fail to recognise the significance of their symptoms. Discussion: Despite the poor prognosis of lung cancer diagnosis, increased awareness of presentation and treatment options can address disparities in health outcomes.
Newton, P.J., Davidson, P.M., Krum, H., Ollerton, R. & Macdonald, P. 2012, 'The acute haemodynamic effect of nebulised frusemide in stable, advanced heart failure', Heart Lung and Circulation, vol. 21, no. 5, pp. 260-266.
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Purpose: To assess the acute haemodynamic effects of nebulised frusemide in a stable advanced heart failure population. In this randomised, double blind, placebo controlled trial, people with stable, advanced heart failure under-going right heart catheterisation were randomised to receive either 40 mg (4 ml) of nebulised frusemide or 4 ml of normal saline. Following inhalation of the study medication, subjects pulmonary pressures were recorded every 15 min for 1 h. There were no significant changes in the weighted average time course data of the subjects (n = 32) in either group over the study period, in particular no differences were observed in haemodynamic parameters between the two groups. Weighted average pulmonary capillary wedge pressure after 60 min in the frusemide group was 22.5 (SD 6.5) mmHg (n = 14) compared to the placebo group's 24.0 (SD 7.3) mmHg (n = 18), p = 0.55. The frusemide group had a significantly greater change in the median volume of urine in the bladder over the study period (186 ml IQR 137.8-260.8) compared to the placebo group (76 ml IQR 39.0-148.0) p = 0.02. This study showed that nebulised frusemide had no significant clinical effect on the haemodynamic characteristics of the subjects.
Disler, R.T., Green, A.R., Luckett, T., Newton, P.J., Inglis, S., Currow, D. & Davidson, P.M. 2012, 'Unmet needs in chronic obstructive pulmonary disease: a metasynthesis protocol', International Journal of Research in Nursing, vol. 3, no. 1, pp. 15-20.
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Abstract: Problem statement: Chronic obstructive pulmonary disease is a chronic progressive illness. Despite the high burden experienced by individuals in the advanced stages of illness, individuals with advanced COPD continue to have unmet needs and limited access to palliative care. This Metasynthesis seeks to describe: the barriers and facilitators care access and provision; the unmet needs of individuals with advanced COPD, their families and carers; and the experiences of health professionals. Data sources: Medline, PsychINFO, AMED, CINAHL and Sociological Abstracts were searched for articles published between 1990 and December 31st 2011. Medical Subject Headings (MeSH) and key words will be used to guide the search. The strategy will be reviewed by the CareSearch palliative knowledge network and a health informatics expert. Approach: Metasyntheses are increasingly used to gain new insights and understandings of complex research questions through the amalgamation of data from individual qualitative studies. The principles of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and thematic synthesis will be used to achieve consistent reporting and transparency of methods. Results: Inclusion of studies, quality assessment and allocation of free codes into EPPI-Reviewer 4 software will be carried out by two independent investigators. Auditing of random cases will be undertaken and disagreements resolved through group discussion of an expert panel. Descriptive and analytical themes will be developed through thematic synthesis and expert panel discussion. Conclusion: Qualitative data provide useful information in understanding the individual's unique experience. Combining discrete qualitative studies provides an important opportunity to provide a voice to patients, their families and professional careers in managing advanced COPD.
Betihavas, V., Newton, P.J. & Davidson, P.M. 2012, 'An overview of risk prediction models and the implications for nursing practice', British Journal of Cardiac Nursing, vol. 7, no. 6, pp. 259-265.
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Chronic heart failure is a common and costly condition and is one of the most common causes of hospitalisation and emergency department presentations in the elderly. This paper discusses risk prediction models in chronic heart failure, their utility in clinical practice and describes the implications for nursing practice. Based on a review of the literature, a description is presented of current risk models for chronic heart failure; the use of risk models in other conditions and the benefits of applying valid and reliable measurement tools in clinical practice. Consideration is given for clinical as well as non-clinical factors being incorporated into risk prediction models.
Davidson, P.M., Jiwa, M., DiGiacomo, M., McGrath, S., Newton, P.J., Durey, A., Bessarab, D. & Thompson, S.C. 2012, 'The experience of lung cancer in Aboriginal and Torres Strait Islander peoples and what it means for policy, service planning and delivery', Australian Health Review, vol. 37, no. 1, pp. 70-78.
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Background. Aboriginal and Torres Strait Islander peoples experience inferior outcomes following diagnosis of lung cancer. Aim. To examine the experience of lung cancer in this population and identify reasons for poorer outcomes and lower levels of treatment compared with non-Aboriginal and Torres Strait Islander peoples, and opportunities for early intervention.
Newton, P.J., Davidson, P.M. & Sanderson, C. 2012, 'An online survey of Australian physicians reported practice with the off-label use of nebulised frusemide.', BMC palliative care, vol. 11, no. 6.
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BACKGROUND: Off-label prescribing is common in palliative care. Despite inconsistent reports of the benefit of nebulised frusemide for breathlessness, its use continues to be reported. METHODS: An online survey was emailed to 249 members of the Australian and New Zealand Society of Palliative Medicine to estimate the use of nebulised frusemide for breathlessness by Australian physicians involved in palliative care in the previous 12 months. RESULTS: There were 52/249 (21%) respondents to the survey. The majority (44/52; 85%) had not prescribed nebulised frusemide in the previous 12 months. The most common (18/44; 43%) reason for not prescribing nebulised frusemide was a belief that there was not enough evidence to support its use. Whilst only a few respondents (8/52; 15%) reported having used nebulised frusemide, all that had used it thought there was at least some benefit in relieving breathlessness. CONCLUSION: This report adds to the series of case studies reporting some benefit from nebulised frusemide in relieving breathlessnes.
Betihavas, V., Davidson, P.M., Newton, P.J., Frost, S.A., Macdonald, P.S. & Stewart, S. 2012, 'What are the factors in risk prediction models for rehospitalisation for adults with chronic heart failure?', Australian Critical Care, vol. 25, no. 1, pp. 31-40.
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BACKGROUND: Risk prediction models can assist in identifying individuals at risk of adverse events and also the judicious allocation of scare resources. Our objective was to describe risk prediction models for the rehospitalisation of individuals with chronic heart failure (CHF) and identify the elements contributing to these models. METHODS: The electronic data bases MEDLINE, PsychINFO, Ovid Evidence-Based Medicine Reviews and Scopus (1950-2010), were searched for studies that describe models to predict all-cause hospital readmission for individuals with CHF. Search terms included: patient readmission; risk; chronic heart failure, congestive heart failure and heart failure. We excluded non-English studies, pediatric studies, and publications without original data. RESULTS: Only 1 additional model was identified since the review undertaken by Ross and colleagues in 2008. All models were derived from data sets collected in the United States and patients were followed from 60 days to 18 months. The only common predictors of re-hospitalisation in the models identified by Ross and colleagues were a history of diabetes mellitus and a history of prior hospitalisation. The additional model extends its scope to include the non clinical factors of social instability and socioeconomic status as predictors of rehospitalisation. CONCLUSIONS: In spite of the burden of hospitalisation in CHF, there are limited tools to assist clinicians in assessing risk. Developing risk prediction models, based on patient, provider and system characteristics may assist in identifying individuals in the community at greatest risk and in need of targeted interventions to improve outcomes.
Inglis, S., Du, H., Newton, P.J., DiGiacomo, M., Omari, A. & Davidson, P.M. 2012, 'Disease management interventions for improving self-management in lower-limb peripheral arterial disease (Protocol)', Cochrane Database of Systematic Reviews, no. 3.
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Evidence supports the use of chronic disease management interventions to improve self-management in chronic diseases other than PAD, however it is unclear what benefits these interventions offer for people with PAD. To our knowledge, there are no other systematic reviews of the evidence for chronic disease management interventions to improve self-management for lower-limb PAD. The objective of this review is to systematically review, synthesise and quantify the effects of non-pharmacological and non-surgical chronic disease management interventions targeting self-management for people with lower-limb PAD.
Du, H., Newton, P.J., Zecchin, R., Denniss, A.R., Salamonson, Y., Everett, B., Currow, D., Macdonald, P. & Davidson, P.M. 2011, 'An intervention to promote physical activity and self-management in people with stable chronic heart failure The Home-Heart-Walk study: study protocol for a randomized controlled trial', Trials, vol. 12, no. 63.
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Background: Chronic heart failure (CHF) is a chronic debilitating condition with economic consequences, mostly because of frequent hospitalisations. Physical activity and adequate self-management capacity are important risk reduction strategies in the management of CHF. The Home-Heart-Walk is a self-monitoring intervention. This model of intervention has adapted the 6-minute walk test as a home-based activity that is self-administered and can be used for monitoring physical functional capacity in people with CHF. The aim of the Home-Heart-Walk program is to promote adherence to physical activity recommendations and improving self-management in people with CHF. Methods/Design: A randomised controlled trial is being conducted in English speaking people with CHF in four hospitals in Sydney, Australia. Individuals diagnosed with CHF, in New York Heart Association Functional Class II or III, with a previous admission to hospital for CHF are eligible to participate. Based on a previous CHF study and a loss to follow-up of 10%, 166 participants are required to be able to detect a 12-point difference in the study primary endpoint (SF-36 physical function domain). All enrolled participant receive an information session with a cardiovascular nurse. This information session covers key self-management components of CHF: daily weight; diet (salt reduction); medication adherence; and physical activity. Participants are randomised to either intervention or control group through the study randomisation centre after baseline questionnaires and assessment are completed. For people in the intervention group, the research nurse also explains the weekly Home-Heart-Walk protocol. All participants receive monthly phone calls from a research coordinator for six months, and outcome measures are conducted at one, three and six months.
Davidson, P.M., Jiwa, M., Goldsmith, A.J., McGrath, S., DiGiacomo, M., Phillips, J.L., Agar, M., Newton, P.J. & Currow, D. 2011, 'Decisions for lung cancer chemotherapy: the influence of physician and patient factors', Supportive Care in Cancer, vol. 19, no. 8, pp. 1261-1266.
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Purpose The purpose of this study is to review the literature examining how the beliefs and behaviours of physicians and patients influence clinical communication, doctor-patient interaction and treatment decisions for lung cancer treatment. Methods Literature was obtained via electronic database searches and hand searching of journals from 1990 to 2011. Results Wide variability in perceptions of the value of chemotherapy in lung cancer is present among both physicians and patients. There is a mismatch in the degree patients and physicians weigh survival, such that patients value survival benefits highly whilst physicians strongly emphasize toxicity and associated symptoms. This lack of congruence between patients and clinicians is influenced by a range of factors and has implications for treatment decisions, long-term survival and quality of life in people affected by lung cancer. Conclusion The divergence of treatment priorities indicates a need for improved communication strategies addressing the needs and concerns of both patients and clinicians. Patients should understand the benefits and risks of treatment options, while clinicians can gain a greater awareness of factors influencing patients' decisions on treatments. Reflecting these perspectives and patient preferences for lung cancer treatment in clinical guidelines may improve clinician awareness.
Du, H., Davidson, P.M., Everett, B., Salamonson, Y., Zecchin, R., Rolley, J.X., Newton, P.J. & Macdonald, P. 2011, 'Correlation between a self-administered walk test and a standard six minute walk test in adults', Nursing and Health Sciences, vol. 13, no. 2, pp. 114-117.
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This study was undertaken to assess the correlation between a self-administered, adapted Six Minute Walk Test (the Home-Heart-Walk) and the standard Six MinuteWalk Test based on the American Thoracic Society guideline.A correlational study was conducted at a university campus in Sydney,Australia. Thirteen healthy volunteers underwent the Home-Heart-Walk and the standard Six MinuteWalk Test on a single occasion.The distance that participants walked during the two tests was assessed using Pearsons correlation.The correlation between the Home-Heart-Walk and the Six Minute Walk Test distance was 0.81. The Home-Heart-Walk distance was highly correlated to the standard Six Minute Walk Test distance in this study. This relationship provides confidence for further research in populations to facilitate monitoring and evaluation.
Davidson, P.M., Salamonson, Y., Rolley, J.X., Everett, B., Fernandez, R.S., Andrew, S., Newton, P.J., Frost, S. & Denniss, R. 2011, 'Perception of cardiovascular risk following a percutaneous coronary intervention: A cross sectional study', International Journal of Nursing Studies, vol. 48, no. 8, pp. 973-978.
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Background: An individuals' perception of the risk of, and their susceptibility to, futurecardiovascular events is crucial in engaging in effective secondary prevention. Aim: To investigate the perception of a cardiovascular event by examining the level of agreement between individuals with CHD views of their actual and perceived risk.
Stewart, S., Carrington, M.J., Marwick, T., Davidson, P.M., Macdonald, P., Horowitz, J.D., Krum, H., Newton, P.J., Reid, C. & Scuffham, P.A. 2011, 'The WHICH? trial: rationale and design of a pragmatic randomized, multicentre comparison of home- vs. clinic-based management of chronic heart failure patients', European Journal of Heart Failure, vol. 13, no. 8, pp. 909-916.
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To describe the rationale and design of the Which Heart failure intervention is most Cost-effective & consumer friendly in reducing Hospital care (WHICH?) trial.
Betihavas, V., Newton, P.J., Du, H., Macdonald, P., Frost, S., Stewart, S. & Davidson, P.M. 2011, 'Australia's health care reform agenda: implications for the nurses' role in chronic heart failure management', Australian Critical Care, vol. 24, no. 3, pp. 189-197.
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Introduction: The importance of the nursing role in chronic heart failure (CHF) management is increasingly recognised. With the recent release of the National Health and Hospitals Reform Commission (NHHRC) report in Australia, a review of nursing roles in CHF management is timely and appropriate. Aim: This paper aims to discuss the implications of the NHHRC report and nursing roles in the context of CHF management in Australia. Method: The electronic databases, Thomson Rheuters Web of Knowledge, Scopus and the Cumulative Index to Nursing and Allied Health Literature (CINAHL), were searched using keywords including; ``heart failure, ``management, ``Australia and ``nursing. In addition, policy documents were reviewed including statements and reports from key professional organisations and Government Departments to identify issues impacting on nursing roles in CHF management. Results: There is a growing need for the prevention and control of chronic conditions, such as CHF. This involves an increasing emphasis on specialist cardiovascular nurses in community based settings, both in outreach and inreach health service models. This review has highlighted the need to base nursing roles on evidence based principles and identify the importance of the nursing role in coordinating and managing CHF care in both independent and collaborative practice settings. Conclusion: The importance of the nursing role in early chronic disease symptom recognition and implementing strategies to prevent further deterioration of individuals is crucial to improving health outcomes. Consideration should be given to ensure that evidence based principles are adopted in models of nursing care.
Sheehan, M., Newton, P.J., Stobie, P. & Davidson, P.M. 2011, 'Implantable cardiac defibrillators and end-of-life care - Time for reflection, deliberation and debate?', Australian Critical Care, vol. 24, no. 4, pp. 279-284.
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Summary Heart failure (HF) is a common condition associated with high rates of morbidity and mortality. Implantable cardiac defibrillators (ICDs) are an important management strategy in HF management and decrease mortality for both primary and secondary prevention. An emerging body of literature identifies the challenges of managing ICDs at the end of life. This report discusses a critical incident experienced by a HF team in a referral centre and outlines the issues to be considered in advancing discussion and debate of managing ICDs at the end of life. Engaging in debate, discussion and consensus guidelines is likely to be crucial in minimising distress and burden for clinicians, patients and their families alike.
Currow, D., Smith, J., Davidson, P.M., Newton, P.J., Agar, M., Care, M.P. & Abernethy, A. 2010, 'Do the Trajectories of Dyspnea Differ in Prevalence and Intensity By Diagnosis at the End of Life? A Consecutive Cohort Study', Journal of Pain and Symptom Management, vol. 39, no. 4, pp. 680-690.
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Context. Breathlessness reportedly worsens as death approaches for many people, but the differences in intensity and time course between underlying causes are not well described. Objectives. To determine differences in the intensity of breathlessness by diagnosis over time as death approaches in a consecutive cohort seen by a specialist palliative care service. Methods. Patients referred to Silver Chain Hospice Care Service over a period of four years (January 2004 to December 2007) had dyspnea evaluated at every clinical encounter until death. A numeric rating scale (NRS) was used to measure the intensity. Patients were categorized into five clusters (lung cancer, secondary cancer to lung, heart failure, end-stage pulmonary disease, and no identifiable cardiorespiratory cause) at three time points (60e53 [T3], 30e23 [T2], and 7e0 [T1] days before death [T0]). Group differences were assessed using analysis of variance. Joinpoint regression models defined significant changes in mean breathlessness intensity.
Du, H., Davidson, P.M., Everett, B., Salamonson, Y., Zecchin, R., Rolley, J.X., Newton, P.J. & Macdonald, P. 2010, 'Assessment of a self-administered adapted 6-minute walk test', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 30, no. 2, pp. 116-120.
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PURPOSE: This study assessed the reliability and viability of the Home- Heart-Walk (HHW) test, adapting a standardized 6-minute walk test protocol for self-administration. &iexcl; METHODS: Twenty-nine volunteers with documented coronary heart disease (CHD) undertook a structured 7-day program using the HHW. &iexcl; RESULTS: The intervention was well received by participants. The intraclass correlation coefficient of the test distance over 7 days was 0.98, and the correlations between investigator and participant measures were high (r 0.99 for day 1 [first test], r 0.99 for day 1 [second test], and r 0.99 on day 7). &iexcl; CONCLUSION: These data demonstrate the potential of the HHW as a tool to promote and monitor physical activity in community-based settings. These observations require further investigation and testing in other populations.
Davidson, P.M., Cockburn, J., Newton, P.J., Webster, J.K., Betihavas, V., Howes, L. & Owensby, D.O. 2010, 'Can a heart failure-specific cardiac rehabilitation program decrease hospitalizations and improve outcomes in high-risk patients?', European Journal of Cardiovascular Prevention and Rehabilitation, vol. 17, no. 4, pp. 393-402.
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BACKGROUND: Heart failure is a common and costly condition, particularly in the elderly. A range of models of interventions have shown the capacity to decrease hospitalizations and improve health-related outcomes. Potentially, cardiac rehabilitation models can also improve outcomes. AIM: To assess the impact of a nurse-coordinated multidisciplinary, cardiac rehabilitation program to decrease hospitalizations, increase functional capacity, and meet the needs of patients with heart failure. METHOD: In a randomized control trial, a total of 105 patients were recruited to the study. Patients in the intervention group received an individualized, multidisciplinary 12-week cardiac rehabilitation program, including an individualized exercise component tailored to functional ability and social circumstances. The control group received an information session provided by the cardiac rehabilitation coordinator and then follow-up care by either their cardiologist or general practitioner. This trial was stopped prematurely after the release of state-based guidelines and funding for heart failure programs. RESULTS: During the study period, patients in the intervention group were less likely to have been admitted to hospital for any cause (44 vs. 69%, P = 0.01) or after a major acute coronary event (24 vs. 55%, P = 0.001). Participants in the intervention group were more likely to be alive at 12 months, (93 vs. 79%; P = 0.03) (odds ratio = 3.85; 95% confidence interval=1.03-14.42; P = 0.0042). Quality of life scores improved at 3 months compared with baseline (intervention t = o/-4.37, P<0.0001; control t = /-3.52, P<0.01). Improvement was also seen in 6-min walk times at 3 months compared with baseline in the intervention group (t = 3.40; P = 0.01). CONCLUSION: This study shows that a multidisciplinary heart failure cardiac rehabilitation program, including an individualized exercise component, coordinated by a specialist heart failure nurse can substantially reduce both all-ca...
Davidson, P.M., Macdonald, P.S., Newton, P.J. & Currow, D.C. 2010, 'End stage heart failure patients - palliative care in general practice.', Australian Family Physician, vol. 39, no. 12, pp. 916-920.
BACKGROUND: Chronic heart failure is common, particularly in older individuals, and comorbidities are frequent. Patients with end stage heart failure can be highly symptomatic and require careful monitoring and treatment adjustment to improve symptoms. OBJECTIVE: This article summarises the fundamentals of implementing palliative care in general practice and provides guidelines on caring for chronic heart failure patients at the end of life. DISCUSSION: The high mortality in chronic heart failure underscores the importance of effective communication, symptom management and advanced care planning. The unpredictability and uncertainty around the timing of death mean that individuals, and their families, may be less likely to have an understanding of their prognosis or have access to supportive and palliative care. Ideally, patients with symptomatic chronic heart failure should be managed in collaboration with a multidisciplinary heart failure program. Symptom management can be achieved by additive therapies and access to specialist palliative care services should be considered when the symptom burden is high.
Du, H., Newton, P.J., Salamonson, Y., Carrieri-Kohlman, V.L. & Davidson, P.M. 2009, 'A review of the six-minute walk test: Its implication as a self-administered assessment tool', European Journal of Cardiovascular Nursing, vol. 8, no. 1, pp. 2-8.
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Background: Promoting self-management and monitoring physical activity are important strategies in chronic heart disease (CHD)management. The six-minute walk test (6MWT) is a commonly used sub-maximal exercise test for measuring physical functional capacity. Aim: The aim of this paper is to review the current literature on 6MWT relating to methodological issues as well as exploring the potential of the protocol to be adopted as a self-administered exercise test. Method: The Medline, CINAHL, Science Direct and the World Wide Web using the search engine Google, were searched for articles describing the administration, reliability and validity of the 6MWT. Findings of the integrative literature review The 6MWT is a simple, safe and inexpensive sub-maximal exercise test. The 6MWT distance is strongly associated with functional capacity, and it is a useful prognostic tool. To date, the capacity for self-administration of the 6MWT has not been investigated. Conclusions: Adapting the 6MWT as a patient-reported outcome measure may enhance the capacity, not only for clinicians to monitor functional status, but also promote self-management by enabling individuals to monitor changes in their functional capacity.
Newton, P.J., Betihavas, V. & Macdonald, P. 2009, 'The role of b-type natriuretic peptide in heart failure management', Australian Critical Care, vol. 22, no. 3, pp. 117-123.
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Heart failure is a complex clinical syndrome that manifests itself with signs and symptoms which are neither sensitive nor specific for the diagnosis of heart failure. Natriuretic peptides and in particular b-type natriuretic peptide (and nt-proBNP) are widely used in clinical practice around the world as a maker of heart failure. BNP is primarily released from the left ventricle in response to pressure and volume overload. The strongest evidence for the use of BNP is to rule in or rule out heart failure as cause of breathlessness in people who present to the emergency room. There is enthusiasm for use of BNP as a marker of heart failure severity as well as a predictor of outcomes in people with heart failure and trials are ongoing. Nesiritide, a recombinant form of BNP is currently being tested as a possible treatment in people with acutely decompensated heart failure.
Phillips, J.L., Davidson, P.M., Newton, P.J. & DiGiacomo, M. 2008, 'Supporting patients and their caregivers after-hours at the end of life: the role of telephone support', Journal of Pain and Symptom Management, vol. 36, no. 1, pp. 11-21.
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Twenty-four hour access is accepted as a gold standard for palliative care service delivery, yet minimal data exist to justify the cost of this initiative to health care planners and policy makers. Further, there is scant information concerning optimal and efficient methods for delivering after-hours palliative care advice and support, particularly in regional and rural settings. This article reports on an evaluation of a local after-hours telephone support service in regional Australia. A centralized after-hours telephone support service was provided by generalist nurses at a Multipurpose Service in a rural community. A mixed-method evaluation, including semistructured interviews, was undertaken after 20 months of operation. During the period March 31, 2005 until November 15, 2006, 357 patients were registered as part of the Mid North Coast Rural Palliative Care Program. Ten percent of patients or their caregivers accessed the After-Hours Telephone Support Service, representing 55 occasions of service.
Davidson, P.M., Cockburn, J. & Newton, P.J. 2008, 'Unmet needs following hospitalization with heart failure: Implications for clinical assessment and program planning', Journal of Cardiovascular Nursing, vol. 23, no. 6, pp. 541-546.
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Background: Measuring health status is increasingly important in both clinical practice and research. The Heart Failure Needs Assessment Questionnaire (HFNAQ) is a self-administered, disease-specific, 30-item questionnaire that measures an individuals perception of his/her needs in the physical, psychological, social, and spiritual domains. Objectives: To assess the prevalence of needs in patients with heart failure (HF)recently discharged from hospital. Methods: The HFNAQ was administered to participants (n = 132; mean [SD] age, 72.3 [9.69]years; 63% male) consenting to attend an HF-specific cardiac rehabilitation program. Results: The total mean HFNAQ score was 67.3 (95% confidence interval, 65.03Y69.75), indicating an average level of need around the midrange of the scale. In this vulnerable postdischarge phase, there was evidence of predominance of psychological and social concerns over physical needs. None of the variables that were examined for associations with the measures of needs reached statistical significance, highlighting the strongly individualized perception of need.
Halcomb, E., Fernandez, R.S., Griffiths, R., Newton, P.J. & Hickman, L. 2008, 'The infection control management of MRSA within the acute care hospital', International Journal of Evidence-Based Healthcare, vol. 6, no. 4, pp. 440-467.
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Background Many acute care facilities report endemic methicillin-resistant Staphylococcus aureus (MRSA), while others describe the occurrence of sporadic disease outbreaks. The timely implementation of effective infection control measures is essential to minimise the incidence of MRSA cases and the magnitude of disease outbreaks. Management strategies for the containment and control of MRSA currently vary between facilities and demonstrate varying levels of effectiveness. Objectives This review sought to systematically review the best available research regarding the efficacy of infection control practices in controlling endemic MRSA or MRSA outbreaks in the acute hospital setting. It updates an original review published in 2002. Search strategy A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search of the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. Selection criteria All research reports published between 1990 and August 2005 in the English language that focused upon the infection control strategies that were implemented in response to either a nosocomial outbreak of MRSA or endemic MRSA within an acute clinical setting were included. Only studies that reported interventions which were implemented following the collection of baseline data were included. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a purposely designed tool. Given the heterogeneity of the interventions and outcomes measures, statistical comparisons of findings were not possible, therefore, the findings of this review are presented in a narrative format.
Davidson, P.M., Driscoll, A., Clark, R., Newton, P.J. & Stewart, S. 2008, 'Heart failure nursing in Australia: challenges, strengths and opportunities', Progress in Cardiovascular Nursing, vol. 23, no. 4, pp. 195-197.
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Australia has a land mass similar to the United States of America, supporting a population of just over 20 million, which is distributed predominantly across the coastal perimeter. The Australian society is rich in cultural diversity fostered by decades of migration. Both these factors present challenges for health care. First, because resources are scare in rural and remote regions, health outcomes are poorer in these regions, especially among indigenous populations. Second, the cultural diversity of Australians is a challenge to providing evidence-based treatment recommendations [1].
Davidson, P.M., Salamonson, Y., Webster, J., Andrew, S., DiGiacomo, M., Gholizadeh, L., Newton, P.J. & Moser, D. 2008, 'Changes in depression in the immediate post-discharge phase in a cardiac rehabilitation population assessed by the Cardiac Depression Scale.', Journal of Cardiopulmonary Rehabilitation and Prevention, vol. 28, no. 5, pp. 312-315.
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Introduction: Depression is increasingly a focus of attention in the management of heart disease. Clinicians in cardiac rehabilitation (CR) are well placed to assess and facilitate management of symptoms of depression, yet the timing and interpretation of measurements remain unclear. Metods: We administered the Hare-Davis Cardiac Depression Scale (CDS) in a usual care, outpatient CR program in a metropolitan setting. As part of routine assessment and monitoring of outcomes in a 6-week outpatient CR program, we administered the CDS at entry, at completion of the 6-week program, and at 12 months. Results: Data were available on 151 patients for the 3 measurement points. At baseline, the mean CDS score was 76.07 (22.38), which dropped at 6 weeks to 64.85 (21.69) but increased slightly at 12 months to 69.79 (24.36). The changes in these scores were statistically significant for all measurement points (P <.03). The trend of change for the CDS was reflected in the subscale scores, which dropped at 6 weeks but increased slightly at 12 months. Discussion: Findings demonstrate a positive impact of CR on CDS scores at 6 weeks and 12 months, although there was a trend for increased scores at 1 year. This observation requires further investigation and underscores the importance of longitudinal studies.
Newton, P.J., Davidson, P.M., Macdonald, P., Ollerton, R. & Krum, H. 2008, 'Nebulized furosemide for the management of dyspnea: Does the evidence support its use?', Journal of Pain and Symptom Management, vol. 36, no. 4, pp. 424-441.
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Dyspnea is a common and distressing symptom associated with multiple chronic illnesses and high levels of burden for individuals, their families and health care systems. The subjective nature dyspnea and a poor understanding of pathophysiological mechanisms challenge the clinician in developing management plans. Nebulized furosemide has been dentified as a novel approach to dyspnea management. This review summarizes published studies, both clinical and experimental, reporting the use of nebulized furosemide. The search criteria yielded 42 articles published in the period 1988 to 2004. Although nebulized furosemide appeared to have a positive influence on dyspnea and physiological measurements, caution must be taken with the results primarily coming from small-scale clinical trials or observation trials. Despite the limitations of the studies reported, given the range of conditions reporting effectiveness of nebulized furosemide, further investigation of this potential novel treatment of dyspnea is warranted.
Halcomb, E.J., Fernandez, R., Griffiths, R., Newton, P. & Hickman, L. 2008, 'The infection control management of MRSA in acute care.', International journal of evidence-based healthcare, vol. 6, no. 4, pp. 440-467.
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Background Many acute care facilities report endemic methicillin-resistant Staphylococcus aureus (MRSA), while others describe the occurrence of sporadic disease outbreaks. The timely implementation of effective infection control measures is essential to minimise the incidence of MRSA cases and the magnitude of disease outbreaks. Management strategies for the containment and control of MRSA currently vary between facilities and demonstrate varying levels of effectiveness. Objectives This review sought to systematically review the best available research regarding the efficacy of infection control practices in controlling endemic MRSA or MRSA outbreaks in the acute hospital setting. It updates an original review published in 2002. Search strategy A systematic search for relevant published or unpublished English language literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search of the original review. Databases searched included: Medline, CINAHL, EMBASE, Cochrane Library and Joanna Briggs Institute Evidence Library. Selection criteria All research reports published between 1990 and August 2005 in the English language that focused upon the infection control strategies that were implemented in response to either a nosocomial outbreak of MRSA or endemic MRSA within an acute clinical setting were included. Only studies that reported interventions which were implemented following the collection of baseline data were included. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Data extraction was undertaken using a purposely designed tool. Given the heterogeneity of the interventions and outcomes measures, statistical comparisons of findings were not possible, therefore, the findings of this review are presented in a narrative format. Results Fourteen papers met the inclusion criteria for this review. Of these, 11 ...
Newton, P.J., Halcomb, E., Davidson, P.M. & Denniss, A. 2007, 'Barriers and facilitators to the implementation of the collaborative method: reflections from a single site', Quality and Safety in Health Care, vol. 16, no. 6, pp. 409-414.
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Background: A collaborative is an effective method of implementing evidence-based practice across multiple sites through the sharing of experience and knowledge of others in a similar setting, over a short period of time. Collaborative methods were first used in the USA but have been adopted internationally. Aim: This paper sought to document the facilitators and barriers to the implementation of the collaborative method, based on a single sites experience of participating in a multisite, state-wide heart failure collaborative. Method: Qualitative data was collected using three complementary methods: participant observation, reflective journalling and key informant interviews. Quantitative monitoring of team performance occurred monthly according to prespecified performance indicators. Findings: Barriers and facilitators that were identified by this study included: organisational factors, team composition, dynamics and networking, changing doctor behaviour, clinical leadership and communication. Conclusion: The findings from this study underscore the importance of leadership, communication and team cohesion for the successful implementation of the collaborative method at individual sites. In addition, the importance of a preparatory stage that deals with known barriers and facilitators to the collaborative method before the commencement of the official study period was highlighted. The potential for the collaborative approach to improve clinical outcomes warrants further systematic evaluation of process issues and consideration of the barriers and facilitators to implementation in various settings.
Hickman, L., Newton, P.J., Halcomb, E., Chang, E. & Davidson, P.M. 2007, 'Best practice interventions to improve the management of older people in acute care settings: a literature review', Journal of Advanced Nursing, vol. 60, no. 2, pp. 113-126.
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Aim. This paper is a report of a literature review of experimental evidence describing interventions to manage the older adult in the acute care hospital setting. Background. Older people are increasingly being cared for in a system largely geared toward
Newton, P.J., Davidson, P.M., Halcomb, E., Denniss, A.R. & Westgarth, F. 2006, 'An introduction to the collaborative methodology and its potential use for the management of heart failure', Journal of Cardiovascular Nursing, vol. 21, no. 3, pp. 161-168.
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Background: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. Aim: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. Methods: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including collaborative methodology, breakthrough series,quality improvement,total quality improvement, and heart failure. Because of the paucity of high-level evidence, all English-language articles were included in the review. Results: On the basis of the identified search strategy, 43 articles were retrieved. Key themes that emerged from the literature included the following: (1) The collaborative methodology has a significant potential to reduce the treatment gap. (2) Leadership is an important characteristic of the collaborative method. (3) The collaborative methodology facilitates sustainability of the quality improvement process. Conclusion: The collaborative methodology, when implemented and conducted according to key conceptual principles, has significant potential to improve the outcomes of patients, particularly those with HF and chronic cardiovascular disease.
Newton, P.J., Davidson, P.M., Halcomb, E., Denniss, R. & Westgarth, F. 2006, 'An introduction to the collaborative methodology and its potential use for the management of heart failure', Journal of Cardiovascular Nursing, vol. 21, no. 3, pp. 161-168.
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Background: Heart failure (HF) is responsible for significant disease burden in developed countries internationally. Despite significant advances and a strong evidence base in therapies and treatment strategies for HF, access to these therapies continues to remain elusive to a significant proportion of the HF population. The reasons for this are multifactorial and range from the financial cost of treatments to the individual attitudes and beliefs of clinicians. The collaborative methodology, based upon a quality improvement philosophy, has been identified as a potentially useful tool to address this treatment gap. Aim: In this manuscript, we review the published literature on the collaborative methodology and assess the evidence for achieving improvement in the management of HF. Methods: Searches of electronic databases, the reference lists of published materials, policy documents, and the Internet were conducted using key words including "collaborative methodology," "breakthrough series," "quality improvement," "total quality improvement," and "heart failure." Because of the paucity of high-level evidence, all English-language articles were included in the review.

Other

Ivynian, S., Newton, P. & DiGiacomo, M. 2016, 'Factors influencing care-seeking in heart failure'.
Ivynian, S., Newton, P. & DiGiacomo, M. 2016, 'Care-seeking decisions in heart failure: a mixed-methods study'.