November – December 2018
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WISHING ALL OUR MEMBERS A MERRY CHRISTMAS AND PROSPEROUS 2019
western nurse is the official magazine for ANF members in WA
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November – December 2018
FEATURED 3 4 7 20
Secretary’s Report ANF Elections Mark’s Q & A Recipe Corner
FAVOURITES 6 10 12 16 22
Internet Watch ANF Out ‘N’ About Across the Nation Around the Globe Research Roundup
HOLIDAY ANF 4 ANF Holiday Apartments – book now!
WIN! 23 Win Blu-rays, vouchers and ANF Cooler bags
CLINICAL UPDATES 8 14 18 19
Oral health: Nursing assessment and interventions STI checks for men in primary care Sertraline Cyclosporin
Talk to us... It’s your magazine. We want your feedback and story ideas! Editor Mark Olson Phone Freecall Fax Email Web
08 6218 9444 1800 199 145 08 9218 9455 anf@anfiuwp.org.au anfiuwp.org.au
Secretary's Report State Secretary Mark Olson
I want to start by thanking members for voting to have me serve another term in what I see as the most important job I’ll ever do – making a difference in the everyday lives of WA’s nurses, midwives and carers. I’ve personally endured six contested elections for State Secretary, and harrowing as they are I’ve always valued them because our members ultimately get to set the direction of their union, which is as it should be. We’ve had more Secretary elections in WA than all the other states combined over the last 24 years and I think it’s one of the reasons WA has better services and cheaper fees than the other states. Elections remind us that we are in these positions not only to lead, but most importantly to serve. Nearly half my life has been spent in service of ANF members in WA and it has been nothing short of a privilege despite the tribulations of fighting for a fair deal in an increasingly difficult public and private sector health environment. I will use my election mandate as always to keep improving conditions and services for members. And I feel optimistic as we continue increasing our membership as WA’s biggest union, with more than 31,000 members, that we are better and better equipped each year for the challenges before us, because let’s face it, whether it’s boom or bust in this State, it’s your professions at the frontline that are always being told to tighten their belts. So, at the end of a long and hard year, I want to remind you that your efforts out there are appreciated, that the people for whom you provide care still have faith in you and that what you do is still extremely important, never forget that. Our ANF Council, our staff and I wish you all a safe and merry Christmas, and I look forward to another successful year with you all in 2019.
Australian Nursing Federation 260 Pier Street, Perth WA 6000
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November – December 2018 western nurse |
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ANF ELECTIONS The ANF in WA recently concluded union and branch elections. We are proud to have had more elections than other State divisions and certainly more than our federal office. ANF State Secretary Mark Olson, who has successfully faced voters six times, believes elections are key to why the ANF in WA is so strong and member-focused.
Mark Olson has been returned as State Secretary in both the ANF WA Union and Branch elections – winning more than 75 per cent of the vote in each poll.
“I and the ANF team have been dealing with the challenges of a very important year for members – fortunately a lot of the work has been paying off,” he said.
And the rest of the team that has led your ANF Council in recent years was also renewed in the Union election on August 27.
“Shortly before the union election, after many months of the ANF trying to work with obstinate public sector bureaucrats to get rid of bullying appraisal meetings, I had a frank face-toface meeting with Health Minister Roger Cook and the Office of the Health Department Director General.
This includes Vice-Presidents Kerry Lee and Michael Clancy, and Executive Members Tanya Wooller and Beth Waters, who like Mark contested and won their positions. In the Branch elections that closed on October 23, Tanya Wooller, Kerry Lee, Glenda Watson, Ray Sinclair and Janet Reah were elected as full term Councillors, with Vince Mazoue filling the casual vacancy.
“As a result, the Health Director General’s Office ordered senior executives in the public sector to make it clear across the public health “I’ve personally endured six sector that there will not be mandatory contested elections for State meetings in any new review process to Secretary, and harrowing as replace annual appraisals.
Mark said he is humbled to be voted back in as Union and Branch State Secretary, but added he didn’t really have time to focus on the elections because his job has been continuing relentlessly before, during and immediately after the polls.
“Some hospital managers are still trying it on, but we’re letting members know the one thing they can count on is they are no longer obliged to attend an appraisal meeting – and they should contact us if anyone is bullying or coercing them to attend a meeting.”
they are I’ve always valued them because our members ultimately get to set the direction of their union, which is as it should be”
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He said at the same time the ANF also put an end to the Nursing and Midwifery Office depriving our members of qualifications allowances.
Mark said the elections may have come during an extraordinarily busy time, but he and the ANF Council are big fans of asking members who they want working for them.
“We stopped the NMO from removing previously approved midwifery qualifications from the official list and made sure they restored the ones they had taken off,” Mark said.
“I’ve personally endured six contested elections for State Secretary, and harrowing as they are I’ve always valued them because our members ultimately get to set the direction of their union, which is as it should be,” Mark said.
“The result was that members who had been deprived of allowances despite having previously approved qualifications got their allowances and they are also being backpaid from the time their qualification has been relevant to their job. “Then smack bang in the middle of the union election, we were also fighting to save jobs of members because of a redundancy program at Ramsay Health Care – and we managed to do that (save jobs) for many staff. “The union elections finish and we have the branch elections, but before, during and after those we were negotiating wages and conditions agreements in both the public sector and St John of God Health Care. “Negotiations for both are likely continuing as you read this. It’s been never-ending, but it’s an immensely satisfying job because we continue to get wins for our members, often against the odds.”
“Elections remind us that we are in these positions not only to lead, but most importantly to serve. I will use my election mandate as always to keep improving conditions and services for members. “2019 is set to be another big year for ANF members as the Federal Election approaches and opportunities arise to secure promises from the political parties to improve health and aged care sectors – let’s make sure we capitalise on these opportunities.” Full results of the WA Branch elections are on our website at https://www.anfiuwp.org.au/resources.php The Union election results are at Western Australian Electoral Commission’s website at https://www.elections.wa.gov.au
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November – December 2018 western nurse |
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InternetWatch AMAZING APPS + ONLINE NEWS
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FIVESuperSites Live Well Longer
This innovative resource helps older Australians explore the possibilities and identify the supports available to remain living at home. It contains resources drawing from the personal experiences of the developers and the challenges faced by people trying to engage with Australia’s emerging individualised aged care system. www.livewelllonger.com.au/
1st International Collection of Tongue Twisters
Quickly, say this out loud five times: Seventy seven benevolent elephants. Welcome to the largest collection of tongue twisters in the world. There’s more than 3500 of these things in many languages. Try one that’s not in your native tongue. We dare you! www.tongue-twister.net/
Comedy Wildlife Photography Awards
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Super Cute Kawaii
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Western Australian Museum
The WA Museum might be temporarily closed for rebuilding until 2020 but there are still plenty of options for visitors. Have a look for information on the new museum, five other locations, and plans for pop-up exhibitions across the State. Check out the cool online exhibits and records too. www.museum.wa.gov.au/
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western nurse November – December 2018
Mark’s
Your iFolio had a bit of a facelift this year, particularly with the new ANF Member Rewards and Offers section. So this edition we’re taking a look at services available on iFolio and the easiest ways to access them. Q. I’d like to make an appointment to speak to an Industrial Officer. What do I do? A. Click ‘Helpline’ on the top of iFolio. Then choose a date and time for an officer to call you on your preferred number. Q. I want to know what I should get paid. Where can I find that? A. Click ‘Employment’ on the top of iFolio. Then input your ‘Category’ – (e.g. registered nurse), and ‘Workplace’, such as ‘Public Sector’. Finally, input your ‘Level’. Private sector workplaces organisations are listed by name. If your workplace is not listed please select ‘click here’ under the heading ‘Payrates’ to contact the ANF or phone on 6218 9444. Under ‘Employment’ there’s also a ‘Curriculum Vitae’ section to help you create your own CV. Q. I’d like to do some continuing professional development. Where are the units and where do I record what I’ve completed? A. Click ‘Clinical Updates’ on the top of iFolio to access our online quizzes. After completing a quiz you can click on ‘My Achievements’ and you will see the clinical update you have just completed has been added. For CPD done outside iFolio (e.g. work organised CPD), click ‘Personal Achievements’, which is also under ‘My Achievements’. Once there, you can also access an ‘AHPRA Audit Log’. That’s where you can provide evidence such as your ‘Identified Learning Need’, which is extremely useful if you are audited. Q. I’m planning holidays and want to use the ANF Holiday Apartments, but I don’t know if they’ll be available and what the cost is. Where’s that information? A. Click ‘Holiday Units’ on the top of iFolio or in the bottom righthand square of the homepage. Margaret River and Kalbarri options are there, with available dates, unit categories, prices, and terms and conditions. You’ll be able to book accommodation and pay with your credit card. There’s also a ‘Frequently Asked Questions’ section.
Tips: For a better chance of getting the apartment you want and at the best price, consider taking leave outside school holiday periods. You can also avoid winter blues by having a warm midyear break in gorgeous Kalbarri. Q. I work in a public hospital. I want to see the ANF’s claim for the public sector wages and conditions agreement. Where’s that on iFolio? A. Click ‘Documents’ on the top of iFolio. This takes you to the Special Notices section. It’s under ANF Claim for the Public Sector EBA 2018. In the same section you’ll also find the ‘Professional Development Annual Declaration’ (which so far is the only document the ANF has approved as a replacement for appraisals) and other important documents such as statutory declarations. Q. I want to read western nurse online. I also want to enter the competitions in the magazine or the photo competition. How do I do this? A. Click ‘Resources’, then click the relevant heading. ‘Resources’ also has lots of other handy features such as merchandise, surveys and scholarships including the ANFIUWP Humanitarian Aid Volunteers Fund. Q. I’ve heard about the new member offers. I want to buy a refrigerator, what do I do? A. Firstly, click ‘Resources’, then go to ‘Offers’. Or get straight through by clicking the prominent square on the homepage titled ‘Member Offers’. Then click the relevant category – for whitegoods such as a refrigerator that would be ‘Home’. The business logos will come up and you can click them to get their specific offer.
Information provided on this page is general advice only. For information specific to your circumstances contact the ANF Helpline or send us your questions by email.
November – December 2018 western nurse |
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update: Oral health: Nursing assessment and interventions Other complications of poor oral health include: Read this article and complete the online quiz to earn 1 iFolio hour
POOR ORAL HEALTH Oral health has been classified as a major public health problem worldwide.1 Preventable diseases of the mouth, such as tooth decay (caries) and gum disease, are some of the most common diseases in the world.2 They are also among the most neglected.2 Prevention through improved oral hygiene is an important aspect of managing this growing burden of disease.2 Oral care is a necessary component of daily hygiene. However, there are many reasons why a patient’s oral hygiene may be poor. These include: • An inability to carry out oral care due to physical or cognitive impairment • Swallowing difficulties • Lack of knowledge or motivation • Poor access to dental services • Lack of access to oral care equipment, e.g. toothbrush, tooth paste, floss, or mouthwash, due to logistical barriers or cost • The use of medications that cause dry mouth or an unpleasant taste in the mouth. • A diet high in acidic and sugary foods and drinks • Smoking, high alcohol consumption and recreational drug use.1 The impact of poor oral care is wide-reaching. An accumulation of micro-organisms in the mouth, as a result of poor hygiene, has been linked to a variety of infections throughout the body including: • Blood – bacteraemia and septicaemia
• Tooth decay (caries), tooth loss, and gum diseases • Dry mouth (xerostomia) and bad breath (halitosis) • Worsening of chronic diseases, such as diabetes • Lack of appetite • Difficulty chewing and swallowing • Reduced nutritional intake, dehydration, and unplanned weight loss
an important role in identifying treatments and medications that may affect the oral health of their patients.1
ORAL HEALTH ASSESSMENT An oral health assessment begins with an oral health history to identify risk factors. This includes oral hygiene beliefs and practices, the current state of the individual’s oral health, and the presence and location of natural teeth, implants and dentures.1 There are a number of screening tools available to determine the need for a full oral assessment (see Table 1).6
• Pain and discomfort • Low self-esteem and poor self-confidence
A full oral assessment is carried out to:
• Increased risk of developing acute illnesses and chronic diseases
• Provide a baseline – initial information about the condition of the patient’s oral cavity
• Adverse pregnancy outcomes
• Allow a care plan to be developed that suits the patients’ individual needs
•
Extended hospital stays.1,4,5
ROLE OF NURSING IN ORAL HEALTH CARE Providing or directing oral care is part of a holistic approach to nursing in all care settings. It contributes to patient wellbeing and has a significant impact on patient outcomes.6 Oral health care has been described as being made up of three pillars: 2 1. Oral health assessments 2. Dental treatment 3. Daily oral hygiene To ensure a patient-centred approach to care, individuals and carers must be involved in decision making around the way oral care is delivered.1 All those involved in nursing care need to be aware of the different types of oral hygiene products available and which are best suited to different patient populations. Nurses also play
• Monitor progress of oral care and treatments • Identify any new problems.3,7 Standardised, validated and reliable oral assessment tools are available to help guide assessment of the oral cavity (see Table 2). An assessment identifies the condition of the teeth, gums, tongue, mucous membranes and lips, and the ability of the patient to perform effective self-care.7 Results of the assessment are used to develop an individualised oral care plan for each patient.
ORAL HEALTH INTERVENTIONS It is preferred that patients carry out their own regular oral care, wherever possible. Nurses may need to teach, encourage, support, or supervise patients to complete these activities.1,2 For patients who can’t manage oral care for themselves, maintaining a patient’s oral hygiene is an important nursing duty.3,5
Table 1: Oral care trigger questions6
• Heart – endocarditis
Question
Response
• Brain – meningitis
Teeth or dentures clean and free of debris
Yes/No
• Respiratory tract – pneumonia
Pink and moist tongue, oral mucosa, and gums
Yes/No
• Liver and gall bladder
Adequate saliva
Yes/No
• Vertebrae and prosthetic joints
Smooth and moist lips
Yes/No
• Chest cavity (mediastinum).1,3
If no to any of the trigger questions do a full oral assessment.
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Table 2: Examples of oral health assessment tools1
Tool
Populations of use
Oral Assessment Guide (OAG)
• For use in acute care settings, ICU, cancer centres, rehabilitation settings
Revised Oral Assessment Guide (ROAG) • Geriatric rehabilitation patients Brief Oral Health Status Examination • Long-term care and residential care settings (BOHSE) • Can be used with cognitively impaired patients Oral Health Assessment Tool (OHAT)
• Long-term care or residential care settings • Can be used with cognitively impaired clients
The Holistic and Reliable Oral Assessment Tool (THROAT)
• Elderly hospitalised patients
The frequency of oral care is determined by the oral assessment and the characteristics of the patient. A minimum of twice a day is required for optimal outcomes.1,3,7
Moisturiser for dry lips or artificial saliva for a dry mouth may also be indicated.3
TEETH CLEANING
Some of the risk factors for poor oral health are the same as for general health conditions and can be addressed as part of promoting healthy behaviours. These include smoking, alcohol misuse, and a poor diet.1,8
One of the most common and important oral care interventions performed by nurses is the proper cleaning of the teeth and gums. Debris and plaque can be removed from the teeth with a soft bristled brush and a small amount of fluoride toothpaste. All tooth surfaces are cleaned with a gentle rotational movement. The surface of the tongue, palate and gums can also be gently brushed.3,7 If a brush cannot be used due to gum tenderness or bleeding, foam sticks or cotton swabs may be used instead. These are moistened with water or non-alcohol based mouthwash.3,7 The mouth can also be rinsed with a nonalcohol based mouthwash if required.3,7 Dentures are removed and cleaned with a toothbrush or denture brush. Denture cleaning products are preferred as they are gentler than regular toothpaste.3 Any remaining teeth need to be brushed in the usual way, and the bare gums brushed with a soft toothbrush.1 Soak the dentures overnight to remove plaque and tartare and to rest the gums, reducing irritation and risk of infection.1
EDUCATION
Other important oral hygiene messages include: • Breastfeed babies and wean to a cup rather than a bottle • Clean teeth at least twice a day, last thing at night and at least one other time each day • Use a small-headed toothbrush with a small amount of fluoride toothpaste • Brush teeth and gums for at least two minutes • Spit out excess toothpaste but don’t rinse, rinsing removes the fluoride from the teeth • Use dental floss or tape to clean small spaces between the teeth • Parents or carers need to brush or supervise tooth brushing for children • Consider using a fluoride mouth wash once a day at a different time to brushing.2
REFERENCES 1. Registered Nurses’ Association of Ontario. Oral Health: Nursing Assessment and Interventions. Toronto, Canada: Registered Nurses’ Association of Ontario, 2008. 2. Coker E, Ploeg J, Kaasalainen S, Fisher A. A concept analysis of oral hygiene care in dependent older adults. Journal of Australian Nursing. 2013; 69(10): 2360–2371. 3. Albrecht M, Kupfer R, Reissmann DR, Mühlhauser I, Köpke S. Oral health educational interventions for nursing home staff and residents. Cochrane Database of Systematic Reviews 2016, Issue 9. Art. No.: CD010535. 4. Hill KE, Tuck A, Ranner S, Davies N, BolieiroAmaral, K. The use of a nursing oral and nutritional assessment tool to improve patient outcomes — one centre’s experience. Renal Society of Australasia Journal. 2014; 10(1): 6–10 5. Willumsen T, Karlsen L, Næss R, Bjørntvedt S. Are the barriers to good oral hygiene in nursing homes within the nurses or the patients? Gerodontology [internet]. 2012; 29(2): e748– e755. doi:10.1111/j.1741-2358.2011.00554.x 6. Stout M, Goulding O, Powell A. Developing and implementing an oral care policy and assessment tool. Nursing Standard. 2009; 23(49): 42-48. 7. Berry AM, Davidson PM, Nicholson L, Pasqualotto C, Rolls K. Consensus based clinical guideline for oral hygiene in the critically ill. Intensive and Critical Care Nursing. 2011; 27: 180–185 8. World Health Organization. Health Topics: Oral Care [Internet]. WHO, 2016 [cited 15 October 2016]. Available from: http://www.who.int/ topics/oral_health/en
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ANF Out 'N' About It’s the end of the year – so we’ll be soon choosing grand prize winners for the Out 'N' About Photo Competition! This edition we feature members from Fiona Stanley, St John of God Murdoch and Sir Charles Gairdner hospitals. The competition starts again next year – so make sure you’re in it to win it by getting your photo snapped when we visit your workplace. Merry Xmas and see you in the new year!
Sir Charles Gairdner Hospital Vivienne Perreau
Fiona Stanley Hospital Donna Beard and Jo Smith
St John of God Murdoch Rini Joseph and Jaya Prasanth
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western nurse November – December 2018
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ANF member Kirsty Haywood's nephew Sunny and her son Hudson having supper in the sunshine by the pool in Margaret River.
WINNERS! One of the winning entries in the ANF Holiday Unit Photo Competition shows ANF member Kirsty Haywood's nephew Sunny and her son Hudson enjoying supper in the sunshine by the pool in Margaret River at the ANF apartments. ANF members Rosie Brown and Paul Kirkby have won first prize in our ANF Futures Survey Competition – they each received a brand new top quality Dyson V10 vacuum cleaner! “I'm still expecting someone to tell me I'm on Candid Camera!” said Rosie, a manager of volunteers in palliative care at Busselton Hospice Care. “The vacuum is amazing and I'm genuinely delighted! “I honestly completed the survey without thinking about the prize. I feel as a union member I have a responsibility to provide feedback so the ANF is able to truly reflect the views of the membership. Winning the prize has come right out of the blue!” Rosie added: “I know how much effort goes into supporting members and appreciate the work the ANF does.” Paul, an enrolled nurse at St John of God Mt Lawley Hospital, said he was “rapt to win” the major prize. “I enter all the ANF competitions,” said Paul, standing next to his daughter Ella, both of them still celebrating their AFL team’s grand final win. He added “it will be great to test out the new vacuum cleaner on the pet hair”, pointing to their friendly dog who greeted western nurse at the gate.
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November – December 2018 western nurse |
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AcrosstheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA
AUS GERMAN MEASLES ELIMINATED IN AUSTRALIA The World Health Organization has declared that Australia has eliminated the devastating viral illness rubella. “The elimination of rubella is a great day for public health in Australia and sends a powerful message that vaccinations work,” said Australia’s Federal Health Minister Greg Hunt on October 31, in response to the WHO announcement. Also known as german measles, if contracted by women during the first 10 weeks of pregnancy, rubella can cause miscarriage or stillbirth, or life long problems for babies. Mr Hunt commended the efforts of “Australia’s health professionals over the decades and the millions of parents who ensure their children are always vaccinated”. “Our National Immunisation Program played an essential role in this huge achievement by ensuring high levels of vaccination coverage for rubella,” he said.
WA ADULTS DRUG TO HELP SICK PREM BABIES A drug used for decades to treat adults with poor circulation could have a new application in helping seriously ill premature babies. Pentoxifylline is being examined by WA researchers because previous small studies have suggested the drug could improve survival and reduce disability when included in the treatment of pre-term infants with severe infections. But little is known about the right dose to use, according to University of Western Australia Medical School Clinical Senior Lecturer Dr Sam Salman, who is working on the project with King Edward Memorial Hospital and Curtin University researchers. Their study examined using pentoxifylline on 26 premature babies born between 23 and 30 weeks and weighing between about 500g and 2kg, who had serious infections.
WA EARLY SPORT REDUCES FRACTURES LATER Playing sport in your childhood and teenage years results in stronger bone density in your early 20s – reducing risk of fractures later in life. Curtin University researchers examined data from the extensive Western Australian Pregnancy Cohort (Raine) Study and found that “young men and women with a history of consistently participating in sport had stronger and denser bones, compared to those who never participated in or dropped out of sport”. “As the development of maximum bone mass is during young adulthood, our findings recommend that early sports participation can help
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western nurse November – December 2018
He said he had only recently announced the “nation-wide immunisation rates for five-year-olds was 94.62 per cent, which is the highest figure on record”. “The science is in and the medical experts’ advice is absolute – vaccinations save lives and protect lives and they are an essential part of a healthy society,” the Minister said. Mr Hunt said Australia has had “rolling epidemics of rubella”. As late as the early 1990s there were 4,000-plus notified cases. At the time of Mr Hunt’s announcement, The West Australian newspaper reported: “WA’s immunisation coverage rates for one, two and five-year-olds are behind the national average.”
Size impacted concentrations of the drug, but also every additional week of life saw a 30 per cent increase in the organ function that metabolised the drug – which lowered concentrations. “We found that there was a six-fold difference in concentration of the drug despite dosing based on weight, suggesting that the current weight-based dosing may be improved by accounting for the age of each individual baby,” Dr Salman said. The drug, also known as Trental®, was developed in the 1970s and has multiple positive effects including i m p rov i n g b lo o d flow and reducing inflammation, according to UWA.
prevent osteoporosis and age-related fractures,” said Dr Joanne McVeigh, lead author of the report of the research that was recently published in the Journal of Bone and Mineral Research. Dr McVeigh, who is from Curtin’s School of Occupational Therapy, Social Work and Speech Pathology, also said: “Early childhood and adolescent years are critical for bone growth, as almost one-half of the amount of bone laid down during this period will be lost after the age of 50. “By participating in sports at a young age, it is expected that our bones will adapt to changes and increases in mechanical loading. “We found a strong connection between young males and females who participated in organised sport during childhood and stronger bone mass, meaning that those who gain optimal peak bone mass in young adulthood were more likely to have greater long-term benefits.”
VIC GETTING VITAMIN D WITHOUT GETTING BURNT
“We can print our ink on any paper-like surface to produce cheap wearable sensors in the form of wristbands, head bands or stickers for example,” he said of the research, which was recently published in the journal Nature Communications.
Personalised ultraviolet sensors that can be worn as a wristband are being developed to allow you manage your vitamin absorption without getting sun damage.
An RMIT statement on the discovery said while humans do need sun exposure to maintain healthy levels of Vitamin D, excessive exposure leads to “sunburn, skin cancer, blindness, skin wrinkling and premature signs of ageing”.
Victorian researchers created an ultraviolet active ink that changes colour when exposed to different types of UV rays. This can be printed and worn as a single use, disposable wristband to provide an accurate and simple measure of personal exposure levels throughout the day.
“Knowing what a healthy amount is for you depends on understanding your personal classification, from Type I to VI, as each has very different solar exposure needs,” said RMIT.
The colour-changing sensors come in six variations to reflect the range in human skin tone.
Professor Bansal said: “We are excited that our UV sensor technology allows the production of personalised sensors that can be matched to the specific needs of a particular individual."
Royal Melbourne Institute of Technology Professor Vipul Bansal said he developed the sensors as a result of a “personal struggle with vitamin D deficiency”.
"The low cost and child-friendly design of these UV sensors will facilitate their use as educational materials to increase awareness around sun safety.”
VIC ‘WEARABLE SKIN’ MONITORS BODY HEALTH
A number of successful wearable prototypes have already been developed from this unconventional gold nanowire film.
“Wearable electronic skin” that interacts with organs in your body to provide you real-time health monitoring via your smartphone has been created by Melbourne researchers.
Professor Cheng said the device is highly durable and portable which allows it to be worn or implanted into any part of the body. The group said it intended to apply the device to “real-world cases in the near future”.
Described as a “stretchable electronic device that can match the mechanical properties of soft tissue”, it can track health signals ranging from muscle strain and blood pressure, to cholesterol and glucose levels. Information can then be monitored on your smartphone via Bluetooth. Professor Wenlong Cheng, Dr Yan Wang and Dr Shu Gong from Monash University’s Faculty of Engineering spent three years researching, developing and patenting the ‘skin’. “Current healthcare treatment is hospital-centred because of our dependence on expensive, heavy diagnostic tools that are only available in specialised medical practices and require trained personnel to operate,” Professor Cheng said. “Wearable biodiagnostics can overcome this limitation and move towards better patient-centred healthcare.” Researchers developed the device by “placing extremely thin gold nanowires, each with a diameter equal to one thousandth of a human hair, in a clean elastomeric sheet that can be stretched up to nine times its original size without tearing”, according to a Monash statement. “Remarkably, trials have shown that the wearable skin can still provide 93 per cent data accuracy even after 2000 stretch and release cycles of up to 800 per cent strain,” the statement said.
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STI checks for men in primary care Read this article and complete the online quiz to earn 1 iFolio hour
Since the late 1990s, the incidence of Human Immunodeficiency Virus (HIV) is Australia has been increasing.1 This is due in part to the considerable investment that has been made in screening for HIV and other sexually transmitted infections (STIs).1 It has also led to a substantial increase in the recorded instances of chlamydia, syphilis, and gonorrhoea. The re-emergence of these conditions has been documented in a variety of developed countries including Australia, the United Kingdom, North America, and parts of Europe.1 Diagnosing STIs has the potential to disrupt transmission and encourage treatment, making effective screening a powerful tool in the fight against these contagious diseases.1
MALE PATIENTS AND THE RISK FOR INFECTION Sexually transmitted infections in males often remain undiagnosed. They often have no symptoms, or limited symptoms that clear quickly.2 Tests often need to be conducted under opportunistic screening, planned screening, and targeted testing identification strategies.2 Most importantly, where symptoms and risk factors suggest the presence of an STI, or where patients directly request screening, tests should always be performed.2 All men between the ages of 15 to 35 are considered high risk for an STI, especially those aged 15 to 19, living in communities with high rates of STIs, or who have suffered from an STI within the past 12 months.2 Other high risk indicators include the presence of two or more sexual partners in the past six months, a new sexual partner in the past three months, and drug and alcohol abuse.2
PERFORMING A BRIEF STI CHECK When there is not enough time to perform a full STI check, a brief STI assessment may be used. Brief assessments are often done as part of another consultation, during targeted screening operations, to test for re-infection at three months and/or opportunistically when a urine sample has already been collected.2
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A urine sample is collected and sent for Nucleic Acid Amplification Testing (NAAT) for chlamydia, gonorrhoea, and trichomonas, as well as a gonorrhoea culture test.2 The names of the patient’s sexual partners should be collected whenever possible so that contact tracing can be performed in the event of a positive result.2 A follow-up appointment should also be scheduled to discuss any results. When communicating with patients about STIs following a brief assessment, it is important that practitioners be very clear about what has been tested for, and what positive results may indicate. Brief STI checks only assess for the most common STIs. Therefore, if there are any positive results found, a full STI assessment is indicated.
PERFORMING A FULL STI CHECK Full STI checks are performed annually, as part of community screening, or on patient request. They should also be performed with the presence of STI-related symptoms, such as discharge from the penis, pain on passing urine, or sores.2
The procedure for the check includes a case history review, a patient discovery conversation, a physical assessment, urine and blood testing, and a follow-up appointment.
CASE HISTORY REVIEW AND PATIENT DISCOVERY The first step is to register the date and results of the patient’s last STI check, and to note whether any treatment programs were offered or completed. Hepatitis B status should also be recorded, if known. Next, the practitioner must ask about the patients’ current symptoms or experience, including whether they are experiencing discharge from the penis, pain on passing urine, and whether they have noticed sores, rashes, or lumps on their genitals. Finally, a discussion with the patient about their sexual partners is required. Relevant information includes the number of sexual partners over the past six months, including regular and casual partners, any new partners over the past three months, and whether partners have been male
or female.2 A discussion about other high risk behaviours, such as unprotected sexual activity and drug or alcohol use may also be considered at this time.
THE PHYSICAL ASSESSMENT Check to see if rash or hair loss is evident about the man’s body, including around the hands and feet. Also try to discover whether ulcers are evident in the mouth. Then, examine the groin for enlarged or tender lymph nodes, and if discovered check for swelling or tenderness at other lymph node locations. Finally, assess the penis, scrotum, and anus for sores, lesions, and other rashes. 2
COLLECTING SAMPLES FOR TESTING First catch urine samples are required from all men during an STI examination. In a full STI check, syphilis and HIV serology are also taken.2 Men who exhibit or complain of penile discharge should undergo two separate penile swabs, instead of (or in addition to) the first catch urine sample.2 If the patient is a man who has sex with other men, it is important that anal and throat swabs are also taken and tested separately for chlamydia and gonorrhoea. If the patient is 45 years or older and demonstrates urinary symptoms, midstream
urine may also be caught and tested for microscopy culture and sensitivities (MC&S) testing for urinary tract infection (UTI).3 If a second sample cannot be obtained, it is acceptable to perform this test instead of the first catch sample.2 If genital sores are present, a dry swab should be performed at the base of the ulcer/scab/ sore/lump. Alternatively, fluid from any blistering may be swabbed. This is used for NAAT for herpes, syphilis, and donovanosis (genital ulcers).2 If the patient’s hepatitis B status is unknown, or if there is no evidence of previous infection or immunisation, then HBsAG, Anti-HBc, and AntiHBs blood tests must be performed.2
COMMUNICATING THE RESULTS AND PLANNING NEXT STEPS Any evidence of an STI, such as the presence of symptoms, should immediately result in symptomatic treatment, with special care taken to treat pain and discharge, sores, ulcers, and rashes appropriately. Immediate treatment, even where symptoms are not present, may be appropriate in some cases. This includes individuals who are known contacts of other STI-positive patients and those in areas with high rates of STIs. In some high-risk environments it is advisable to immediately treat for gonorrhoea, in case
follow up treatment regimens cannot be maintained.2 Regardless of the test results, an STI check always offers an opportunity for education regarding safe sexual practices and methods for reducing the risk of infection. All patients should be encouraged to optimise their sexual health through regular screening and prevention, as indicated.
REFERENCES 1. Wilkinson et al. “Seek, Test, Treat” Lessons From Australia: A Study of HIV Testing Patterns From a Cohort of Men Who Have Sex With Men. J Acquir Immune Defic Syndr. 2015 Aug 1;69(4):460-5. doi: 10.1097/QAI.0000000000000613. 2. CARPA Standard Treatment Manual: A clinic manual for primary health care practitioners in remote and Indigenous health services in central and northern Australia. Central Australian Rural Practitioners Association Inc., Central Australian Aboriginal Congress, CRANAplus Inc., Flinders University through the Centre for Remote Health. 6th Edition. 2014. Available at: http://remotephcmanuals.com.au/publication/ stm.html 3. RCPA Manual [Internet]. The Royal College of Pathologists of Australia. Available from: https://www.rcpa.edu.au/Library/PractisingPathology/RCPA-Manual/Items/PathologyTests/M/MCS-urine
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AroundtheGlobe WORLD NEWS
US PATIENTS GET PIRATES’ DISEASE
In a recently released documentary called Vitamania, he said “many people who have difficulty affording food tend to go for food that is high fat, high calorie, and very filling” because that “will fill you up and will satisfy you more than eating fruits and vegetables”.
Crusaders, seafaring explorers and pirates suffered from it centuries ago – yet scurvy is occurring right now in the USA among patients of low socio-economic status.
ScienceAlert added that a 2016 ABC report from Sydney’s Westmead Institute for Medical Research also described scurvy occurring in a group of Australian diabetes patients. But their main issue was overcooking vegetables so much that vitamin C was destroyed.
Dr Eric Churchill, who practises medicine in Springfield, Massachusetts, said his team over the past six years has diagnosed 20 and 30 new cases of the disease, which is caused by vitamin C deficiency.
Tomatoes, oranges, peppers, guavas, strawberries, and coriander are among excellent sources of vitamin C.
“Bleeding gums, decaying teeth, thinning hair and overwhelming fatigue were the symptoms that drove Sonny Lopez from Springfield, Massachusetts to (Dr Churchill),” said the website ScienceAlert, describing the circumstances of one of the cases. Dr Churchill said: “We diagnosed our first case about five to six years ago. The initial case came through the hospital and was quite dramatic, someone with a mental health issue who would only eat bread and cheese. Between then and now we have diagnosed somewhere between 20 and 30 cases of scurvy.” Dr Churchill believes the reoccurrence of the disease is just another example of how “socio-economic inequality” harms people. “These people have ended up falling victim to an illness that simply should not exist in a developed country,” he said.
QUICK CONVALESCENCE FROM QUITTING CANNABIS Quitting cannabis for even just a week can lead to improved memory, US scientists have found. A study of 88 adolescents and young adults aged 16-25 years who used cannabis regularly showed that marijuana-abstinence participants “had better memory overall and at weeks one, two, three” of abstinence, compared with non-abstinence candidates. The participants – recruited by researchers from Boston’s Massachusetts General Hospital from the community and a local high school between July 2015 and December 2016 – were randomly assigned to four weeks of cannabis abstinence. “There was an effect of abstinence on verbal memory … that was consistent across four weeks of abstinence … and was driven by improved verbal learning in the first week of abstinence,” said the researchers in their study recently published in the Journal of Clinical Psychiatry. “(But) there was no effect of abstinence on attention.” The researchers concluded: “This study suggests that cannabis abstinence is associated with improvements in verbal learning that appear to occur largely in the first week following last use. “Future studies are needed to determine whether the improvement in cognition with abstinence is associated with improvement in academic and other functional outcomes.”
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ORAL HYGIENE MAY HELP WITH DIABETES Treating periodontitis might help Type 2 diabetes sufferers manage blood glucose levels.
Lead researcher Professor Francesco D’Aituo, of the UCL Eastman Dental Institute, said: “Gum disease is closely linked to diabetes and it is well known that it can lead to a higher blood glucose level as well as chronic inflammation around the body, which both could promote the development of kidney and vessel damage if sustained for long periods of time.
More than 250 patients with poorly controlled diabetes and active periodontitis, commonly known as gum disease, took part in an oral health study led by University College London.
“This is the first long-term, randomised study to show a substantial benefit of treating gum disease on diabetes control. Lowering blood glucose level by 0.6% is the equivalent of prescribing a patient an additional, second blood sugar lowering drug.”
“After 12 months, those who … received the more intensive gum therapy had reduced their blood glucose level by on average 0.6 per cent,” the university said of the study, which was published in the Lancet Diabetes and Endocrinology journal.
The study’s senior author, Professor John Deanfield, of the UCL Institute of Cardiovascular Sciences, said: “Inflammation may be part of the biological pathways that lead to several health conditions including diabetes, heart disease, dementia and cancer.”
“The participants also showed reduced chronic inflammation – which could lower their risk of serious diabetes-related complications, such as heart disease, stroke and kidney disease.”
He said the findings “are exciting and could lead to new strategies to improve care (and) large-scale clinical outcome trials should now be designed”.
‘THE PILL’ COULD CUT OVARIAN CANCER RISK
stopping use), or former users (>1 year after stopping use) of different hormonal contraceptives”.
Women taking hormonal contraception have significantly less chance of getting ovarian cancer, a study of nearly 1.9 million female subjects has found. Such contraception “prevented 21 per cent of ovarian cancers” among the study’s participants, concluded a report of the research published in September in the prominent UK medical journal The BMJ. The assessment by researchers from the University of Aberdeen and the University of Copenhagen was based on information provided by 1,879, 227 women in Denmark aged 15-49 years, from 1995 to 2014. Participants were categorized as “never users” and “current or recent users (≤1 year after
DOGS SNIFF OUT MALARIA The “first rapid and non-invasive test for malaria” could soon be possible because of clever dogs. Pooches can be trained to detect the scent of the deadly mosquitotransmitted disease in samples of socks worn by infected children, according to researchers at the UK’s Durham University. “While our findings are at an early stage, in principle we have shown that dogs could be trained to detect malaria infected people by their odour with a credible degree of accuracy,” said principal investigator Professor Steve Lindsay, of the university’s Department of Biosciences. “This could provide a non-invasive way of screening for the disease at ports of entry in a similar way to how sniffer dogs are routinely used to detect fruit and vegetables or drugs at airports. “This could help prevent the spread of malaria to countries that have
“Based on the relative risk for the never use versus ever use categories of hormonal contraception … the population prevented fraction was estimated to be 21 per cent – that is, use of hormonal contraception prevented 21 per cent of ovarian cancers in the study population,” said the BMJ report. There was, however, “little evidence of major differences in risk estimates by tumour type or progestogen content of combined oral contraceptives”. And “use of progestogen-only products were not associated with ovarian cancer risk”. The researchers concluded that: “Use of contemporary combined hormonal contraceptives is associated with a reduction in ovarian cancer risk in women of reproductive age – an effect related to duration of use, which diminishes after stopping use. These data suggest no protective effect from progestogen-only products.”
been declared malaria free and also ensure that people, many of whom might be unaware that they are infected with the malaria parasite, receive antimalarial drug treatment for the disease.” Researchers from The Gambia in West Africa and London used nylon socks to collect foot odour samples from apparently healthy children aged five to 14 in the Upper River Region of The Gambia. The samples, which comprised samples from 30 malaria-positive children and 145 from uninfected children, were transported to the Medical Detection Dogs charity in Milton Keynes in the UK, where dogs were trained to distinguish between the scent of children infected or not infected with malaria parasites. “The dogs were able to correctly identify 70 per cent of the malaria-infected samples. The dogs were also able to correctly identify 90 per cent of the samples without malaria parasites,” said the university. November – December 2018 western nurse |
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Illustration 1: Mechanism of action of SSRIs.4
update: Sertraline other alternative antidepressants, opioids such as fentanyl, stimulants, illicit drugs and other agents. Therefore, transitions between antidepressants should be done carefully, under the supervision of an appropriately trained medical profession.2 Sertraline is in the Australian pregnancy category C (may cause harmful effects on the human fetus or neonate without causing malformations). Maternal use in late pregnancy has the potential to cause neonatal toxic symptoms and selflimited withdrawal effects.2 Selective Serotonin Reuptake Inhibitors are indicated for postnatal depression, and sertraline is a preferred treatment for breastfeeding mothers.2 Evidence to support the use of SSRIs for the treatment of childhood depression is limited. All children should see a psychiatrist prior to commencing treatment.2
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Generic Name: Sertraline Trade Names: Sertra, Sertracor, Setrona, Eleva,
Xydep, Zoloft Drug Class: Selective Serotonin Reuptake Inhibitors (SSRIs)
INDICATIONS Sertraline is one of the most commonly prescribed antidepressants in Australia.1 It is also used to treat obsessive-compulsive disorder, panic disorder, social phobia and premenstrual dysphoric disorder (see Box 1).2
ADVERSE EFFECTS Common adverse effects associated with the use of SSRIs include nausea, diarrhoea, agitation, insomnia, drowsiness, tremor, dry mouth, headaches, weight gain or loss, and sexual dysfunction. Extrapyramidal reactions including tardive dyskinesia (involuntary movements of the face and jaw) and dystonia, and electrolyte disturbances may also occur. Rarely, liver complications, blood dyscrasias and other conditions such as seizures may arise.2
Box 1. Premenstrual dysphoric disorder.3
Premenstrual dysphoric disorder is a severe mood disorder characterised by physical, affective and/or behavioural symptoms, which arise within a week of the onset of menses. Potential symptoms include affective lability (mood swings), irritability or anger, depressed mood, anxiety, loss of interest in usual activity, lack of energy, changes in appetite or sleep, breast tenderness, breast swelling or bloating.
DOSING AND ADMINISTRATION Table 2. Dosing and administration of sertraline.2
Indication
Dose
Description
Major depression
Adults: 50mg once daily
Increase as required to a maximum of 200mg daily.
Obsessivecompulsive disorder
Adults, children over 12 years: 50mg once daily
Increase as required to a maximum of 200mg daily.
MECHANISM OF ACTION These medications prevent the reuptake of serotonin in the presynaptic terminal.2 Serotonin (5-hydroxytryptamine) is a neurotransmitter that functions in mood and arousal, as well as the modulation of pain and gut regulation.4 Decreased transmission of serotonin in the central nervous system is associated with a wide range of affective disorders, including depression and mania. By preventing reuptake, These medications increase the concentration of serotonin in the synapse between the neurons and improves serotonergic transmission in the brain (see Illustration 1).4
Children 6-12 years: 25mg once daily Panic disorder, social phobia
Adults: 25mg
PRECAUTIONS These medications should be used cautiously in individuals with epilepsy, bipolar disorder, angle-closure glaucoma and in those with a high risk of bleeding. There is a potential for drug interactions when used in combination with other prescription and non-prescription medications. Treatment with drugs that may cause hyponatraemia may increase the risk of drug-induced hyponatraemia. Serotonin toxicity may arise with concurrent use of these medications and moclobemide or monoamine oxidase inhibitors (MAOIs), as well as some
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Premenstrual dysphoric disorder
Adults: Continuous treatment – 50mg once daily Cyclic treatment – 50mg once daily, 14 days prior to menses.
May increase to 50mg once daily after one week depending on response and tolerance May increase to 50mg once daily after one week depending on response and tolerance Use the lowest effective dose and frequently reassess the need for continued treatment.
COMPARATIVE INFORMATION All SSRIs (citalopram, duloxetine, escitalopram, fluoxetine, fluvoxamine, paroxetine and sertraline) share equivalent effectiveness for the treatment of depression. Only sertraline and fluoxetine are advertised for premenstrual dysphoric disorder in Australia (although evidence to support efficacy remains limited). Compared to fluoxetine, sertraline has a shorter half life (24 hours versus 16 days) and a lower potential for drug interactions.2 The rise of antidepressant use in Australia: effective or excessive treatment? Antidepressants are the most commonly prescribed psychotropic drugs in the world. Between 2000 and 2011, there was a 95.3% increase in the defined daily dose of antidepressants/1000 people/day in Australia, despite a lack of new medications and minimal advances in treatment.1 On one hand, it seems antidepressants are being used for too broad a population and for too long without considering alternative interventions.5 While antidepressants are effective for treating major depression, evidence suggests limited benefits for those with mild to moderate symptoms.5 Broad use of SSRIs has the potential to increase the risk of adverse effects and complications,1 and may reduce the likelihood of accessing more beneficial treatments. On the other hand, depression remains underdiagnosed and there is a well-documented pattern of individuals failing to access treatment for mental health conditions in Australia. This may suggest that there is a need for more rather than less antidepressant use, especially if it results in a reduction in suicide rates.5 Overall, thorough assessment, follow-up, titration and trial weaning of medications in stable individuals is paramount to ensure appropriate use of anti-depressants in all cases.
REFERENCES 1. Stephenson CP, Karanges E, McGregor IS. Trends in the utilization of psychotropic medications in Australia from 2000 to 2011. Aust N Z J Psychiatry. 2013 Jan;47(1):74-87. 2. Australian Medicines Handbook 2016 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2016 July. 3. Hantsoo L, Epperson CN. Premenstrual dysphoric disorder: epidemiology and treatment. Curr Psychiatry Rep. 2015 Nov;17(11):87. 4. Rhoades RA, Bell DR, editors. Medical Physiology: Principles for Clinical Medicine. 4th edition. Baltimore, MD: Lippincott Williams & Wilkins; 2013. 5. Mitchell P. Are antidepressants over-prescribed in Australia? The Conversation [Internet]. 2013 Jan 25 [cited 2016 Sep]. Available from: https:// theconversation.com/are-antidepressants-overprescribed-in-australia-11788.
Cyclosporin Table 1. Drug interactions with cyclosporin.1
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Generic name: Cyclosporin, ciclosporin, cyclosporine Brand names: Neoral, Sandimmune Drug Class: Calcineurin inhibitors
INDICATIONS Cyclosporin is an oral or injectable medication with a wide range of clinical indications including prevention of transplant rejection, nephrotic syndrome, rheumatoid arthritis, and psoriasis or atopic dermatitis.1 It has been consistently used for immunosuppression post solid organ transplant for more than 20 years.2 It is also considered acceptable for use with immune and inflammatory conditions such as ulcerative colitis and aplastic anaemia.1
MECHANISM OF ACTION Cyclosporin is a lipophilic cyclic peptide. It is an effective immunosuppressant that prevents both the cell-mediated and humoral immune response.2 It competitively binds to calcineurin in the cytoplasm of human cells, which blocks transmission of the cytokine genes required for the synthesis of interleukin-2, tumour necrosis factor and related cytokines, and limits T cell proliferation and differentiation.1,2
PRECAUTIONS Cyclosporin is contraindicated in nontransplant patients with uncontrolled hypertension or renal impairment, as well as in those with an allergy to solubiliser (an intravenous product), concurrent malignancy, untreated infection, or hypersensitivity.1,2 It may be considered for individuals with renal damage caused by an underlying disorder, when all other treatments have failed.1 Caution should be taken when using calcineurin inhibitors while breastfeeding and with concurrent treatment with a wide range of medications (see Table 1).
ADVERSE EFFECTS Cyclosporin is associated with a range of serious adverse effects including gingival hyperplasia, hirsutism, nephrotoxicity, hypertension, hypercholesterolaemia, neurotoxicity, raised aminotransferases, electrolyte imbalance,
Drugs
Risk
Recommendation
Nephrotoxic agents including non-steroidal anti-inflammatories, aminoglycosides and contrast media
Additive nephrotoxicity (worsening renal failure)
Avoid if possible
Potassium, potassium-sparing diuretics, ACE inhibitors, sartans
Hyperkalaemia
Use cautiously, regular monitoring required
hyperglycaemia, diarrhoea, and diabetes.1 Acute nephrotoxicity is dose-related and reversible. In contrast, chronic nephrotoxicity may be irreversible resulting in permanent renal damage.1 Other potential adverse effects include muscle weakness, myopathy, haemolytic uraemic syndrome, and allergies.1
DOSAGE The dose and route of cyclosporin administration is dependent on the indication (see Table 2). Post-transplant, individualised doses are determined by the relevant specialist, based on local protocols and the type of transplant performed.1
ADMINISTRATION Oral cyclosporin is available as liquid or capsules. It exists in a modified or nonmodified formulation. Both versions have large variability between users, which is influenced However, the modified by ethnicity.1 formulation creates a microemulsion, which is more consistently absorbed than the nonmodified version.1 Storage and methods of administration of oral formulations are important. The medication must be stored around room temperature (approximately 20-30 degrees Celsius). It is best administered at consistent times, around oral intake and 12 hours apart.1,2 Depending on its formulation, it may be administered with milk (non-modified), chocolate milk (non-modified), orange juice or apple juice.2
It should not be administered using a plastic cup or fork, as the medication will adhere to plastic.2 Regular oral hygiene is recommended to prevent complications such as bleeding, swelling and tenderness of the gums.1 Intravenous cyclosporin is more likely to cause toxicity and should only be used when oral administration is not possible.2 Intravenous doses must be diluted to 1:20 or 1:100 in 5% glucose or 0.9% sodium chloride and administered via a glass container with a nonPVC giving set.1
MONITORING Frequent monitoring is required in transplant patients (and other patient populations) in order to titrate cyclosporin doses and screen for toxicity. Whole blood concentrations are measured with a trough level and two hours post-administration or using timed collections to determine the area under the curve.1 Other relevant blood tests include full blood count, renal and liver function tests, blood glucose concentrations, lipids and electrolytes.1
REFERENCES 1. Australian Medicines Handbook 2015 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2018 July. 2. Hardinger K, Magee CC. Pharmacology of cyclosporine and tacrolimus [Internet]. Wolters Kluwer; 2016 Nov 25 [cited 2016 Dec 19]. Available from: http://www.uptodate.com/contents/ pharmacology-of-cyclosporine-and-tacrolimus
Table 2. Cyclosporin dosing (recommended initial doses, specialist advice is always required).1 Indication
Dose
Schedule
Prevention of transplant rejection
Adult or child (oral): 8-15mg/kg/day Adult (oral; when used with diltiazem): 3-8mg/kg/day
Commence within 12 hours of surgery Maintain dose for 1-2 weeks post surgery then gradually reduce to maintenance dose Give as 2 divided doses per day
Nephrotic syndrome
Adult (oral): 5mg/kg/day Child >1 month (oral): 6mg/kg/day Adult or child with renal impairment (oral): <2.5mg/kg/day
Give as 2 divided doses per day Cease if no improvement after 3 months
Immune and inflammatory disease
Adult (oral, initial dose): 2.5-3/kg/ day Adult (maintenance dose): 2.55mg/kg/day
Increase dose by 0.5-1 mg/kg/day in 1-2 month intervals (max 5mg/kg/day) Give as 2 divided doses per day
Severe ulcerative colitis
Adult (continuous IV infusion): 2mg/kg/day
Change to oral dosing as soon as possible
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EASY CHRISTMAS HAM A Christmas table doesn’t feel as festive without a succulent baked ham at the centre. It pulls the feast together like no other dish can. And who doesn’t look forward to eating leftover ham for days? But cooking a ham worthy of being at the centre of family tradition can be daunting, especially when you’re already time-poor this time of year. We make it easy for you in this recipe. Buy pre-cooked ham that’s been smoked or cured from your local butcher (but you may need to put in an order weeks in advance) and finish it off in the oven at home with a delicious glaze. Then you’ll have the juicy, moist, glazed ham you deserve this holiday season.
Come and learn Jamie Oliver’s hints, tips and shortcuts to cooking delicious and affordable meals from scratch! JAMIE’S MINISTRY OF FOOD WOULD LIKE TO WISH ALL THE MEMBERS OF THE ANF IN WA A VERY MERRY CHRISTMAS AND A HAPPY NEW YEAR.
WE’LL BE BACK IN 2019, SO WATCH THIS SPACE FOR MORE COURSES. BEST WISHES JAMIE’S MINISTRY OF FOOD AUSTRALIA
jamiesministryoffood.com.au
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EQUIPMENT
INSTRUCTIONS
• Cuisinart 2pc Carving Set
1. Preheat oven to 180C.
• Ironwood Gourmet Pyramid Carving Board
2. Add the orange marmalade, fresh orange juice, Dijon
mustard, honey, and crushed garlic to a saucepan. Cook over low heat until the mixture begins to bubble. Reduce the heat and allow to simmer until the mixture becomes a dark, sticky glaze. Set aside.
• Chasseur Roasting Pan 40x26cm • Roasting rack • Saucepan
3. Use a sharp knife to remove the rind of the ham from
the fat. Then score the ham in a diamond pattern. Make long lines across the ham in one direction then repeat in the other direction.
• Garlic crusher • Ladelle Merry Bauble Ham Bag 44x55cm
4. Place the roasting rack in the Chasseur roasting pan
• Knife
and the ham on the rack. Insert a clove at the crossings to follow the diamond pattern.
INGREDIENTS
5. Baste ham with the glaze and bake for about half an
• Cooked leg ham, approximately 4kg
hour or until golden and caramelised, making sure to continue basting the ham while cooking.
• 1 cup orange marmalade • 2 tbsp fresh orange juice
6. Once the ham is cooked, place it on the Ironwood
• 2 tbsp Dijon mustard
carving board. Use the Cuisinart carving fork to hold the ham and the knife to cut slices across the ham.
• 1 cup honey • 2 cloves garlic, crushed
7. Store leftover ham in the Ladelle drawstring ham bag
• Salt and cracked black pepper
to keep it fresh and ready to eat.
• Whole cloves, for garnish
Recipe published courtesy of Kitchen Warehouse
15
ANF15
ANF MEMBERS
$
OFF When you spend over $50
Present this voucher in-store or enter promo code at online checkout to redeem this offer
Excludes appliances, workshops & gift vouchers. One use per customer. Valid until 20/02/19
AUSTRALIA’S #1 IN KITCHENWARE SHOP ONLINE AT WWW.KITCHENWAREHOUSE.COM.AU
November – December 2018 western nurse |
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ResearchRoundup LATEST AND GREATEST FROM SCIENCE QIMR Berghofer Medical Research Institute researchers, who led the study and worked with collaborators from the University of Queensland, said early results are “very promising” for a new treatment for melanoma and DFTD. “When we tested the Australian spider peptide on human melanoma cells in the laboratory, it killed the majority of them. We also found the peptide slowed the growth of melanomas in mice,” said Dr Maria Ikonomopoulou of QIMR. She said the funnel web peptide was also better at killing melanoma cancer cells and stopping them from spreading than a Brazilian spider peptide previously studied for its anti-cancer properties.
FONT THAT FIXES FORGETFULNESS A new font that helps you retain more of what you read has been created by Melbourne researchers. Sans Forgetica has “varying degrees of ‘distinctiveness’ built in” that differ from design principles normally associated with conventional typography. “These degrees of distinctiveness cause readers to dwell longer on each word, giving the brain more time to engage in deeper cognitive processing, to enhance information retention,” said RMIT University, where the font was developed. RMIT Senior Marketing Lecturer (Experimental Methods and Design Thinking) Dr Janneke Blijlevens said typical fonts were very familiar. “Readers often glance over them and no memory trace is created,” she said. But if a font is too different, the brain cannot process it and the information is not retained. “Sans Forgetica lies at a sweet spot where just enough obstruction has been added to create that memory retention,” Dr Blijlevens said. About 400 Australian university students participated in a laboratory and online experiment conducted by RMIT to determine which font, among several with various “obstructions”, resulted in the best memory retention. Sans Forgetica, which is likely the world’s first typeface specifically designed to help retain more information and remember more of typed study notes, is available for free at http://sansforgetica.rmit/
DEADLY SPIDER MAY HOLD CANCER CURE FOR HUMANS AND MARSUPIALS A compound extracted from the lethal Australian funnel-web spider kills melanoma cells extremely effectively, a Queensland study has found. The spider-derived peptide also terminates cells from the Devil Facial Tumour Disease (DFTD) that is devastating populations of Australia’s largest carnivorous marsupial, the Tasmanian devil.
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western nurse November – December 2018
Additionally, the researchers found the Australian peptide did not affect healthy skin cells as much as the Brazilian peptide for both melanoma and DFTD. “We also experimented with different versions of the compound to try to find which one would be best at killing the DFTD cells,” Dr Ikonomopoulou said. “When we altered two particular amino acids in the peptide chain, the compound became even better at destroying the DFTD cells.”
NUGGETS WITHOUT KILLING THE CHICKEN Growing chicken meat in a lab in just two days by using cells from a single feather without killing the bird is now a reality. A San Francisco-based food business called Just, which created the meat, even has a video on its website showing the source of the feather, a healthy white chicken named “Ian”, running near a group of people eating nuggets created from its cells. “Just Meat is made in a process similar to brewing beer, yeast grown for breadmaking, rennet used to make cheese, and other foods made by large-scale cell culture,” the website said, adding that the cells in its lab bioreactor are fed plant-based nutrients. The company purports its process is safe being “free of antibiotics” and having “a much lower risk of foodborne illness”. Just also points to environmental benefits, saying “preliminary analyses show significant reductions in land use, water use, Greenhouse Gas emissions, and energy use”. The company said JustMeat would be commercially available “by the end of 2018” and that “Ian is now spending his days at a sanctuary in Northern California”. In October, BBC news correspondent James Cook, who sampled nuggets at Just’s facility said: “It’s really tasty. It tastes like chicken.” However, he added: “The physicality, the feel of it in your mouth is slightly different.”
WIN WIN WIN WIN Kitchen Warehouse vouchers Members have indicated they really, really, really like our Kitchen Warehouse voucher prizes! So another 30 gift vouchers are up for grabs to spend on the wonderful products in Kitchen Warehouse stores.
PADDINGTON’S ADVENTURES ON BLU-RAY – WIN ONE OF 30 DOUBLE-FILM PACKS! It’s been 60 years since the first print appearance of a certain ultra-polite, marmalade-loving bear, who lives in London but is originally an orphan from Peru. We are of course describing the one and only Paddington Bear. The anniversary seemed a good excuse to offer ANF members a chance to win the two charming films based on Michael Bond’s much-loved character. Given it’s Xmas, we thought we’d skip the usual movie plot synopsis and provide some Paddington fun facts instead:
3. Paddington (2014) and its sequel Paddington 2 (2017) have become two of the highest grossing UK independent films in modern history, according to the UK’s Press Association. Empire movie magazine exalts the first film, Paddington, as “marmaladen with gloriously silly jokes, pitch-perfect performances and incidental detail”, concluding “this is a warm, witty and wondrously inventive great big bear-hug of a movie”. The prestigious film publication doesn’t hold back the praise on Paddington 2 either, commenting that “it should be prescribed as an antidote to anyone who finds the madness of the modern world a bit wearing”. The reviewer adds: “It’s probably possible to not absolutely love it, but it’s hard to see how.”
1. Before he was a book, Paddington was a real teddy bear. “I bought a small toy bear on Christmas Eve 1956,” says Bond on the official Paddington website. “I saw it left on a shelf in a London store and felt sorry for it. I took it home as a present for my wife Brenda and named it Paddington as we were living near Paddington Station at the time. I wrote some stories about the bear, more for fun than with the idea of having them published. After 10 days I found that I had a book on my hands.” 2. The first book, A Bear Called Paddington, was published on October 13, 1958. By 1965, Bond’s books were so successful he was able to quit working for the BBC and become a full-time writer. They’ve sold more than 35 million copies worldwide and have been translated into more than 40 languages, including Latin!
FLEET NETWORK WINNER!
SUMMER FUN MADE EASIER WITH OUR SPECIAL ANF COOLER BAGS – 500 TO BE WON! ANF Cooler Bags are perfect for lazy days at the beach, summertime picnics or even for keeping shopping items from overheating til you can refrigerate them. Since we’re giving you a shopping bag with this edition, we thought we’d also give you a chance to win its chillier sibling. With 500 ANF Cooler Bags to be won, you’ve got a great chance of nabbing one, so enter now! To enter the ANF cooler bag competition, the Paddington competition, or the Kitchen Warehouse voucher competition, just log on to your iFolio and then click through to Resources – that’s where you’ll find the ‘Competitions’ section. Food products pictured here in the new ANF cooler bag are for illustration purposes only.
Julie-Anne Neil
Congratulations to Julie-Anne Neil – who has taken home $500 cash as the winner of Fleet Network’s ANF WA Members Competition! Julie-Anne, a nurse at Katanning Hospital, salary packaged a car with Fleet Network during May and June, and automatically went into the draw. “This is the first time I have arranged a novated lease with Fleet Network and I was extremely happy with their service. I just let them know that I was looking for a white Subaru XV Hatch, they sourced it for me at a discounted price and it was delivered within the month," Julie-Anne said. “The effort I put in was minimal, it couldn’t have been any easier really. Fleet Network personnel talk you through the process, assist with all the paperwork and the staff are always pleasant, professional and helpful. It was exciting to drive up to Perth to pick up my new car!” If you are looking to salary package a new car, call Fleet Network on 1300 738 601 or visit www.fleetnetwork.com.au/anfwa to view our exclusive western nurse deals.
November – December 2018 western nurse |
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SPECIAL OFFER EXCLUSIVE TO bayswater mazda*
Special offer for Australian Nursing Federation WA: • Free 4 years/40,000 kms scheduled servicing • Free loan car for all routine servicing • Free $500 Caltex Fuel card for all new vehicle purchases • Free ongoing Roadside assistance when purchasing a vehicle
Salary packaging?
Ensure your Fleet Company contacts Bayswater Mazda to gain the full benefits of this offer.
*Special offer available to Australian Nursing Federation WA members. Vehicle must be purchased new from Bayswater Mazda and all servicing must be done at Bayswater Mazda. Servicing offer excludes Mazda 2 and Mazda 3. MD25174
Driving is better with Bayswater www.bayswatermazda.com.au/anfwa (08) 9783 9023 Cnr 374 Guildford & Garratt Road, Bayswater