Western Nurse Magazine November 2024

Incorporating Western Midwife

Hear from the new ANF State Secretary, Romina Raschilla.

Secretary's Report

ANF State Secretary Romina Raschilla

I’m sure many of you are interested as to what’s been happening here at the ANF over the past few months, and in these uncertain times, you deserve answers. My name is Romina Raschilla, your new State Secretary. I am a Registered Nurse, Manager, and former Vice President of the ANF, now appointed by the Council to serve as your State Secretary. I have also since been appointed to State Secretary of the ANMF WA Branch in the interim until an election can be held in the coming months.

I understand that with the recent changes in leadership, many of you may feel uncertain about the state of your Enterprise Agreements (EBAs), the future of member services, and the direction of the ANF itself. These are valid concerns, and I want to reassure you of both my commitment and that of the ANF to addressing these issues head-on.

We are navigating multiple ongoing EBA negotiations, from the public sector to Ramsay, St John of God, and Silverchain. Rest assured, securing the best possible wage and working conditions for our members remains the ANF’s top priority. I look forward to advocating for you throughout these negotiations, ensuring we achieve the outcomes you deserve.

As your Secretary, I am committed to rebuilding the trust between the ANF and our members. I understand that recent events may have caused frustration, but my goal is to bring stability and refocus our efforts on what truly matters— delivering for you. During my time on the ANF Council, I have always been a strong advocate for nurses and midwives, and that will continue as I take on this new role.

The fact is, we are one of Western Australia’s largest unions, and to effectively face the challenges ahead, we must stand united. The strength of our union comes from the collective power of its members. By standing together, we can ensure that we are in the strongest possible position to secure the wages, conditions, and respect that nurses and midwives have long deserved.

The instability that has plagued us will not continue. My sole focus is now on wage and conditional outcomes for all ANF members. You have waited long enough for action, and I am here to ensure that the ANF moves forward, united and determined to deliver results.

Thank you for your ongoing dedication, and I look forward to working with you all as we strive for the fair and equitable outcomes you deserve.

Romina Raschilla

ANF: The Path Forward

Unity in the Face of Challenges: A New Era with Romina Raschilla as ANF Secretary

The Australian Nursing Federation (ANF) has recently undergone significant changes, with Romina Raschilla stepping into the role of State Secretary. As a Registered Nurse and manager with extensive experience and a longstanding commitment to the ANF, Romina is no stranger to the challenges that lie ahead. As we face critical negotiations for the Public Sector, Ramsay, and St John of God Enterprise Bargaining Agreements (EBAs), one thing is clear: we must stand united to achieve the outcomes that nurses and midwives across Western Australia deserve.

Romina’s appointment comes at a pivotal time for the ANF. After months of uncertainty, her leadership represents a fresh start—a chance to refocus on what truly matters: our members. With decades of advocacy experience and a deep understanding of the healthcare landscape, Romina is dedicated to ensuring that the ANF not only continues to fight for its members but does so with renewed vigor.

A Call for Unity

Unity is not just a word; it’s the foundation of our strength as a union. In recent times, we’ve faced internal challenges, changes in leadership, and shifting political landscapes. But now is the time to come together as one. As Romina has expressed, the only way to successfully navigate the hurdles ahead is by working collectively.

The upcoming negotiations for the Public Sector, Ramsay, and St John of God EBAs are crucial. These agreements will set the standard for wages, conditions, and the well-being of nurses and midwives across the state. While each EBA presents unique challenges, our ability to face these head-on as a united workforce will determine the success of these negotiations.

Public Sector EBA: A Historic Opportunity

The Public Sector EBA negotiations will be one of the most significant in years. After a long period of wage stagnation and worsening working conditions, now is the time to make meaningful progress. With a 20% wage increase as a key demand, alongside critical improvements to staffing levels and working conditions, we have a chance to reverse the damage that’s been done over the past decade.

The ANF understands the urgency of these negotiations. The health of our workforce and the quality of care in WA’s hospitals depend on the success of this EBA. But success won’t come easily. The government will undoubtedly resist many of our demands, which is why we need every member to be engaged, ready to stand firm, and show solidarity throughout this process.

Ramsay and St John of God EBA: Strength in the Private Sector

Private sector nurses and midwives at Ramsay and St John of God are also facing critical EBA negotiations. The challenges are not dissimilar—understaffing, long hours, and stagnant wages continue

to impact the quality of care and the well-being of staff. These agreements must address those issues head-on.

With Ramsay we have seen long-overdue negotiations stagger on with little movement and one rejected ballot already in August. With the St John of God negotiations set to begin at the end of this year, the ANF has work to do to ensure both EBAs are settled with collective member approval.

What’s clear is that regardless of whether you work in the public or private sector, we are all in this together. The conditions we fight for in one EBA have ripple effects on the others. The stronger we are in our collective advocacy, the better the outcomes will be for all members across the board.

Facing the Challenges Ahead—Together

The ANF has an opportunity to start fresh and refocus on what truly matters—fighting for the wages, conditions, and respect that nurses and midwives have earned. The challenges are significant, but with untied leadership and the collective strength of our members, there is no doubt we can overcome them.

It’s essential that every ANF member stays informed, engaged, and ready to take action when called upon. Whether through industrial action, attending meetings, or simply lending your voice in solidarity, every contribution matters. Together, we can achieve the fair and just outcomes that every nurse and midwife in WA deserves.

The coming months will be crucial. With the Public Sector, Ramsay, and St John of God EBAs on the line, we need unity more than ever. Let’s move forward together, stronger and more determined than ever before. This is our time to stand up for our profession and the future of nursing and midwifery in Western Australia.

The ANF is committed to deepening our connection to country and honouring the rich heritage of our traditional owners. We invite our talented Indigenous members and artists to express their interest in contributing First Nation and Torres Strait Islander art to enhance the ANF’s visual identity. If you are passionate about sharing your culture and creativity, we would love to hear from you. Please email Western.Nurse@anfiuwp.org.au for more information.

Your workers compensation Questions Answered

Updates to the WA Workers Compensation Act

The Insurance Commission of Western Australia is a statutory corporation and Government Trading Enterprise owned by the Western Australian Government. They provide selfinsurance arrangements for the Government, covering over 109 WA public authorities for workers compensation, property and liability. This includes WA Health.

of income compensation and medical and health expenses will be paid. If your claim is not accepted, you will not have to pay back any provisional payments made.

From 1 July 2024, new legislation governing workers compensation in Western Australia became effective. This is the first major update since 1981. It will affect government workers claiming workers compensation in Western Australia, including nurses and midwives.

The new Workers Compensation and Injury Management Act 2023 aims to modernise existing legislation to better meet the standards and expectations of the modern workplace. To learn more about the new act and how it will affect your workplace, the Western Nurse reached out to the Insurance Commission of Western Australia. Here is what they said.

What do nurses and midwives need to know?

The key message is that workers compensation remains in place for nurses and midwives to support you when it’s most needed. Of course, we hope you will never experience an injury at work, but if it happens it’s always good to be informed.

What are the main changes?

Changes

to provisional income

compensation and medical expenses

A beneficial change to you when claiming workers compensation is the introduction of provisional payments, when liability is deferred. A claim may be deferred when more time is needed to collect relevant medical or factual information on the incident causing your injury.

In practical terms, this means if the Insurance Commission cannot make a decision on your claim within 28 days, provisional payments

Changes to deemed acceptance

On claims where a liability decision is deferred, the Insurer will have a maximum of 120 days from receiving the claim to make a liability decision. If this has not taken place the claim will automatically be deemed as accepted.

Under the 1981 Act, whilst not the norm, some claims remained without a decision for years. This will no longer be the case.

Higher medical benefits limit

The new Act has doubled the limit on medical and health expense entitlements from 30 percent to 60 percent of the general maximum amount. The general maximum amount is a dollar-limit prescribed by the Government and indexed each year.

Under the new Act, from 1 July the limit will be $158,692. If the legislation had not changed, this limit would have been $79,346. Services such as general practitioner, physiotherapy, pharmaceuticals, specialist, hospital and more are covered under the medical and health expenses.

Extension to cover for catastrophic injury sustained at work

One of the major changes in the new Act is to extend the Catastrophic Injury Support Scheme (CISS) to include workers catastrophically injured in the workplace. The scheme has been in place since 2016 for people catastrophically injured in motor vehicle crashes, to cover their lifetime care and support.

Under the new Act, the Insurance Commission is now able to coordinate and fund the treatment, care and support of people catastrophically injured in their workplace. Nurses and midwives found eligible to participate in the CISS will be covered to receive personalised coordination of treatment and ongoing care such as home modification, prosthesis or home carers among others.

How has the Insurance Commission of Western Australia prepared for these changes

Over the last year, all of us at the Government Insurance Division within the Insurance Commission have invested significant effort to ensure our systems and staff knowledge are up to date, ready for 1 July.

Representatives from the Health Service Providers across WA have attended our meetings and seminars and received our written updates, aimed at informing and supporting the people in your workplaces who provide injury management on workers compensation claims.

Given this is a change after 43 years the new Act represents a significant change for all stakeholders including your workplace and all its staff.

What should I do if I’m injured at work?

While we hope you will never need us, we continue to work closely with you and your employer if you do, making sure your experience with workers compensation is as smooth as possible.

If you do suffer a workplace injury:

• Seek first aid immediately and report your accident or injury to your employer

• Make an appointment to see a doctor of your choice as soon as possible

• Ask the doctor for a First Certificate of Capacity

• Ask your employer for a Workers Compensation Claim Form or download from the WorkCover WA website

• Complete the worker section of the form and return it to your employer along with the Certificate of Capacity and keep a copy for your records

• Employer to submit to their Insurer within 5 working days

• The Insurer must provide you with a liability notice within 14 days from when they receive your claim

For more information about workers compensation, visit the Insurance Commission of Western Australia website at icwa. wa.gov.au or workcover.wa.gov.au

Members can also contact the ANF directly for support with workers compensation matters.

The Western Nurse will publish more answers to any questions you might have. Write to us at Western.Nurse@anfiuwp.org.au if you have another question about workers compensation.

Representatives from state government agencies, including all Department of Health Service Providers, attend a seminar to learn about the new Act.

Presenters from WorkCover WA and Insurance Commission of Western Australia providing employers with knowledge and support, in the transition to the new Act.

Saving lives in Tonga

In September 2023 ICU nurse and ANF member Sandra Guzzi travelled to Tonga as part of a volunteer program to assist a team performing open heart surgeries for those in need. She volunteered with the Open Heart International [OHI] Adult Cardiac Surgery team, to make sure locals could get access to the cardiac care they needed.

This isn’t the first time Sandra has volunteered with OHI, and she says it won’t be her last. Sandra said services provided by OHI play a crucial role in Tonga.

“Tonga does not have a cardiac service and OHI is the only charity that provides free heart surgery in Tonga,” Sandra said.

“Patients are otherwise transferred to India for heart surgery, without family or support.

“Unfortunately, rheumatic heart disease is rife in Tonga, destroying heart valves. This results in a much younger population requiring heart surgery than in Australia.

During this trip Sandra and the team performed surgeries on 13 adults, addressing complex valve issues including mitral, aortic and tricuspid valve replacements. The paediatric team who also travelled to Tonga successfully operated on 10 children with congenital heart defects. These 23 people will have had their lives improved immeasurably.

Sandra is no stranger to this type of work. She is an experienced cardiac ICU nurse, having worked at the Mount Hospital ins Perth and in Sydney in specialised cardiac ICUs. She has travelled overseas with OHI five times before, once before to Tonga.

Once her team had had a chance to settle into Tonga, they went to work at Vaiola Hospital on the mainland, south-west of the capital Nukuʻalofa, where they set up an ICU to start treating patients.

Sandra was assigned as ICU Team Leader and worked alongside two other ICU nurses from Sydney and two doctors from Geelong Hospital.

“I was the only OHI volunteer from WA amongst the team of 24. Vaiola Hospital does not have an ICU. We set up the recovery ward as an ICU the day before surgery started,” Sandra said.

“It was a tight schedule, but we got it done with the fantastic work from the local Tongan nurses, many of whom I worked alongside with during OHI's last trip in 2019, which was pre-COVID.

“Due to staffing constraints, our week in ICU was exceptionally busy. The local nurses were not familiar with the care required for heart surgery patients.

“We provided bedside education on chest drain management, inotropic support, mechanical ventilation, cardiac arrythmias, pacing and other nursing care tasks required for the patients.

Sandra and the team worked every day for the eight days they were there, while still ensuring patient and staff safety was maintained.

“The nurses received education from all the ICU team, and we facilitated their learning with OHI nursing care pathways and education packages.

For Sandra, the highlight of this tremendous experience was not just seeing her patients thrive, but the camaraderie that grew between both the local and OHI teams.

“Every morning before handover, the Tongan ICU and theatre teams would sing Christian hymns to the patients and pray for them and thank the OHI team for their presence.

“It was a beautiful melody that we experienced every shift.”

Sandra has no regrets about her decision to volunteer overseas and there is no doubt her drive to do so has changed the lives of many for the better. She reflects that overseas work like this can also make people realise how lucky they are in their own lives.

“These trips are life changing, for both participants and the patients.

“Every OHI trip makes you more humble and grateful for our excellent health service in Australia.

“Tonga has certainly experienced setbacks since last year's earthquake and tsunami and even though they have little, they give so much to the OHI team, spoiling us with delicious food and beautiful gifts.”

Not being satisfied with what she has already given in terms of time and expense, Sandra has already made plans for her next round of overseas volunteering.

“I cherished my time in Tonga and look forward to the next trip in 2025. To attend OHI trips you must be invited back every trip by the OHI coordinator, it is not an automatic right, and I will continue to go until I retire from nursing.”

The Western Nurse wishes Sandra all the best luck with that commendable aspiration.

Fighting syphilis in WA

Nurses and midwives working across Western Australia, especially in more remote areas, will no doubt be aware of the ongoing syphilis epidemic affecting hundreds of people a year.

Despite being treatable and preventable, the syphilis epidemic is now in its tenth year in Western Australia.

Health teams across the country have been working to curb the rate of infection, with the WA Syphilis Outbreak Response Group (WA SORG) established in WA by the Department of Health in response to the outbreak.

The Western Nurse spoke with Kelley Trawinski a Clinical Nurse Specialist for the WA Country Health Service team to learn more about how nurses and midwives can help limit the spread of this treatable yet potentially deadly disease. Kelley has worked on a number of public health campaigns relating sexual health across the state. Most recently she has been focusing on developing strategies to combat the spread of syphilis, with a particular emphasis on congenital syphilis, in regional areas.

Rasing awareness

Kelley said education and awareness around the disease is key to stopping the spread of both infectious and congenital syphilis.

“It is paramount that ongoing support and education be offered to all WA healthcare workers so the importance of timely and opportunistic testing and treatment can be understood,” Kelley said.

“For sexually active people it is really important to get tested regularly for all STIs, particularly for syphilis. A great majority of those who have it do not have any symptoms and can therefore go on to infect others unknowingly.

“You can be infectious to sexual partners for up to two years, and studies show that vertical transmission (passing the infection from mothers to babies) can occur up to nine years after infection if left untreated. If syphilis is untreated, tertiary syphilis can occur. Approximately 1 in 3 people with untreated syphilis develop tertiary syphilis years later. It can affect the brain, eyes, ears and heart.

“Untreated syphilis in pregnancy can lead to congenital syphilis. Up to 40 percent of pregnancies affected by syphilis will result in stillbirth or neonatal death shortly after delivery. For babies who survive, congenital syphilis can lead to devastating physical abnormalities including deafness, blindness and skeletal abnormalities, low birth weight, poor feeding, developmental delays and seizures. According to the World Health Organisation, syphilis is the second leading cause of preventable stillbirth globally.”

Background for the current outbreak

The current syphilis outbreak in Australia is tracked back to early 2011, with an increase of cases reported in northwest Queensland. Following this, further outbreaks were declared in the Northern Territory in 2013, regional Western Australia in 2014 and South Australia in 2016.

In Western Australia, the syphilis outbreak was first identified in the Kimberley region in mid-2014. A related cluster of cases was identified in the Pilbara area in 2018. According to the WA Government, cross-border and cross-region population movement contributed to the spread of syphilis to the Midwest and Goldfields regions. WA SORG formed in August 2018 to coordinate the response to the outbreak in the Kimberley and Pilbara regions.

By 2020 other syphilis outbreaks were identified in metropolitan Perth and the South West regions of WA, making the outbreak a state-wide issue. With syphilis outbreaks declared across all regions of WA in 2020, the Chief Health Officer in WA authorised a statewide public health response to infectious syphilis. Four years on, while the figures are trending down, syphilis is still a major issue.

Who is at risk?

Information published online by WA Health reported that Aboriginal people in the Kimberley, Pilbara, Goldfields and Midwest regions were considered at risk for infectious syphilis. Other groups considered at risk include young sexually active heterosexual people, people who use methamphetamine or inject drugs, culturally and linguistically diverse people, those experiencing homelessness and men who have sex with men. There was also a reported increase in the general population, especially in women of reproductive age, in metropolitan areas and southern regions of WA.

With a reported increase of congenital syphilis cases, pregnant people are at an increasing risk.

until July 2024

Syphilis - Infectious notifications rate (per 100,000 population) by region 2023

Region Rate

Metro Perth 15.6

Pilbara 3.9

Kimberley 2.6

Goldfields 1.5

Midwest 0.6

Southwest 0.6

Wheatbelt 0.3

Great Southern 0.3

Figures taken from the WA Department of Health Notifiable Infectious Disease Dashboard (www.health.wa.gov.au/articles/n_r/ notifiable-infectious-diseasedashboard) accessed 1 July 2024.

Kelley is encouraging those working in emergency departments to consider testing for young women of reproductive age who fall into the high risk populations.

“You may be the only point of contact for this person to get tested, and therefore prevent a potential congenital syphilis case. A full STI screen including syphilis requires a serology test. If you are working in a GP practice or Aboriginal Community Clinic and notice syphilis serology hasn’t been included on the antenatal testing pathology form, ask the doctor to add it.”

Testing is key to treatment

Testing for syphilis plays a major role in tracking and reducing the number of cases. Making syphilis a standard part of STI screening is imperative to achieve frequent testing and reduce stigma. testing is particularly important, as in the majority of cases patients won’t know they are infected and either have no symptoms, or very varied or ambiguous clinical presentations.

“Some people get a sore, called a chancre, but most people are asymptomatic. If there is a chancre or sore it is crucial to have a PCR swab taken and sent for syphilis testing.”

Testing involves a simple blood test, but this doesn’t mean testing is always easy.

“For many people, having a blood test can be a traumatic experience. For others, the number of days from having the blood test to receiving the results, especially in remote areas, may be a barrier.

“In some cases patients can have a ‘point of care test’. This depends on your individual situation and availability of the test. This test takes 15 minutes and is a bit like getting a blood sugar test, just a little prick to the end of your finger.”

The current advice for testing for syphilis is that all pregnant women should be tested for syphilis at their first antenatal visit, and again at both 28 weeks and 36 weeks, with additional tests advised for those living in the Kimberley, Pilbara or Goldfields at birth and 6 weeks post-partum. Pregnant women who had little or no antenatal care should be tested for syphilis whenever they present for health care.

Syphilis testing should be offered opportunistically to all sexually active persons and as a part of the work-up for patients experiencing any STI symptoms. This is particularly important for patients who present with ulcers, rash, or unexplained neurological changes.

The rise of congenital syphilis

Congenital syphilis is acquired by an infant from the mother during pregnancy. Recent reports show the rates of congenital syphilis are increasing across the country. This is of great concern to healthcare professionals as the disease can have a hugely detrimental effect on a child, while also being difficult to diagnose.

“Risk assessment and management of neonates born to mothers with positive syphilis serology is determined on the basis of the maternal treatment history, infant serology and other investigations and a physical examination of the baby,” Kelley said.

“Clinical evidence of congenital syphilis can include rash, mucosa lesions, nasal discharge, inflammation of the liver, bony tenderness, eye lesions, sepsis and jaundice. But often the baby will have no immediate physical symptoms. Depending on a few specific criteria, the infant may be under surveillance for up to two years to determine if they have congenital syphilis.”

Kelley’s advice for any nurses or midwives treating patients who are at risk of congenital syphilis is simple.

“Test, test, test. It’s a simple blood test and often people present asymptomatic so there is no way of knowing unless patients get tested. It is also good a idea to contact the Public Health Nurses or Physicians in their region in conjunction with the treating doctor or paediatrician. Diagnosing congenital syphilis in newborns can be difficult as symptoms are often not present at birth. In most cases, they appear within three months. Overall, congenital syphilis falls into two categories, early and late.

Children under two who were infected in utero fall into the early congenital syphilis category. Clinical signs may include:

• hepatosplenomegaly

• skin rash

• condylomata lata

• rhinitis

• bone involvement, or osteochondritis

• pseudoparalysis due to epiphysitis

• meningitis

• anaemia

• failure to thrive.

Children over two, who were infected in utero fall into the late congenital syphilis category. Clinical signs may include:

• one or more of Hutchinson’s triad (interstitial keratitis, defective incisors and nerve deafness)

• gummata

• neurosyphilis

• frontal bossing and anterior bowing of the shins.

Treating congenital and infectious syphilis

Penicillin remains the drug of choice in treating syphilis and is the only effective treatment for syphilis in pregnancy. Ongoing syphilis serology is required during and after treatment to ensure the patient’s serological response to treatment can be accurately assessed.

WA Health stresses that treatment for, and follow-up of, congenital syphilis should be done in consultation with an experienced paediatrician who has knowledge in treatment for congenital syphilis.

Getting support and resources

Public Health Units have all the up-to-date information. Their contact details can be found here: www.health.wa.gov.au/ articles/a_e/contact-details-for-public-health-units

More information can also be found on the WA Health silver book: www.health.wa.gov.au/Silver-book/

Fiona Watson: working with loss

Award winning midwife, veteran nurse and long-time ANF member Fiona Watson knows exactly how important her job is, especially in times of loss.

She was recently presented with the Excellence in Midwifery awards at this year’s WA Nursing and Midwifery Excellence Awards, something she feels deeply honoured to have received, but she feels an even greater privilege in caring for her patients and supporting them through both good days and bad.

Her greatest passion in midwifery is working with the Perinatal Loss Service (PLS), providing ongoing support for women and their families following the loss of a child.

“Watching someone take their first or last breath is a privilege, watching families hold their breath as they birth a baby is the greatest honour for me,” Fiona said.

“The gift I can give is time. PLS really is a specialty that few hold so close to their hearts. I am thankful to be supported by an amazing group of midwives at Rockingham who also have a deep passion for PLS.”

When she tells others she is a midwife Fiona notes that a common response is that her job must be “so rewarding”. This may seem at odds with her work in PLS which, by its very nature, deals with loss and grief.

“It really is more rewarding than people understand. I always talk about the passion in perinatal loss, that really does spark a conversation to me. ‘Speak their name and love them’ is my quote that I tell parents of stillbirth or miscarriage babies.

“If we can keep their names alive, we keep their stories alive. All they ever knew was love. Once you start talking about PLS, most people are connected someway to someone who has had a stillbirth or miscarriage. It opens conversation which is what is needed to reduce the stigma.”

Fiona never intended to work as a midwife, but her experience in her own life led her down a path towards the profession.

“I was always interested in working for the RFDS team, and after a welcome surprise baby came into our lives, that halted the idea for then,” Fiona said.

She became a qualified Registered Nurse in 2011 and then moved onto the paid placement model at Rockingham General Hospital.

“This was a great opportunity to learn as you go with the support of an amazing obstetric team and supportive midwifery team.

Fiona then worked as a Graduate Registered Nurse at Royal Perth Hospital, and loved it.

“The support of the team was encouraging. Initially I was on 5A, then my second rotation was at Shenton Park in Orthopaedic Rehab. Two amazing wards with great SDNs and Managers.

“I loved midwifery more than I imagined and progressed through different roles!”

Another major factor for Fiona in further branching out into midwifery, was the support she had herself during her own three births.

“Two amazing midwives really still stand out, Anna and Nola. They were both so encouraging and they supported myself and my husband through our labours.

“To be cared for like that, and now care for others, is a great privilege.”

Fiona has now been a midwife for eight years.

“I am now working as a Registered Nurse/Midwife at Rockingham General Hospital, returning to the floor after five years as Staff Development Midwife, a role I am so passionate about.

“Students, Graduates and education are so important. However, I am really enjoying being back with the women and their families.”

While her passion for her work is undeniable, Fiona is acutely aware that it can still be a very difficult job at times. Her advice to others is to learn to separate your working life from your home life, something much easier said than done.

She says that “taking off your work backpack” is one of the hardest aspects of being a midwife.

“I often describe to junior practitioners about their home and work backpacks. When you’re driving into to work pick a spot close to work where you’ll take off your ‘home backpack’ and pickup your ‘work backpack’. A moment where you can switch off from one to the other.

“Leave your work backpack at work, don’t take the troubles of the day home with you. Learn how to ask for help and debrief all situations good and bad with yourself, colleagues or professional teams available to you.”

“I love my job, I don’t think a lot of

Even with all her years of experience in midwifery, being able to leave work at work can be extremely difficult.

“I’ll wonder what happened, or when she delivered, or if the baby is ok.

“It is such a work of heart that some cases can keep you up at night if you don’t take off your ‘work backpack’.”

Reflecting on her career, Fiona said working as a midwife taught her grace and patience. She strives to bring these things to everything she does in her crucial role within the community.

“My job is to support women and families in their choices, and teach and nurture them to be parents.

“The role of the midwife is so important - whether it’s your first or fifth baby, the midwife is the constant care provider, a shoulder to cry on and a health professional to discuss concerns.

“The midwives in our community support so many families multiple times through pregnancies. It is such an amazing asset to the community to have the same midwife through all of their journeys.

“Midwives play a crucial role in the community by providing essential prenatal, childbirth, and postnatal care. Midwives empower women with knowledge and choices regarding their reproductive health.”

She joined the ANF as a Student Nurse in 2008.

“I had heard about the education and professional development that was accessible, I also wanted advocacy for better working conditions and pay that a strong union could provide for WA Nurses.

“I also knew about the support I could receive should I need it in the future.”

When asked what she most enjoyed about being a member of the ANF, Fiona said she still loved sitting and reading the magazine, which the team at the Western Nurse appreciates greatly.

Looking back on her career Fiona has a lot of great memories, and even with the harder aspects of her job, she doesn’t regret her decision to step into the roles she has chosen.

“I love my job, I don’t think a lot of practitioners can truly say that in their role. Is it hard? Yes! Everyday is a challenge, but with an amazing supportive team and my own family supporting me, I couldn’t think of anything else I’d want to do."

It is probably this positive outlook and dedication to her job that saw Fiona win this year’s Excellence in Midwifery award.

“It was such an honour! To even be nominated was a surprise. There are so many midwives doing amazing work every day. To be recognised for my work around Perinatal Loss was so special.

“To speak a tiny voice for all of the families and babies I have cared for, and will continue to care for, was truly incredible. I am thankful to my Manager Beth who nominated me and continues to support me in the PLS role.”

Beating burnout: One nurse’s journey in mental health and well-being

Jeanelle’s story may feel painfully familiar to many nurses and midwives. Her first year working as a nurse was difficult and tiring, and the growing stress of the job seemed unrelenting. She had a consistent feeling that something was wrong, while at the same time she kept telling herself that it wasn’t.

It started to affect her personal life and her mental health, and there didn’t seem to be anywhere to turn. The pressure kept mounting. She didn’t know it at the time, but she was experiencing burnout. Now, five years later, Jeanelle is on a mission to help other nurses and midwives find strategies to cope.

She spent four years researching and creating helpful resources for nurses and midwives, including her book, Nursing the Nurse: The Ultimate 6-Step Guide to Beating Nurse Burnout.

A build up to burnout

Jeanelle graduated as a nurse in late 2019, and started full time work in May 2020, just as the COVID pandemic was starting. This was no doubt a stressful time for all nurses, but especially for those newer to the industry.

“I was originally due to start in August of 2020, but I was told they were going to need nurses to start now, so I put my hand up to start early,” Jeanelle said.

“I was less than six months into my grad working on a brain injury rehab ward. It was a very heavy load emotionally and then also everyone was getting sick.”

It didn’t take that long before Jeanelle started to feel the effects of the stress and the emotional load. She noted that others around her were feeling the same.

“I headed into my career thinking how amazing it is that I get to help my patients and help their families. I was getting to do what I discovered was my passion, but then I was seeing all these nurses around me who had been in it for so long, talking about how it is never going to change, how awful the work was, and how they are struggling with the shift changes.

“They would say how they can’t wait to retire, or they can’t wait to get out, even just that they couldn’t wait to get home and have that glass of wine.

Jeanelle shared some of these feelings and stresses, but she convinced herself that things would get better.

This, she said, was a common theme among other nurses; that you could just ignore the issue and it would get better. It didn’t. Instead, it got worse.

“I was really starting to resent my work,” Jeanelle told the Western Nurse.

“I started thinking maybe I’m not cut out for this, and maybe I was a bit doe-eyed going into my career. I thought maybe I had a complete misunderstanding of what it meant to be a nurse, because if someone who has been doing it for five plus years couldn’t cope how am I going to cope feeling this way at six months in.

“I was snapping at my friends and family, cancelling social events because I wanted to sleep, calling in sick so that I could sleep. I was starting to feel frustration at myself for not being able to do as much exercise as I used to do or asking why I couldn’t stay on top of my work.”

The warning signs

There are a few common signs of burnout, some of which are so ingrained in nurses it is sometimes hard to self-identify they are in a state of burnout.

Not being able to get a full night’s sleep, taking extra time off work to recover from a shift and feeling unprepared to go back on shift are all signs.

“I’m not going to say that everyone should always wake up and feel super pumped to go to work, but I’ve actually spoken to a few nurses who said they have had a feeling of panic come over them when they realized they have to go into a shift. That’s not normal but sometimes we think it is.”

Jeanelle said a reliance on drinking is a common red flag.

“We have a huge drinking culture in nursing, having a glass of wine is not the same as having a bottle of wine because you need it to go to sleep. That’s a red flag.”

Searching for help

She started asking those around her, including managers and coordinators, if they had any tips on how to better manage the stress and the negative emotions. The most common response was to accept this feeling as normal, and to get used to it. Jeanelle didn’t accept that, but she also didn’t want to end up quitting the profession.

“We often say we work in a ‘broken system’ and whilst that’s true we need to consider the fact that when someone presents with a problem, we often know how to address it. So, why is there burnout if the systems isn’t as broken as we think? The answer is simple, yet powerful – toxic culture aka a 'broken culture'.

“We’ve all heard it said ‘nurses eat their young’ amongst other sayings. We have a severely toxic culture of guilt tripping, apathy towards our colleagues and a lack of managerial support because they, within themselves, are burnt out!”

What followed was a four-year journey of discovery, looking for resources and searching for better ways of dealing with burnout. This culminated in her writing and publishing her book in January of 2023, which collates all the strategies and resources she discovered on her path back from burnout.

She said the most striking impediments for nurses trying to deal with burnout was a lack of training, and an absence of tailored resources.

“I remember in my training being told that self-care is important, but I was never given the ‘how’. This is a major gap in our training.

“We get taught to focus on things like our documentations, and while there is the brief mention self-care, but not once did they go over how you recover from a shift or how you process the death of a patient. There is none of that.”

A journey back to normal

Jeanelle spent years and thousands of dollars pouring through resources and attending courses, only to find that very few really addressed the issues facing nurses.

“It took me so long because everything I found was tailored to business owners, people who didn’t have to do shift work or students. It was never tailored to a shift working nurse.

“We have identified that nurses have suffered burnout, especially during COVID, but we still haven’t taken any major action towards dealing with this.

“The research articles talk about how people are burned out, what leads to burnout and the effects of burnout, but there are no real tangible ways to of being able to move out of burn out specific to the nursing world. There is a big gap in knowledge.

“This gap lies more in tailoring resources to the needs of a nurse.”

Jeanelle says this is especially problematic given how little free time nurses have to look for resources. She decided it was hugely

important that the resources she collected could be consumed easily and quickly. Her book is very short, intentionally so, and she has also created brief summaries and workbooks to allow nurses to quickly engage with the material.

Stepping away from burnout

For Jeanelle and many other nurses, the first step in addressing burnout is acknowledging you are experiencing it, and then deciding to act. This first hurdle is often the hardest. For Jeanelle, identifying she had an issue was akin to “turning a light switch on in a dark room.” She said it can be especially difficult for nurses, midwives and other healthcare workers to seek help.

“Nurses don’t like to admit they we are in a patient role. When we are in burnout we are actually stepping into a patient role and we don’t like being on that side of the clipboard. We are a very proud species.

“I’m a strong believer in self-awareness; it is the way to get to selfcare, because once you are aware of a problem you can take action.

“For me it was a big thing identifying my own burnout, because I thought it was normal. The point where I realized it is not normal was when I started to take out frustration on my loved ones in my personal life, and when I realised my anxiety and depression was creeping up on me more than before. I thought it was because I was dealing with such a high stress job. Yes, it is that, but I also wasn’t doing anything about it.”

Once you have acknowledged burnout there are a lot of different tools and strategies for beating burn out, but learning to unwind and process a stressful shift is crucial.

“Knowing how to unwind after a shift is one of the things I’ve focused most on because I feel like that is a skill we don’t get taught in university.

“Learning how to unwind in a sustainable way is so important. We all have to learn how to leave work at the door and be present and be at peace with your family without guilt. This will help us return to work feeling refreshed and ready to face the next.”

Moving forward

Jeanelle decided to write the book once she realised the strategies she had been using were helping, and she was now coping a lot better than she thought. She recalled a moment when she noticed she was able to process and move forward from things that previously would have sent her into a spiral.

“I was in a metro ICU. We just had a patient die after several rounds of CPR. We had cleaned up the space and I asked my co-workers when is our debrief. They said we would be having one and when I asked why not they said it was going to happen again, and it was close to shift change, and we were all behind on work. Basically, they said we just had to get the shift done.

“In that moment I was so grateful for the techniques I had developed so I could deal with this by myself. Had I not, I think I would have been a blubbering mess. Without these strategies to fall back on, this reliable system I had built, there is no way I would have been able to cope. I would have left the industry by now.”

In many ways, writing the book was a way for Jeanelle to put everything she had learned together in a chronological order. She also described the process as quite healing. Now any nurse can pick it up and use the tools and strategies she has compiled.

Copies of her book can be purchased online at: nursingthenurse.com/ntn-book-pod

Miriam Lang: from agricultural scientist to WACHS Nurse

Recent nursing graduate Miriam Lang might have made the decision to train as a nurse later than most, but it seems like nothing will get in the way of the former agricultural scientist as she faces the challenges of a new career.

Now 58, Miriam completed her nursing degree online through Charles Darwin University in July 2023. Her decision to train and work as a nurse might sound familiar to many current and former nurses: she wants to care for people.

“I have always wanted to help people and make a difference in their lives,” Miriam recently told the Western Nurse.

“Initially, I focused my career on the production of food as an agricultural scientist. However, after a successful 30-year career, I felt the need to help and care for people in a different way.”

Miriam finds even the simplest of things can make a big difference to her patients.

“The best thing about being a nurse and working within a medical team is that you can apply your knowledge and skills to make a difference in someone’s life every day,” Miriam said.

“It could be as simple as administering extra analgesia to resolve pain symptoms or just having a friendly chat to get to know and understand your patient better.”

Supporting patients through communication and education is a key part of nursing. One of Miriam’s more memorable experiences from her first year as a graduate nurse relates to just this.

“A stand-out experience was when I provided education on the management of a new diagnosis of diabetes,” Miriam said.

“The diagnosis took the patient by surprise. The patient needed to learn about changes to their diet, how to check their blood glucose levels and how to administer insulin. Upon discharge, the patient expressed their gratitude for their nursing care which included taking into consideration the finer details of their care needs.”

Miriam takes great pride in the care that this patient received, but she noted that the experiences and outcomes for the patient once they had left her care were equally if not more important to her.

“It’s even more rewarding to note that this patient is now independently managing their diabetes at home and has not represented to the hospital.”

While the shift from agricultural science to nursing might seem like a big career move, it was a much easier choice for Miriam to keep working in the country.

“As a country girl brought up in Moora, I have always enjoyed living in rural towns such as Meekatharra, Merredin, Katherine and now Albany in the Great Southern,” Miriam said.

“Within small communities, it’s easy to make new friends especially if you enjoy sport and if you like the outdoors. It generally isn’t a long drive to find somewhere to go for a walk or go camping to relax and clear your head on your days off.”

Now, with over a year of work under her belt, Miriam is still enjoying her role as a WACHS nurse in Albany. Her roles so far have been quite varied, covering a lot of different types of care.

“For the first six months of my graduate nursing year, I worked in the medical ward at Albany Hospital. Patients on the ward often have comorbidities such as cardiovascular, respiratory, diabetic and kidney disease. For my final six months, I have been allocated to Palliative Care.”

Miriam noted that this is a slightly different role, primarily focused on improving the quality of life for patients and their families facing problems associated with a life-limiting illness.

“In both work areas, we are managing and treating acutely unwell patients, with the main difference being the inclusion of physical, psychosocial, and spiritual care with medical care,” Miriam said.

“This involves seeing patients as either an inpatient or an outpatient, in the comfort of their own home or in residential care.”

Miriam noted her biggest challenge is keeping across the number and range of tasks she has to do as part of her day-to-day job. She has found many solutions to this come from working as a team, and taking time to look after yourself.

“My greatest challenge as a graduate nurse has been managing unanticipated tasks and keeping on track with daily planner tasks. I have learnt that it is important to remember that you are in a team and not working in isolation. Someone is always available to help you and you are never alone.

“Starting as a graduate nurse, my advice is to be gentle with yourself. If in doubt, always ask and if you feel like your task list is unachievable, prioritise, ask for help, and remember you can leave a task for the next shift.”

Having a focus on self-care and not being too hard on yourself, is particularly important to Miriam and she says it should be equally important for other graduates to keep this in mind as they start their careers. Making the best use of your time is also crucial.

“As a nurse, depending on the type of work you are doing, you may be doing shift work or working daytime hours. There is plenty of time to keep up with your personal study and maintain an exercise regime,” Miriam said.

“At the end of the shift, smile, because you survived, and you did your best. My last bit of advice is to do something for yourself every day because you deserve it.”

ANF Industrial Officer Advice

Protecting yourself on social media

For most of us, social media is an everyday part of our lives. Around 60 percent of Australians use Facebook, with many using other platforms, such as Twitter (now called X), TikTok, Instagram, LinkedIn, Reddit, Youtube or Pintrest.

With social media being so pervasive it is important to understand the risks and implications it can have on your professional life.

Never forget that what you post online can be seen by a large number of people, and once something is online it stays there forever.

As health professionals, nurses and midwives need to be aware of their responsibilities, and the consequences of what they share or post online.

Social media and AHPRA

Under the AHPRA code of conduct nurses and midwives will put their registration at risk if they:

• Share confidential health or patient information online

• Post inappropriate comments about colleagues or patients

• Use social networking sites to bully or intimidate colleagues

• Distribute sexually explicit material

• Use social networking sites in any way which is unlawful Students may also jeopardise their ability to join the national register if they breach the code of conduct.

Social media and your workplace

Most workplaces now have their own social media policies, and it is important that you know and understand what your specific workplace policy entails.

These policies can be very different from workplace to workplace, but as a general rule it is always better to avoid a number of key requirements.

• Don’t criticise your work colleagues

• Don’t criticise your employer

• Don’t make comments about any workplace dispute

General advice for social media

Stories of people who have been reprimanded by their employer, or even lost their jobs, for something they have posted online are common. The line between your professional life and your personal life is also very much a gray area, so make sure you protect yourself as best as possible.

• Don’t identify yourself as a nurse or midwife. If you do, then keep in mind that AHPRA considers any opinion or advice you give online will be held to the same professional standards as if you were in the workplace.

• Don’t identify your workplace. This is to avoid any risk of breaching your work’s social media policies. This can mean naming your workplace or a photo of you in uniform.

• Don’t post pictures of patients. Even with their permission this is likely a breach of privacy and professional conduct.

• Don’t post evidence of yourself breaking the law

• Think twice about adding work colleagues as friends or followers on social media. What you share with them may well be shared with your employer.

• Don’t post anything that could be construed as bullying, harassment, vilification, or defamatory towards any individual.

Aciclovir: a medication update

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Aciclovir: a medication update

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Brand name: Aciclovir, Zovirax, VirusPOS, Xorox1,2,3

Drug class: antivirals1

MECHANISM OF ACTION

Aciclovir is a guanine analogue that selectively inhibits the replication of herpes simplex virus (HSV-1 and HSV-2) and varicella-zoster virus (chicken pox).1,4 After administration aciclovir is converted to aciclovir triphosphate by viral and cellular enzymes and then incorporates itself into viral deoxyribonucleic acid (DNA), inhibiting viral DNA synthesis and viral replication.1,5

ADMINISTRATION

Aciclovir may be administered orally in tablet form, intravenously, and topically in cream or ointment form.1

INDICATIONS

Oral aciclovir is indicated for:6,7

• Treatment of first episode, primary or non-primary, genital herpes simplex

• Management of recurrent episodes of genital herpes simplex in patients with frequent or severe recurrences

• Treatment of acute attacks of herpes zoster (shingles)

• Management of patients with advanced symptomatic HIV disease.

Intravenous aciclovir is indicated for the treatment of:8

• Acute mucocutaneous herpes simplex virus infections in immunocompromised patients

• Severe first episode, primary or non-primary, genital herpes simplex

• Acute varicella zoster virus infections in immunocompromised patients

• Severe or systemic manifestation of herpes zoster

• Herpes simplex encephalitis.

Topical aciclovir is indicated for the treatment of labial herpes simplex (cold sores) and herpes simplex keratitis (herpetic eye infections).2,3,9

CONTRAINDICATIONS

Aciclovir is contraindicated in patients with hypersensitivity to aciclovir or valaciclovir.1,6-9

INTERACTIONS

Aciclovir has a number of clinically meaningful drug interactions.

Concurrent use of aciclovir and other nephrotoxic drugs, such as calcineurin inhibitors, may increase the risk of renal adverse effects.10

Probenecid inhibits renal tubular secretion of aciclovir, increasing its concentration. If probenecid and aciclovir are used concurrently the patient should be closely monitored for adverse effects and the aciclovir dosage reduced if appropriate.10

PRECAUTIONS

Renal impairment

Oral and intravenous aciclovir should be used with caution in patients with renal impairment. As aciclovir is excreted by the kidneys impaired renal function may result in retention of the drug.6,7,8

A lower dose should be used for patients with renal impairment according to creatinine clearance (CrCL).1

For orally administered aciclovir:1

For the treatment of genital herpes simplex:

• CrCL of 10-25mL/minute – 200mg every 6-8 hours

• CrCL of less than 10mL/minute – 200mg every 12 hours.

For the treatment of herpes zoster:

• CrCL of 10-25mL/minute – 800mg every 8 hours

• CrCL of less than 10mL/minute – 800mg every 12 hours.

For intravenously administered aciclovir:1

• CrCL of 26-50mL/minute – 5-10mg/kg every 12 hours

• CrCL of 10-25mL/minute – 5-10mg/kg every 24 hours

• CrCL of less than 10mL/minute – 2.5-5mg/kg every 24 hours and after haemodialysis.

Pregnancy and breastfeeding

• Aciclovir is considered safe to use during pregnancy.1,2,3,11

• Aciclovir is also considered safe to use while breastfeeding. 1,2,3,11

DOSAGE

Oral treatment

Genital herpes simplex1

Initial infection

Adult oral 400mg 3 times daily for 5-10 days

Child (3 months - 12 years) oral 10mg/kg (maximum 400mg) 5 times daily for 5-7 days

Recurrent infections

Adult oral 400mg 3 times daily for 5 days

Child (3 months - 12 years) oral 10mg/kg (maximum 400mg) 5 times daily for 5-7 days

Immunocompromised

Adult (HIV positive) oral 400mg 3 times daily for 5-14 days

Child (3 months - 12 years) oral 20mg/kg (maximum 400mg) 5 times daily for 7-14 days

Varicella zoster1

Child (3 months - 12 years) oral 20mg/kg 4-5 times daily

Herpes zoster1

Adult

Intravenous treatment

Topical treatment

Adult Child (> 3 months) apply 5 times daily for 4-5 days

Ointment – herpes simplex keratitis3

Adult Child apply 1cm of ointment into the lower conjunctival sac 5 times daily for the shorter of 3 days after corneal epithelium is healed or 14 days

ADVERSE EFFECTS

Oral and intravenous aciclovir

Common adverse effects associated with aciclovir include headache, nausea, vomiting, diarrhoea, headache, and hallucinations. Intravenous aciclovir may also be associated with encephalopathy and injection site reactions.1 Aciclovir may infrequently be associated with dizziness, agitation, confusion, weakness, arthralgia, oedema, sore throat, constipation, abdominal pain, rash, and renal impairment.1

Rarely, aciclovir may be associated with fatigue, anorexia, seizures, hepatitis, neutropenia, leucopenia, crystalluria, Stevens-Johnson syndrome, toxic epidermal necrolysis, coma, and anaphylaxis.1

Topical aciclovir

The most common adverse effect associated with aciclovir is transient stinging.2,3 Aciclovir cream may also be associated with dry or flaking skin.2

Aciclovir may infrequently or rarely be associated with hypersensitivity reactions. Aciclovir cream may also be associated with erythema and itch, while aciclovir ointment may be associated with superficial punctate keratitis.2,3

REFERENCES

1. Aciclovir. 2024 [cited 2024 Mar 2]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https://amhonline.amh.net.au/chapters/anti-infectives/antivirals/ guanine-analogues/aciclovir

2. Aciclovir (skin). 2024 [cited 2024 Mar 2]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https://amhonline.amh.net.au/chapters/dermatologicaldrugs/drugs-skin-infections/antivirals-skin/aciclovir-skin

3. Aciclovir (eye). 2024 [cited 2024 Mar 2]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https://amhonline.amh.net.au/chapters/eye-drugs/drugseye-infections/antivirals-eye/aciclovir-eye

4. Zachary KC. Aciclovir: An overview. 2022 [cited 2024 Mar 2]. In: UpToDate [Internet]. Waltham (MA): UpToDate Inc. Available from: https://www. uptodate.com/contents/acyclovir-an-overview

5. Taylor M, Gerriets V. Acyclovir. 2023 [cited 2024 Mar 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: https://www.ncbi.nlm.nih.gov/books/NBK542180

6. Therapeutic Goods Administration. Australian Product Information: Aciclovir AN [Internet]. Woden (Australia): TGA; 2013 [cited 2024 Mar 2]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository. nsf/pdf?OpenAgent&id=CP-2014-PI-02640-1

7. Therapeutic Goods Administration. Australian Product Information: Zovirax Tablets [Internet]. Woden (Australia): TGA; 2016 [cited 2024 Mar 2]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository. nsf/pdf?OpenAgent&id=CP-2010-PI-06103-3

8. Therapeutic Goods Administration. Australian Product Information: Aciclovir Viatris [Internet]. Woden (Australia): TGA; 2024 [cited 2024 Mar 2]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository. nsf/pdf?OpenAgent&id=CP-2021-PI-01764-1

9. Therapeutic Goods Administration. Australian Product Information: Xorox [Internet]. Woden (Australia): TGA; 2021 [cited 2024 Mar 2]. Available from: https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/ pdf?OpenAgent&id=CP-2020-PI-02298-1

10. Drug interactions: Guanine analogues. 2024 [cited 2024 Mar 2]. In: Australian Medicines Handbook [Internet]. Adelaide (Australia): Australian Medicines Handbook. Available from: https://amhonline.amh.net.au/ interactions/ guanine-analogues-inter 11. Aciclovir. 2023 [cited 2024 Mar 2]. In: Pregnancy and Breastfeeding Medicines Guide [Internet]. Melbourne (Australia): The Royal Women’s Hospital. Available from: https://thewomenspbmg.org.au/medicines/ aciclovir

Genital herpes simplex, acute mucocutaneous herpes simplex, and herpes zoster1

Candida auris – A microorganism

Candida auris – A microorganism

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Candida auris (C. auris) is the most talked about multidrug-resistant emerging fungal pathogen, causing difficult-to-control nosocomial outbreaks worldwide. Reported in 40 countries, including Australia, it was recently listed as the second major human pathogen on the official WHO fungal priority pathogens list (WHO FPPL). 1

C. auris infection and colonisation is a notifiable infection in Western Australia. 2

This article discusses the occurrence, transmission, screening, diagnosis, and treatment of C. auris.

OCCURRENCE

C. auris is a common commensal of the skin and mucous membranes,1 found in a colonised person’s axillae, nose and throat, groin, rectum, urine, sputum, wounds, or on medical devices.3

In immunocompromised people, C. auris often causes invasive fungal infections by disseminating through the bloodstream to internal organs (liver, brain, lungs, bones, kidneys, and, most commonly, the urinary tract), ears (otitis media), heart lining (pericarditis), or wounds.1,3

Invasive infections have a mortality rate of up to 72%. 3

Risk factors:1,3,4

• Immunocompromised people, or those with chronic disease (e.g. diabetes, lung disease, renal failure, cardiovascular disease, malignancy)

• Use of broad-spectrum antibiotics, antifungals, invasive medical devices, or invasive procedures

• Intensive care patients, preterm neonates, older adults

• Ward or close contact with infected/ colonised people.

TRANSMISSION

Readily transmitted between people, C. auris is commonly a healthcareassociated infection (HAI), acquired from colonised (and asymptomatic) patients and contaminated objects.1,2,4

C. auris can survive on surfaces for up to one month and has developed resistance to common disinfectants.1,2,4

It has been isolated from objects in affected healthcare facilities, such as beds, oximeters, trolleys, electrocardiogram leads, air, floor, and walls.4

The incubation and infectious periods of C. auris are unknown. 4

SCREENING

Screen high-risk patients on admission (axillae and both sides of the groin, using dry swabs pre-moistened with sterile water) and pre-emptively isolate and treat (as below).3,4

Screening should include:2,4

• Close contacts of infected or colonised people

• Anyone admitted to a hospital or residential care facility overseas within the last 12 months

• Any person transferred from a hospital with endemic C. auris in Australia

All precautions apply until three consecutive negative culture results are available.3

DIAGNOSIS

C. auris is diagnosed with microbiological culture of blood samples or swabs of the infected site. The organism is difficult to identify definitively and cultures take up to 10 days,4 though interim screening results are usually available after 48 hours. 3

TREATMENT

Resistant to many antifungals, C. auris has a high rate of treatment failure.4 Studies reveal fluconazole resistance in over 90% of cases, while some strains are resistant to all antifungal medications.1,3

Treatment must be guided by an infectious disease specialist. 2

A single-drug regimen of intravenous echinocandin is usually recommended for empirical and initial therapy. It is not recommended to treat asymptomatic colonisation.4

PRECAUTIONS

Practise transmission-based precautions (contact, droplet, airborne) on all patients with known or suspected C. auris infection or colonisation.3

It is recommended to isolate these patients in a single, non-carpeted room with a dedicated bathroom.3,4

Use dedicated equipment when possible, clean the room and equipment at least daily with a Therapeutic Goods Administration (TGA) approved or chlorine-based disinfectant, and post door signs to alert staff.3,4

Receiving departments (e.g. radiology) must be notified to take precautions, and affected patients scheduled last on the day’s list.4

DOCUMENTATION

As all previously colonised or infected people are considered infectious indefinitely, place an alert in their medical records to ensure measures are taken upon readmission or transfer to another facility.2,4

Patients should also receive written notification of their status and an information sheet.3

REFERENCES

1. Irinyi L, Malik R, Meyer W. Candida auris: the most talked about multidrug-resistant emerging fungal pathogen. Microbiol Aust [Internet]. 2022;43(4):173–6. doi:10.1071/MA22057

2. Government of Western Australia Department of Health. Candida auris infection or colonisation: Statutory notification [Internet]. Perth (Australia): Government of Western Australia; 2023 [cited 2024 Mar]. Available from: https://www.health. wa.gov.au/Articles/A_E/Candida-auris-infectionor-colonisation

3. The Communicable Disease Control Directorate. Guidelines for the Screening and Management of Multi-resistant Organisms in Healthcare Facilities 0010 v.2 [Internet]. Perth (Australia): Government of Western Australia Department of Health; 2024 [cited 2024 Mar]. Available from: https://www.health. wa.gov.au/~/media/Corp/Policy-Frameworks/ Public-Health/Screening-and-Management-ofMulti-resistant-organisms-in-Healthcare-FacilitiesPolicy/Screening-and-Management-of-Multiresistant-organisms-in-Healthcare-Facilities-Policy. pdf

4. Ong CW, Chen SCA, Clark JE, Halliday CL, Kidd SE, Marriott DJ, et al. Diagnosis, management and prevention of Candida auris in hospitals: position statement of the Australasian Society for Infectious Diseases. Intern Med J [Internet]. 2019;49:1229–43. doi:10.1111/imj.14612

AcrosstheNation

Financial complaints rise to record 105,000

The Australian Financial Complaints Authority (AFCA) has reported more than 105,000 financial complains made in Australia in the last financial year.

This represents a 9 percent increase from the previous year, which in turn followed an unprecedented 34 percent jump in complaints a year earlier.

Chief Ombudsman David Locke said the number of complaints was disappointing.

“While we haven’t seen the scale of increase we experienced a year ago, these record numbers are still too high,” Mr Locke said.

“We are disappointed we haven’t seen a reduction. Our view is that firms could be resolving more complaints themselves, or preventing them in the first place.

“We continue to take steps to be able to keep up with the increasing demand for our service, but it’s in everyone’s interests that rising complaints are tackled at the source.”

According to the AFCA, preliminary data showed scams were a key driver, along with a surge in complaints about comprehensive motor vehicle insurance.

Banking and finance complaints rose 11 percent to 59,636, general insurance complaints rose by 4 percent to 29,096 and scam-related complaints rose by 81 percent to 10,951, although scam related complaints were already trailing off.

“We saw scam-related complaints dip a little towards the end of the year, possibly reflecting recent government and industry efforts to prevent and address scams,” Mr Locke said.

“Our hope is that this improvement continues in the coming year.”

Mr Locke said AFCA looked forward to the results of the government’s work on mandatory codes addressing scams.

“Clearer obligations will help us, as an ombudsman service, in resolving complaints about the way a financial firm has handled the fallout from a scam.”

The most complained about products in the last financial year were: personal transaction accounts (16,365 complaints, up by 19 percent); credit cards 11,84, up by 12 percent); and personal loans (7,660 complaints, up by 17 percent).

Important changes to superannuation now in place

The Australian Taxation Office (ATO) is reminding all taxpayers to be aware that important changes that might impact their superannuation came into effect from 1 July 2024.

ATO Deputy Commissioner Emma Rosenzweig said taxpayers should ensure they understand their superannuation entitlements and requirements.

“Super is one of the most important investments many Australians will have,” Ms Rosenzweig said.

“It’s important you remain engaged with your super through all stages of your life, not just when you are ready to retire.

According to a statement released by the ATO, from 1 July 2024 the superannuation guarantee rate increased from 11 percent to 11.5 percent.

“Employers will need to calculate super contributions at 11.5 percent of their eligible workers ordinary time earnings, for payments of salary and wages from 1 July this year,” the statement read.

“Super contributions for the quarter ending 30 June are still calculated at the 11 percent rate for payments made prior to 1 July. The super guarantee rate is scheduled to further increase to 12 percent from July 2025.

Ms Rosenzweig said an increase to the super guarantee rate means more money going into people’s superannuation.

“When it comes to your financial future, every bit counts,” Ms Rosenzweig said.

“Take the time to check on your super regularly, or you could be missing out on the right entitlements.”

The concessional super contributions cap increased from $27,500 to $30,000 per year. The concessional contributions cap is the maximum amount of beforetax contributions (including employer guarantee amounts) that can be contributed to your super each year without contributions being subject to extra tax, unless you are eligible to access unused concessional contribution cap amounts from previous years.

Other key changes from 1 July include the non-concessional super contributions cap increase to $120,000, from $110,000, per year and, for employers, the maximum super contribution base increasing to $65,070, from $62,270, for the 2024–25 financial year.

“Boosts to concessional and nonconcessional caps will now give individuals greater scope to make voluntary contributions. Growing your super by making extra payments adds up over time,” Ms Rosenzweig said.

New government program to support babies with peanut allergies

The Australian Government has announced funding for the National Allergy Centre of Excellence (NACE) to deliver the ADAPT Oral Immunotherapy Program, which aims to support babies with a peanut allergies.

According to a statement release by the Australian Government, the program aims to change the way peanut allergy is treated, moving from strictly avoiding peanuts in diets to safely building a tolerance to the allergen and achieving remission.

“Peanut allergies can be deadly, even very tiny amounts of peanut – touched, breathed in or eaten – can cause a lifethreatening reaction (anaphylaxis),” the statement read.

“At one year of age, about three in 100 children are allergic to peanuts.

“The NACE, hosted by Murdoch Children’s Research Institute, has partnered with ten paediatric hospitals across five states to launch the program into mainstream care.

“The oral immunotherapy treatment will be free for children under the age of one, who are diagnosed with peanut allergy and receiving care by an allergist at one of the participating hospitals.”

In Western Australia, these participating hospitals include Perth Children’s Hospital and Fiona Stanley Hospital.

The Australian Government is providing $27 million to establish the National Allergy Centre of Excellence and a National Allergy Council.

In addition, Murdoch Children’s Research Institute received $2.5 million through the National Health and Medical Research Council’s Centres of Research Excellence scheme to fund the Centre for Food Allergy Research.

Assistant Minister for Health and Aged Care Ged Kearney said the government is investing in world class health and medical researchers to better understand and treat allergies and anaphylaxis.

“Having a little bub with a deadly peanut allergy brings so much worry for parents. From preparing food, to giving your baby a kiss, it’s impossible to let your guard down,” Minister Kearny said.

“Too many children in Australia have a life-threatening peanut allergy. This new program will help change that.”

TGA warning for advertising prescriptiononly weight-loss medicine

The Therapeutic Goods Administration (TGA) has issued a statement reminding businesses and media outlets that it is unlawful to publicly advertise prescriptiononly medicines, including prescription-only weight loss medicines.

The TGA has said that advertising prescription-only medicines directly to consumers undermines individual health practitioner advice and may create an inappropriate demand for particular medicines which may not be the appropriate treatment for that individual’s circumstance.

“The Therapeutic Goods Act 1989 (the Act) applies to anyone publishing information about therapeutic goods, including media outlets and suppliers of those goods,” the TGA statement read.

“Media platforms are responsible for ensuring their content does not directly or indirectly promote the use or supply of therapeutic goods to the public. A key consideration for media is whether they are seen to be promoting a particular prescription medication.

“Those who breach the Act can face significant fines, or civil or criminal proceedings.”

In the last 6 months, the TGA has issued over 70 infringement notices totalling over $1 million to 19 businesses or media outlets for alleged unlawful advertising of prescription-only medicines. These include more than $300,000 in relation to weightloss medicines, and three infringement notices to a media outlet for alleged unlawful advertising of a prescription-only medicine on their platform.

The TGA has said it will continue to take action against the unlawful import, supply, manufacture and advertising of these products when detected.

AroundtheGlobe

CEPI and WHO urge broader pandemic research strategies

The Coalition for Epidemic Preparedness Innovations (CEPI) and the World Health Organization (WHO) are calling on researchers and governments to strengthen and accelerate research to prepare for the next pandemic.

In a joint statement issued earlier in the year CEPI and the WHO emphasised the importance of expanding research to encompass entire families of pathogens that can infect humans, regardless of their perceived pandemic risk, as well as focusing on individual pathogens.

“The approach proposes using prototype pathogens as guides or pathfinders to develop the knowledge base for entire pathogen families,” the joint statement read.

The statement follows a report issued by WHO Research and Development Blueprint for Epidemics urging a broaderbased approach by researchers and countries. Over 200 scientists from more than 50 countries contributed to the report, which evaluated the science and evidence on 28 virus families and one core group of bacteria, encompassing 1652 pathogens.

The epidemic and pandemic risk was determined by considering available information on transmission patterns, virulence, and availability of diagnostic tests, vaccines, and treatments.

“This approach aims to create broadly applicable knowledge, tools and countermeasures that can be rapidly adapted to emerging threats,” CEPI and WHO said in their statement.

“This strategy also aims to speed up surveillance and research to understand

how pathogens transmit and infect humans and how the immune system responds to them.”

CEPI and WHO also called for globally coordinated, collaborative research to prepare for potential pandemics.

“History teaches us that the next pandemic is a matter of when, not if.” WHO DirectorGeneral Dr Tedros Adhanom Ghebreyesus said.

“It also teaches us the importance of science and political resolve in blunting its impact.

“We need that same combination of science and political resolve to come together as we prepare for the next pandemic. Advancing our knowledge of the many pathogens that surround us is a global project requiring the participation of scientists from every country.”

Dolce & Gabbana release perfume for dogs

Italian luxury fashion house Dolce & Gabbana has released a new fragrance designed exclusively for dogs, called Fefé.

Founded in 1985 in Legnano by Italian designers Domenico Dolce and Stefano Gabbana, this marks the first time the company has released a fragrance specifically for canines and, according to the brand’s publicity material, draws its inspiration “from the unwavering love for Domenico Dolce’s loyal companion, Fefé.”

The company describes the dog fragrance as “gentle and delicate, and “crafted for a playful beauty routine.”

Directions for use on the Dolce & Gabbana website suggest that owners “spray Fefé on your hands or on a brush and proceed by rubbing or brushing your dog’s fur from the middle of the body towards the tail to give them a moment of scented pampering.”

Fefé can also be sprayed directly onto your canine companion, with particular attention given to avoiding spraying around your dog’s nose.”

The Dolce & Gabana website said Fefé marks the brand’s inaugural alcohol-free fragrance mist tailored specifically for dogs.

“It’s an olfactory masterpiece featuring the cocooning and warm notes of Ylang, the clean and enveloping touch of Musk, and the woody creamy undertones of Sandalwood,” the website said.

If all that doesn’t sound decadent enough, the fragrance will cost about $160 AUD per 100ml bottle. The bottle itself features a sleek design made from green lacquered glass with a red metal cap, with the front of the container being adorned with a 24-carat gold-plated paw..

New warning on UK toothpaste

The NHS and UK supermarket chain Asda are working together to ensure potentially lifesaving advice is on millions of toothpaste tubes and mouthwash bottles.

Asda oral hygiene products will now feature NHS advice in over 500 Asda stores across the country, to raise awareness of the symptoms of mouth cancer, and encourage people to contact their GP or dentist if they notice any potential symptoms.

The guidance will be clearly displayed on the packaging, along with a link to more detailed information about mouth and throat cancer on the NHS website.

National clinical director for cancer at NHS England Professor Peter Johnson said that by placing health messaging on products like toothpaste tubes and mouthwash bottles that people use every day, the NHS was encouraging people to be vigilant

about potential symptoms of mouth cancer and to get checked early.

“Like many other cancers, mouth cancers have a much better prognosis if found early – raising awareness is a crucial step, and while many of these symptoms won’t be caused by cancer, we’d encourage anyone with any concerns to come forward and contact their dentist or GP,” Dr Johnson said.

Asda Vice President for Commercial Strategy, Operations & Own Brand Sam Dickson, said Asda sells over 2 million of these everyday items each year, so making this small change to their packaging means they can make a big difference in encouraging shoppers to be more aware.

President of the Mouth Cancer Foundation and Oral Maxillofacial Surgeon Mahesh Kumar said early detection is key in the fight against mouth cancers to save and improve lives.

“Any cancer caught early usually incurs a less invasive treatment plan. It is incredibly important to raise awareness of the signs and symptoms among the general public.

“The NHS advice on oral hygiene products will go a long way to highlighting the importance of looking after our oral health and acting sooner when something out of the ordinary is discovered.”

Figures from the UK Mouth Cancer Foundation show that it is the eighth most common type of cancer in the UK, with over 11,700 new cases diagnosed annually.

Prisoners serving life banned from marrying in UK prisons

New laws passed in the United Kingdon will prevent prisoners serving whole life orders from getting married or entering a civil partnership In the UK a whole of life order means the prisoner is never to be

released, a sentence reserved for the most serious crimes.

According to a statement from the UK Government this new measure of the Victims and Prisoners Act, recently signed into law, will “deny the most heinous criminals from enjoying the important life events they callously took from their victims, while preventing families from the trauma of seeing them getting married or entering civil partnerships.”

“It will also ensure that their horrific crimes are treated with the severity they deserve and maintain confidence in the justice system,” the statement said.

UK Lord Chancellor and Justice Secretary, Shabana Mahmood said victims should not be tormented by seeing those who commit the most depraved crimes enjoy the moments in life that were stolen from their loved ones.

“That is why I have acted as soon as possible to stop these marriages and give victims the support they deserve.”

Prior to these new laws coming into force, prisoners serving a whole of life order could make a formal application for marriage or a civil partnership and could only be refused by a prison Governor on the grounds of security concerns.

The Lord Chancellor will retain the right to permit ceremonies in the most exceptional circumstances.

Kangaroos escape from Czech prison

Authorities in the Czech Republic have reported two kangaroos that escaped from a prison in the country’s north have both returned safely to the facility.

Two kangaroos escaped from the Jiřice Open Prison, located about 50 kilometres northeast of the capital, Prague. Jiřice Open Prison keeps a range of animals on site as a part of its rehabilitation program for prisoners.

Local media reported that one of the two escaped kangaroos returned to the prison shortly after it hopped away from its enclosure, having presumably seen enough of the local countryside. The second escapee had more of a taste for freedom, leading Czech authorities on a weeklong

search of the area, before eventually returning to the facility in Jiřice.

During its time on the run, a representative from the prison had urged members of the public not to approach the kangaroo, but to contact authorities if they saw it.

The Czech Republic Prison Service or Vězeňská služba České republiky (VSCR) posted to its Facebook account the second runaway kangaroo returned to the prison “voluntarily”

“After a week of freedom, he ran back to the prison premises, where the prisoners caught him in a volleyball net, according to instructions, and locked him in a transport box,” The VSCR post said.

“The fugitive was taken back to the paddock, where his fugitive partner was already waiting for him.”

The kangaroo was reportedly uninjured, but very hungry. A vet was called to check on the animal’s health.

According to a previous statement made by VSCR, Jiřice Open Prison was opened in November 2017 and aims to reduce reoffending through an intensive individual approach to convicts.

“The main goal of the project is to prepare inmates for life in the community with a focus on their abilities and skills in assessing, planning and making decisions about everyday life tasks and issues,” the statement read.

Jiřice Open Prison also hosts a project where prisoners provide initial obedience training for guide-dogs.

ResearchRoundup

Cat owners more neurotic, study says

A new study at James Cook University suggests dog owners are likely to be more resilient and less neurotic than cat owners, and that the difference might come down to key personality differences inherent between the two groups of people.

Researchers surveyed and interviewed 321 people who were dog or cat owners or neither. JCU psychology lecturer Jessica Oliva said personality differences have been consistently shown between "dog people" and "cat people".

Overall, dog owners demonstrated higher levels of resilience and cat owners demonstrated higher levels of neuroticism, after controlling for age and gender.

“Dog ownership has been associated with reduced loneliness in people living alone during periods of prolonged isolation, such as during covid lockdowns, suggestive of higher levels of resilience in dog owners,” Dr Olivia said.

“So our research investigated the predictive power of dog versus cat ownership on personality traits and resilience.

“Interestingly, there is evidence to support the idea that genes guide ownership of a particular species. It may be that influences on ownership are linked with genetically-derived personality traits, so both the personality trait and propensity to own a particular animal are inherited.

“Simply put, people who are naturally predisposed to being resilient may like dogs more, rather than the dog causing people to be resilient. Though it’s also possible the responsibilities and potential challenges associated with owning a dog may also build resilience over time, or it may be a mix of the two."

It is therefore also not possible to know if neuroticism drives people to own cats or whether cat ownership causes neuroticism.

“The higher resilience of dog owners may be why they were found to be less lonely than non-dog owners during lockdown,” Dr Olivia said.

Study finds snails like red, dislike garlic

According to new research from CSIRO, pest snail species prefer the colour red but dislike garlic.

Researchers evaluated the mechanisms that attract or repel snails, including different colours and potential deterrents such as garlic or coffee. Researchers conducted laboratory and field tests on four invasive snail species as part of a $4.6 million Grains Research and Development Corporation (GRDC) national research program.

According to a statement from the CSIRO, this program is designed to provide Australian grain growers with new tools and management techniques to combat snails, aiming to minimise losses and improve market opportunities for affected crops.

CSIRO Senior Research Scientist Dr Valerie Caron said snails being attracted to the colour red was unexpected, as it is generally thought that gastropods can’t see colours.

“Red doesn’t play an obvious role in snail life, so this colour preference was a surprise,” Dr Caron said.

“Garlic was most effective at preventing snails from reaching food sources under laboratory conditions. Coffee barriers offered only limited protection, especially after 24 hours, with some snails even eating the coffee grounds.

“Ultimately, we’re working to develop new management techniques for snails using attractants (colour) for trapping and removal and safe repellents, such as garlic, as barriers.”

French Masters student Cedric Kosciolek was “chief snail wrangler” for the project during his internship at the CSIRO European Laboratory.

“When we think about snails, and gastropods more generally, we expect them to be a boring subject,” Mr Kosciolek said.

“But my internship showed me the opposite. We saw behavioural differences between the four species. It just confirmed that the natural world is always full of surprises and diversity.”

The CSIRO hopes determining the mechanism behind snail behaviour could reduce the impact snails have on Australian grain crops.

Further research and field trials in Australia will be needed before push–pull mechanisms could be deployed in the field against invasive snails.

GRDC pest manager Leigh Nelson said GRDC has a long history of investing in research to find new ways to control pest snails.

“Invasive snails and slugs contaminate cereal and legume crops and cost the grain industry over $170 million each year,” Dr Nelson said.

“The development of improved management tactics for snails and slugs remains a top priority to improve grain growers’ profitability.

“This investment looks to provide Australian grain growers with new tools and management techniques to combat snails, aiming to minimise losses and improve market opportunities for affected crops.”

Johns Hopkins Scientists probe cause of COVID-19 related diarrhea

Johns Hopkins Medicine scientists say they have found several molecular mechanisms for COVID-19 related diarrhea, suggesting potential ways to control it.

According to a statement released by Johns Hopkins Medicine, until now, the mechanisms of COVID-19 diarrhea were not understood, and this research creates a more complete picture of the mechanisms that could lead to potential treatments.

Emeritus Professor of Medicine and Physiology at the Johns Hopkins University School of Medicine Mark Donowitz, M.D said While COVID-19 diarrhea is not life-threatening like cholera, it can often predict a severe case and also who gets the long covid syndrome.

“The precise mechanisms of long COVID are a big mystery, although we now know that the virus can persist in the intestine for a long time,” Dr Donowitz said.

“The next big question is to determine what exactly allows the virus to live in the intestine and what allows the virus to live over a long period of time.”

According to the statement from Johns Hopkins, some aspects of COVID-19 diarrhea have been determined, including that ACE2, an enzyme to which the virus attaches, and TMPRSS2, an enzyme that allows the virus to enter cells, are present in the intestine.

“In an effort to determine the mechanism by which COVID-19 diarrhea occurred, Dr Donowitz and his team used a model of normal human intestines called enteroids,” the statement said.

“Formed by stimulating human stem cells to develop into many of the cells lining the intestine, enteroids form a single layer of cells in a petri dish oriented in the same direction as the normal intestine.

“The research team exposed the enteroids to live SARS-CoV-2 virus and saw changes in the gut cells’ protein expression and function.”

In typical diarrhea there are changes in transport proteins that move molecules across cell membranes. These changes inhibit sodium and chloride absorption and produce chloride secretion. In COVID-19 diarrhea, both effects occurred, which is common in diarrheal diseases.

According to Dr Donowitz, unlike many diarrheal diseases in which the protein that is the basis of cystic fibrosis is activated, a different class of proteins, called calcium-activated chloride channels, were involved in the chloride secretion in COVID-19 diarrhea.

“An unusual aspect of COVID-19 diarrhea was that, while many diarrheal diseases are caused either by direct effects on the transport proteins or by the accompanying inflammation, Donowitz and his team saw a combination of the two in the enteroid cells,” the statement from Johns Hopkins said.

“The researchers suggest that the inflammation linked to COVID-19 diarrhea may be similar to the inflammatory effects of COVID-19 in the lungs and other parts of the body. This suggests that testing the role of inhibitors of this response may be a way to treat COVID-19 diarrhea.”

Along with the unpleasant aches, fever, sore throat, cough, respiratory distress and other symptoms that may accompany a COVID-19 infection, up to half of people who get the virus will experience diarrhea.

Nearly a third will go on to develop long COVID.

CyberNews

AFP part of campaign to disrupt cryptocurrency scams

The Australian Federal Police recently announced a collaboration with a blockchain data platform to target criminal cryptocurrency scammers in a global operation that identified more than 2,000 compromised crypto wallets belonging to Australians.

The AFP-led Joint Policing Cybercrime Coordination Centre (JPC3) and Chainalysis (the blockchain data platform collaboration) known as Operation Spincaster, targeted criminals who were using a tactic the AFP called “approval phishing” criminals deceive victims into signing a malicious blockchain transaction. A joint statement issued by the AFP and Chainalysis delved deeper in the basic mechanics of the scam.

“Once signed, the criminal has access to the victims’ crypto wallet and can spend specific tokens inside the victim’s cryptocurrency wallet,” the statement read.

“This method allows the criminal to drain the victim’s wallet of those tokens at will, which is similar to giving someone permission to transfer money from your online bank account.

“Approval phishing is increasingly seen in investment scams, where victims are offered high returns on cryptocurrency investments, and romance scams, where criminals use the illusion of a romantic or close relationship to manipulate and steal from victims.”

The tactic has been used to steal more than $4 billion in cryptocurrency from unsuspecting victims around the world since May 2021.

AFP Detective Superintendent Tim Stainton said cybercrime was borderless and cannot be tackled by one country or agency alone.

“Working together and sharing knowledge with industry, government and law enforcement partners is crucial,” Detective Superintendent Stainton said.

“The intelligence we have gathered collaboratively throughout Operation Spincaster has shed a clear light on new tactics being used by cybercriminals in their continued efforts to defraud Australians. It will form a key part of our ongoing investigations to identify cybercrime victims and disrupt offenders in Australia."

Chainalysis Director of Investigations Phil Larratt said they were proud to work with Australian law enforcement agencies.

“The results of the operational sprints are enduring and create a positive impact in tackling a growing threat facing the community,” Mr Larratt said.

“We look forward to the continued success of these sprints and playing our part in enabling agencies in Australia and across the globe with the tools and expertise on this journey.”

AI social media accounts being used to amplify divisive politics

CyberCX Intelligence, a cyber security provider based in Australia and New Zealand uncovered a network of at least 5,000 inauthentic X/Twitter accounts used to amplify divisive political issues in Australia, the US, UK and other western democracies.

The network of accounts, which CyberCX dubbed the Green Cicada Network, is reportedly controlled by a Chinese-language Artificial Intelligence (AI) Large Language Model (LLM) and is linked to a researcher affiliated with Tsinghua University and Zhipu AI, a prominent Chinese AI company.

“With most of the accounts currently inactive, the network is likely an information operation capability in a development or experimental phase,” The statement read.

CyberCX Chief Strategy Officer Alastair MacGibbon said the Green Cicada Network is one of the largest ever documented networks of inauthentic accounts discovered on a social media platform.

“While most accounts in the network are dormant, we have observed the network addressing system errors and ramping up political activity in recent months,” Mr MacGibbon said. Make no mistake, this is a weapon that could be used to harm and undermine democracy in countries like Australia, the United States and the United Kingdom.”

The network was discovered by CyberCX Intelligence researchers in May when a cluster of X accounts began malfunctioning and producing the same AI-generated response.

According to CyberCX accounts linked to the network were creating or amplifying content related to Australian political issues, such as nuclear energy, recent allegations about CFMEU corruption, immigration policies and Australia’s relationship with China. Accounts also posted about civil unrest in the UK.

CyberCX Executive Director of Cyber Intelligence, Katherine Mansted said this network is consistent with a broadly observed shift in China’s approach to information operations and disinformation campaigns.

“Historically, Chinese information operations have focused on promoting pro-Chinese Communist Party ideologies. However, this approach has begun to pivot towards operations that mimic the Russian style of deepening polarisation by amplifying divisive views from multiple perspectives,” Ms Mansted said.

“The Green Cicada Network also highlights how generative AI is making scaled, malicious activity more accessible to an increasingly wide range of threat actors.

ANF Photo Competition

Congratulations to our winners

Thanks again to everyone who entered in our previous ANF Photo competition. Congratulations go to winner Annemarie, who has been working in nursing for 40 years, for her lovely photo of herself and her son (who is a Clinical Nurse at Perth Children’s Hospital) and her daughter (who is a nurse at Bunbury Regional Hospital). Annamarie has won a two-night getaway at the Rendezvous Hotel Perth Scarborough.

Submit your best photos and win

Second place goes to Ted for his excellent photo with remote are nurses Celia, Ciara and Susan, take while Ted was part of a cardiology clinic team visiting Warakurna.

Share your photos of yourself, your family or your team at work with any of our great ANF products and go in the running to win a range of great prizes. A selection of the best photos will feature in the next edition of the Western Nurse. All entries must include your name and your membership number to be in the running.

If you think you have a winning photo you can email your competition entry to us at western.nurse@anfiuwp.org.au

ELECTION RESULTS

ANFIUWP results

The results for the 2024 ANFIUWP Council election are as follows:

President - David Poole

Executive Members - Jane-Anne Gardner & Mark Olson

(Mr Olson’s position made vacant since the election)

Executive Members - Casual Vacancy - Kaitlyn Ellis

Councillors - Kirsten Mennell, Elaine Daniels, Jamie Puls, Brittany Toledo, Megan McDermott, Samantha Fenn & Jack Ling

Councillor - Casual Vacancy - Katarzyna Witek

ANMF WA Branch results

Branch Vice President: Jane-Anne Gardner

Branch Executive Committee: Samantha Fenn, Megan McDermott

Councillors: Jack Ling, Brittany Toledo, Kaitlyn Ellis, Melissa O’Brien Smith, Christine Heald

Fetal presentation in late pregnancy: a clinical update

Fetal presentation in late pregnancy: a clinical update

Read this article and complete the quiz to earn 1 iFolio hour

Read this article and complete the quiz to earn 1 iFolio hour

Fetal presentation refers to the part of the fetus that directly overlies the pelvis and is positioned to enter the birth canal first. 1 Fetal presentation is influenced by the fetal lie as the lie determines which part of the fetus is positioned over the pelvis. 1 The fetal lie is the longitudinal axis of the fetus relative to the longitudinal axis of the mother, it can be:1

• Longitudinal, where the fetal spine is parallel to the maternal spine

• Transverse, where the fetal spine is at a 90° angle to the maternal spine

• Oblique, where the fetal spine is neither parallel nor at a 90° angle to the maternal spine

• Unstable, where the fetus is continually changing position.

Fetal presentation becomes important in late pregnancy in preparation for birth. 2 The ideal fetal presentation for vaginal delivery, called the cephalic of vertex presentation, is the crown of the fetus’ head against the cervix, with their chin tucked into their chest.1,2 As the fetus’ head is the largest and least flexible part of their body, it is safest for the head to enter the birth canal first during a vaginal delivery.2 Any other fetal part entering the birth canal first increases the risk of obstructed labour and umbilical cord prolapse.2

Cephalic presentation is the most common fetal presentation; the fetus was in the cephalic presentation in approximately 94% deliveries in Australia in 2019. 3

FETAL ABNORMAL PRESENTATION

Abnormal presentation, also called malpresentation, occurs if the fetus is in any position other than the cephalic presentation.2 Abnormal presentation is caused by the fetal lie with the fetus’ brow, face, buttocks, leg, foot, shoulder, arm, or umbilical cord against the cervix (see Illustration 1).2

Abnormal presentation occurs in approximately one in 25 pregnancies. 2

CAUSES AND RISK FACTORS

The cause of abnormal presentation is not always identifiable, however the risk of abnormal presentation is increased by: 2

• A low lying placenta

• Amniotic fluid excess or deficit

• An abnormally shaped uterus

• Uterine problems, such as large fibroids

• Multiple pregnancy.

Abnormal presentation is also more common in first pregnancies, patients over 40 years of age, and patients who have had abnormal presentation in a previous pregnancy.2

TYPES OF ABNORMAL PRESENTATION

Types of abnormal presentation include breech presentation, face presentation, brow presentation, compound presentation, shoulder presentation, funic presentation, oblique lie, and unstable lie.2,4

Breech presentation occurs when the fetus is lying longitudinally with its buttocks or feet positioned to descend first into the birth canal.2,5 There are three types of breech presentation:2,5

• Complete breech is characterised by a buttock first presentation with the hips and knees flexed

• Frank breech is characterised by a buttock first presentation with the hips flexed, knees extended, and feet in proximity to the fetal head

• Incomplete or footling breech is characterised by a feet first presentation with one or both legs extended at the hip and knee joint.

Breech presentation is the most common type of abnormal presentation with a reported incidence of approximately 4.1%.3

Face presentation occurs when the fetus is lying longitudinally with its head positioned down, but with its neck completely extended and the occiput touching the fetal spine so the presenting part is the face.6 Face presentation is rare with a reported incidence of approximately 0.17%.6

Brow presentation occurs when the fetus is lying longitudinally with its head positioned down, but with its neck partially extended so the presenting part is the brow.6 Brow presentation is rare with a reported incidence of 0.03-0.2%. 6

Compound presentation occurs when a fetal extremity presents alongside the main presenting part.7 The most common compound presentation is a fetal hand or arm presenting with the head.7 Compound presentation is rare with a reported incidence of 0.07-0.4%.7

Shoulder presentation occurs when the fetus is lying transversely with a shoulder positioned to descend first into the birth canal.4

Funic presentation occurs when the umbilical cord is positioned between the fetal presenting part and the cervix.2,8 It is often caused by an oblique or unstable lie.2 Funic presentation is very rare with a reported incidence of 0.006-0.16%.8

Oblique lie occurs when the fetal head is high above the birth canal against the

Longitudinal lie Vertex Presentation

Longitudinal lie Breech Presentation

Transverse lie

Illustration 1: Fetal vertex longitudinal and transverse presentation.

maternal hip, with no particular fetal part presenting.1,2

Unstable lie occurs when the fetus is continually changing position with no particular fetal part presenting.2,4

ASSESSING FETAL PRESENTATION

Fetal presentation should be assessed as part of routine clinical examination at each antenatal visit in late pregnancy.5

Fetal presentation can be accurately identified from 36 weeks gestation through abdominal palpation, particularly if performed by an experienced health professional.1 The Leopold manoeuvre, a systematic method of abdominal palpation is generally used to determine fetal position, presentation, and engagement.5,9 The Leopold manoeuvre involves four manoeuvres:5,9,10

• Fundal palpation, also called the fundal grip, to locate the position of the fetal head

• Lateral palpation, also called the umbilical grip, to locate the position of the fetal spine, anterior shoulder, and extremities

• Palpation of the area above the symphysis pubis, also called Pawlick’s grip, to locate and assess the fetal presenting part

• Deep pelvic palpation to confirm presentation, assess the degree of mobility and flexion of the presenting part, and determine how far the fetus has descended.

An obstetric ultrasound should be performed to confirm fetal presentation if an abnormal presentation is suspected or there is any doubt as to fetal presentation following abdominal palpation.1,5 In cases of abnormal presentation an ultrasound can also establish the type of abnormal presentation.5

MANAGING FETAL PRESENTATION

Accurate identification of fetal presentation in late pregnancy, from 36 weeks gestation, can facilitate timely discussion, planning, and specialist referral as required.1

Abnormal presentation in late pregnancy can have a major impact on birth plans as abnormal presentation increases the likelihood of birth interventions, such as assisted delivery or caesarean section, being required.2

The management of abnormal presentation depends on the type of fetal presentation, the stage of pregnancy, and the response to interventions.2

External cephalic version

It may be possible to correct the fetal presentation by gently manoeuvring the fetus into a cephalic presentation using external cephalic version (ECV). 2

External cephalic version involves applying external pressure and firmly pushing or palpating the mother’s abdomen to coerce the fetus to change position into a cephalic presentation.1,5 Where available, and clinically appropriate, ECV should be offered to all women in late pregnancy with an abnormal fetal presentation.1,5 ECV should be performed by a health professional with appropriate expertise in a health setting with facilities for an emergency caesarean section.1,5 Tocolytics may be used to facilitate ECV and increase cephalic presentations.1

ECV has a reported success rate of 36.772.3%.1 If ECV is successful, routine antenatal care should continue as usual for a cephalic presentation.5

Relative contraindications to ECV include:1,5

• Multiple pregnancy

• Previous caesarean section

• Uterine anomaly

• Placenta praevia

• Oligohydramnios (abnormally low amniotic fluid)

• Current or recent vaginal bleeding

• Ruptured membranes

• Fetal anomalies or compromise.

Complications associated with ECV include transient abnormal cardiotocography patterns, persistent pathological cardiotocography, vaginal bleeding, and placental abruption.1

Delivery

There is no consensus on the optimal mode of delivery for a fetus that remains in an abnormal presentation at term.2,5 The appropriate delivery mode will depend on the type of abnormal presentation, individual maternal and fetal characteristics, the experience of the attending health professionals, and the facilities available in the healthcare facility.1,2

The benefits and risks associated with caesarean delivery and vaginal assisted delivery should be thoroughly explained to the patient to facilitate informed decisionmaking about their birth plan.1,2

REFERENCES

1. Australian Government Department of Health. Clinical Practice Guidelines: Pregnancy Care [Internet]. Canberra (Australia): Australian Government; 2020 [cited 2022 Mar 30]. Available from: https:// www.health.gov.au/sites/default/files/ documents/2021/02/pregnancy-careguidelines-pregnancy-care-guidelines.pdf

2. Healthdirect Australia. Pregnancy, Birth and Baby [Internet]. Malpresentation; 2020 [cited 2022 Mar 30]. Available from: https://www.pregnancybirthbaby.org.au/ malpresentation

3. Australian Institute of Health and Welfare. Australia’s mothers and babies [Internet]. Canberra (Australia): Australian Institute of Health and Welfare; 2021 [cited 2022 Apr 12]. Available from: https://www.aihw. gov.au/reports-data/population-groups/ mothers-babies/overview

4. Government of Western Australia North Metropolitan Health Service. Clinical Practice Guideline KEMH Postnatal Wards: Abnormalities of Lie/Presentation [Internet]. Perth (Australia): Government of Western; 2018 [cited 2022 Apr 12]. Available from: https://www.kemh.health.wa.gov.au/~/ media/HSPs/NMHS/Hospitals/WNHS/ Documents/Clinical-guidelines/ObsGyn-Guidelines/Abnormalities-Of-LiePresentation.pdf?thn=0

5. BMJ Best Practice. Breech presentation [Internet]. London: BMJ Publishing Group Ltd; 2021 [cited 2022 Apr 12]. Available from: https://bestpractice.bmj.com/topics/ en-us/668

6. Makajeva J, Ashraf M. Delivery, Face and Brow Presentation. 2022 [cited 2022 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK567727

7. Barth WH. Compound fetal presentation. 2021 [cited 2022 Apr 12]. In: UpToDate [Internet]. Waltham (MA): UpToDate Inc. Available from: https://www.uptodate.com/ contents/compound-fetal-presentation

8. Aguir R, Gomes JC, Rodrigues T. Cord presentation in labour: imminent risk of cord prolapse [Internet]. BMJ Case Rep. 2021 [cited 2022 Apr 12];14:e243320. doi: 10.1136/bcr-2021-243320

9. Superville SS, Siccardi MA. Leopold Maneuvers. 2021 [cited 2022 Apr 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing LLC. Available from: https://www.ncbi.nlm.nih.gov/books/ NBK560814

10. Peninsula Health. Shared Maternity Care Program Guidelines: Abdominal Palpation/ Auscultation of Fetal Hearth Rate [Internet]. Melbourne (Australia): Peninsula Health; 2018 [cited 2022 Apr 12]. Available from: https://www.peninsulahealth.org.au/wpcontent/uploads/Abdominal-Palpation-andAuscultation-Guideline.pdf

THE BRAIN

ACROSS

1 Disease, ailment (6)

5 Bag-like parts of an animal or plant full of liquid (4)

9 Original, uncensored version (5)

10 Human eggs (3)

11 Person’s ability to taste and assess the quality of good food or wine (6)

13 Flows back (4)

15 Painfully hit one’s toe on a hard surface (4)

16 Damaged body pumps, caused by a doomed love affair (6,6)

20 Someone dependent on drugs (4)

22 Property to rent (6)

24 Infectious disease that causes swelling in the neck and a slight fever (5)

25 Long thin object put inside a tube in the body so that its walls stay firm allowing bodily fluids to flow through (5)

27 Dismiss something as the cause of a disease (9)

28 All babies are born this way (5)

30 Ankle bones (5)

31 Killer whale (4)

33 Offer relief to bodily pain (4)

35 Infectious disease that leaves the sufferer feeling weak and fatigued for a long time (9,5)

39 Agile, lithe (4)

41 Long period of time (4)

42 Severe medical condition in which bacteria enter the blood after a surgical operation or an accident (6)

45 Water-carrying plant tissue (5)

46 Oxygen compound (5)

47 Things that come in twos, like kidneys or lungs (4)

48 Spurt out small droplets from the mouth when suffering from a cold (6)

DOWN

1 --- of the Human Heart, 1992 film (3)

2 --- Wayne, US rapper (3)

38

3 --- Nan, Chinese name for Vietnam (3)

4 Severe (of pain) (5)

5 Guide or control the movement of a vehicle (5)

6 Palindromic ABBA song (1,1,1)

7 Treatment for a fracture, used to immobilize a broken arm (4)

8 Suffering solar-caused damage to the epidermis (8)

12 Breezy (4)

14 Herb that contains some Vitamin K and C (5)

15 Hollow tube surgically placed in the brain to help drain cerebrospinal fluid and redirect it to another location in the body where it can be reabsorbed (5)

17 Deleted (6)

18 More robust (7)

19 Hair or bristle-like appendage on a larger botanical structure (3)

21 Run ---, go crazy (4)

10 Ova, 11 Palate, 13 Ebbs, 15 Stub, 16 Broken hearts, 20 User, 22 Rental, 24 Mumps, 25 Stent, 27 Eliminate,

23 Condition that develops when your blood produces a lower than usual amount of healthy red blood cells (7)

24 Simian animals that have sometimes been used for medical testing (7)

25 Embark on a journey (3,3)

26 Body organs containing tympanic cavities and ossicles (4)

29 Mournful dedication to a deceased person (5)

31 Make a speech (5)

32 Shopkeeper from The Simpsons (3)

34 Half (4)

36 One who gives an organ to another to help save their life (5)

37 Study of correct reasoning (5)

38 Goes up (5)

40 Govern as a monarch (4)

41 Ampere (abbrev) (3)

43 Litigate (3)

44 Female pronoun (3)

9

1

Across:

Malady, 5 Sacs,

Uncut,

28 Naked, 30 Tarsi, 31 Orca, 33 Ease, 35 Glandular fever, 39 Spry, 41 Aeon, 42 Sepsis, 45 Xylem, 46 Oxide, 47 Pair, 48 Sneeze.

Down: 1 Map, 2 Lil, 3 Yue, 4 Acute, 5 Steer, 6 SOS, 7 Casyt, 8 Sunburnt, 12 Airy, 14 Basil, 15 Shunt, 17 Erased, 18 Hardier, 19 Awn, 21 Amok,

23 Anaemia, 24 Monkeys, 25 Set off, 26 Ears, 29 Elegy, 31 Orate, 32 Apu, 34 Semi, 36 Donor, 37 Logic,

Rises, 40 Rule, 41 Amp, 43 Sue, 44 She.

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