Western Nurse Magazine September October 2018

September – October 2018

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Secretary's Report

September - October 2018

FEATURED

State Secretary Mark Olson

3 Secretary’s Report 4 Negotiations with St John of God Health Care 8 Special Deals for Our Members 12 Tribute to Dianne Pember 14 Mark’s Q & A 28 Recipe Corner

That’s because no party with any hope of forming government has yet supported the campaign’s worthy goal of having staff ratios in nursing homes made part of the law.

But those who are backing the campaign, including the ANF in WA, are hardly helpless.

We all know there’s a Federal Election next year where the competition is tight between the Liberal incumbents and the Labor Opposition.

That’s an ideal scenario for effecting positive change in aged care, because the major parties are scrounging for votes and will make commitments to get them.

FAVOURITES 6 18 22 26 30

The federal ANMF campaign to achieve safe levels of staffing in aged care has been running for months, with little achieved to date.

Internet Watch ANF Out ‘N’ About Across the Nation Around the Globe Research Roundup

HOLIDAY ANF 4 ANF Holiday Apartments – book now!

But if this campaign isn’t making headway in such favourable conditions, another approach needs to be taken before we run out of time.

What are major issues?

1. Neither the Liberal Party nor the Labor Party are supporting having ratios in aged care, even though that’s exactly what’s needed to improve life for both staff and residents. Sure, the Federal Government has called for an aged care royal commission, but that will finish after the Federal Election. This means the Liberals can look like they’re doing something by launching their investigation, but don’t have to actually act before the election to improve residential care. We are also concerned that workers will become the scapegoat in that inquiry.

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2. Worse still than doing nothing to support the campaign, both the Liberals and Labor have actively moved against it. In September, both parties voted against Senator Derryn Hinch’s Senate motion calling for mandatory ratios for registered nurses and carers in aged care centres.

CLINICAL UPDATES

3. And, both Liberal and Labor federal governments have neglected to properly fund aged care over the years.

WIN!

13 16 20 24

Ross River virus Combined oral contraceptives Prazosin Hypertension – back to basics

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

Australian Nursing Federation 260 Pier Street, Perth WA 6000

Use the QR code reader on your smartphone to quickly save all of the ANF’s contact details.

What can be done?

1. The ANMF federal office needs to stop giving Labor an easy ride. This and all our campaigns should be only about doing all we can to achieve improvements for our members and those for whom they provide care. Our campaigns should not be about traditional union political leanings and helping Labor get elected. The formula that’s worked so well for the ANF in WA is what’s required here – work with the parties that will help our members and pressure those that won’t, no matter who they are. Therefore, the federal ANMF must target both Labor and Liberal candidates in marginal federal seats leading up to the election, to make them clarify their position and hopefully provide support. Specifically in WA, we can focus on local marginal seats – starting with that of WA Federal MP Ken Wyatt, who fortuitously is also Federal Minister for Senior Australians and Aged Care.

2. With the help of WA members, we can launch a campaign of media stories about what is faced daily by local members and the seniors they try to keep safe and healthy in aged care facilities amidst ever dwindling resources. That campaign can include high-profile advertising.

3. The Royal Commission will occur – let’s ensure, by being involved at all stages, that it exposes poor conditions and moves towards ratios, and moves away from scapegoating workers.

4. We can also have our own local political candidates to hit the major parties where it hurts most – votes. In the recent ANF Futures Survey, thousands of members said they want the ANF to support members to stand as candidates to “pursue better outcomes for ANF members”. Let’s do that for aged care.

These are just some of the initiatives possible. In coming weeks I’ll be canvassing members about the directions you wish to take. We have an opportunity to make a difference. We need to act. Now.

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September–October 2018 western nurse |

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DISGRACE The ANF’s negotiations with St John of God Health Care over wages and conditions have exposed this employer’s lack of respect and decency in its treatment of staff.

Staff at St John of God hospitals say they are sick of being treated with a lack of respect and decency by their employers – and they worry about the safety of their patients.

Hundreds of members responded to an ANF survey about their work conditions – with a shocking third of all respondents saying the skill mix where they work is so bad “there are times when patient safety is at risk”.

Nearly half the staff who completed the survey said the skill mix is inappropriate much of the time, and about 94 per cent endured staff shortages in their area.

About 71 per cent of respondents said they are being made to take annual leave at “low activity” times, while more than one fifth have had their contracted work hours cut in the last three years.

WA State Secretary Mark Olson launched the survey before beginning negotiations for a new staff wages and conditions agreement at St John’s, because he had been contacted by a number of members complaining about their employer’s “lack of respect and decency”.

He subsequently found St John’s weren’t really interested in negotiating.

“It became clear to me very quickly that they’re more interested in squashing the rights of their staff to squeeze more cash out of their hospitals,” Mark said.

“That’s ironic, given they purport to be a Christian ‘not-for-profit’ organisation offering ‘hospitality, hope and healing’.

“It’s not very Christian that they’ve basically got a part-time work force by forcing full-timers onto a

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“If St John’s is struggling financially, why aren’t they sending executives and HR staff home when work is slow and deducting that time from their leave?

Why don’t they cut the hours and pay of the executives and HR?” 70-hour-a-fortnight contract. Then, they try to make them work extra hours for free and try to make them feel grateful to have a job.”

He added: “This is way more than a disagreement over pay. This about a lack of respect and decency.

“If St John’s is struggling financially, why aren’t they sending executives and HR staff home when work is slow and deducting that time from their leave? Why don’t they cut the hours and pay of the executives and HR?”

“What kind of an employer orders staff to go home when work is slow – and then deducts that time from their leave entitlements? And doesn’t St John’s care about having patients in an environment of staff shortages and a highly inappropriate skill mix?

Mark said the negotiations will continue, but the ANF is not going to tolerate having its members treated terribly by St John’s. “I will keep members informed about what steps we can take to make this right,” he said. 

Some of St John's hospitals

Cold and Flu season once again triggers rise in Asbestos disease diagnoses.

Australia’s leading health and advocacy association for Asbestos Disease, the Asbestos Diseases Society of Australia (ADSA), has continued to see a rise in the diagnosis of asbestos disease this cold and flu season.

People who may have been exposed to asbestos and are suffering persistent coughs or ongoing respiratory illness are urged to ask their doctor to investigate.

Alternatively you can make an appointment with ADSA’s onsite screening service led by Dr Gregory Deleuil who has been specialising in this area of medicine and treating patients for over 25 years.

Contracting an asbestos related disease can occur through both occupational and non-occupational exposure. Any one in the community is at risk if they have some form of exposure.

PHONE 1800 646 690

Need support?

The team is here to help.

For over 35 years, The ADSA has been helping thousands of Australians and their loved ones with asbestos related issues access independent advice and assistance.

Today the Advisory Service continues to provide advice to members and the public in the following areas: + Medical Support + Legal Matters + Counseling and Support Groups for Sufferers and their families + Industrial and Environmental Hygiene

BELOW: ADSA’s Counsellor and Head of the Advisory Service Rose Marie Vojakovic AM CTA with President of the ADSA Robert Vojakovic AM JP.

ABOVE: ADSA’s Dr Gregory Deleuil

What are the warning signs to be aware of?

Prior to a person being diagnosed, they may experience: + shortness of breath + persistent coughs + rapid weight loss + chest or abdominal pains + blood in the sputum

The team also support and fund raise for lifesaving medical research. Get in touch today to find out how you can help.

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September–October 2018 western nurse |

5

InternetWatch AMAZING APPS + ONLINE NEWS

Driversnote Ta dah! A vehicle log book, ideal for businesses, employees, employers, the selfemployed and just about anyone who drives. It automatically tracks your trips and creates the proper documentation for your mileage claim. Better still, it meets the requirements from the Australian Taxation Office. Free

Bike Repair On the roadside or in the garage, here’s a quick guide to bicycle repair.

This one contains more than 50 photo repair guides and near on 100 tips and tricks. You can collect information about your bike’s parts, keep a history of the maintenance tasks you have performed and even add reminder tasks. $5.99

Star Rover Do you love a starry night?

Do you want to know about everything ‘up there’? Star Rover is a planetarium for your smart phone.

Just hold up your phone and it will tell you exactly what you are pointing at.

And as you move the screen, the map updates in real time. Free

Homescapes Help Austin the butler bring back warmth and comfort to his wonderful mansion. It’s a mess and needs a makeover! Show off your designer skills by furnishing and decorating the house areas, including the kitchen and garage. Free

Gardenscapes From the creators of Homescapes, it’s time to clean the garden! Rake your way through a storyline full of unexpected twists and turns to restore a wonderful garden to its former glory. Enjoy hanging out with Austin, your butler, and the resident dog. Free

Colour by Number Colour by Number is an anti-stress activity based on the original paper based art form.

Fill in the numbers according to the colour chart and you will have created a masterpiece in no time. There are more than 500 pictures to discover. Free

Relax Melodies: Sleep Sounds Lovely, a soundtrack for drifting off to sleep. Choose from nature sounds, orchestral tunes, white noise, meditations, and more. There’s a gorgeous sound of rain on the roof and a distant train, designed to soothe even the most wound-up sleepers. Free

Bonza Puzzles Bonza is a new type of crossword that has become an instant classic. It mixes word search, jigsaw and trivia to create something completely fresh. If you like a word challenge and you enjoy pushing boxes around with your fingers, then you’ll love this game. Even create your own puzzle. Free

Baikoh Another game for you word fiends. And kind of like Tetris. Write words by tapping tiles that randomly fall from the top of your screen. Type quickly and constantly to destroy tiles and keep them from reaching the top of your screen, or just use power-ups to make everything explode. Lots of sarcastic humour in this one. Genius. Free

Gaston Adventure From the creators of Peppa Pig and Ben and Holly, here’s Gaston, the sassiest ladybird in town who barks like a dog, ruff ruff! Help Gaston fly, ignoring the balloons that are moving towards him and win the points as each balloon gets bigger and bigger. Don’t pop them though. Free

FIVESuperSites Roald Dahl

Roald Dahl once said: “If you have good thoughts they will shine out of your face like sunbeams and you will always look lovely.” This delightful website is aimed at both adults and children and contains stories, activities, quizzes and loads more! Who could ask for more? www.roalddahl.com/

Australian Battery Recycling Initiative

The ABRI is a not-for-profit association that promotes responsible environmental management of batteries and is working towards effective stewardship of all end-of-life batteries. Head to their website to locate your nearest collection centre. www.batteryrecycling.org.au/ recycling/handheld-batteries

Shaun Tan

Originally from Perth, Shaun Tan has been writing and illustrating picture books for well over two decades. He is best known for illustrated books that deal with social and historical subjects through dreamlike imagery. You’ll find a gallery of his amazing work at shauntan.net/

Auslan Signbank

Australian Sign Language, also known as Auslan, is the national language of the deaf community. Search the dictionary, locate signs related to medical and health topics, watch videos of people using Auslan signs, and find classes. www.auslan.org.au/

Lonely Planet

Whet your travel appetite by cruising around the world. On the Lonely Planet website that is!

This month features ‘Places that rock, coastal formations around the world’ or ‘Strap yourself in, the world’s most extreme road trips’. The videos are super cool, often giving an "off the beaten track" view of places far and wide. www.lonelyplanet.com/

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western nurse September–October 2018

EN

ANUM

RN

CNS

RN

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The only health fund created exclusively for nurses, midwives and carers See how our prices compare with some of the major health funds in WA*: HEALTH FUNDS

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Nurses & Midwives Health is an industry-based health fund, open to members of the ANF. Eligibility also extends to family members of eligible members^.

For your free, side-by-side comparison, and our latest offers, visit nmhealth.com.au or call 1300 344 000 * Comparison based on price only. Contributions are quoted for a family and include no Lifetime Health Cover loading and include the 25.415% Australian Government Rebate on Private Health Insurance. Rebate levels vary from 0.00% to 33.887% which you can change when you get a quote. Rates are effective as at 1 April 2018 and are sourced from privatehealth.gov.au. ^Eligibility criteria and conditions apply. See website for details.

Nurses & Midwives Health Pty Ltd ABN 70 611 479 237. A Registered Private Health Insurer. NMH-ANFWA-07/18

September–October 2018 western nurse |

7

WAIT, THERE’S MORE… HAVE WE GOT GREAT DEALS FOR YOU!

The now-mammoth ANF Member Rewards and Offers page on iFolio is growing all the time. Save thousands of dollars with great deals on everything from mortgages and electrical goods, to discounted chicken dinners and haircuts – and even cut your power bills! That’s with still the lowest union fees by far.

If you haven’t been on iFolio for a while you’re missing out on terrific bargains.

There are also discounts on energy bills, groceries, manchester, furniture, optometry services, first aid courses and even haircuts.

We’ve completely revamped the ANF Member Rewards and Offers page over the past year, so there are discounts across many areas of your life.

Offers on car purchases and leasing, and health insurance are also included – as are discounted chicken dinners!

On the opposite page we’ve listed the business names we’ve negotiated with to offer our members the likes of special mortgage and credit card deals, and best-price online appliance shopping.

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western nurse September–October 2018

And when you’re holidaying at the ANF’s high quality but lowcost resort apartments in Margaret River or Kalbarri, we’ve got you a range of places where you can eat and drink at a nice ANF member price, as well as discounted tours and safaris.

All the specific discounts are on your iFolio.

ANF State Secretary Mark Olson said the revamp of our offers page began with the intention of cutting costs for members.

“We started out wanting to replace an electrical goods discounter who demanded more than $15,000 of our members’ dollars each year just to provide discounts,” Mark said. “Another such ‘discounter’ wanted about $25,000 a year, and both services were to increase in price as our membership grew.

“We thought, why not save all that cash and set up our own discount arrangement that will never cost members a cent ever again and still give them fantastic deals?

“We found three better options that cost members nothing, yet give you terrific deals – with perks like best price guaranteed, free delivery and free removal of your old whitegoods.

“Then we thought, why stop at electrical goods?

We kept going – the result is you have an extensive discount list that would be the envy of most professional organisations in the nation – especially given we still have the cheapest union membership fees by far.”

Mark said the member offers are on top of numerous existing ANF professional services plus the heavily discounted resort accommodation.

“The ANF already saves you lots of money on your work essentials, including your professional insurances and continuing professional development (CPD),” he said. “But our goal is to find savings for you everywhere.

“So we’ll keep expanding the Member Offers page indefinitely. If you want to see what deals are available, log onto iFolio and click the ‘ANF Member Rewards and Offers’ link on the home page. Or look under the ‘Resources’ tab and then go to the ‘Offers’ section.”

“We started out wanting to replace an electrical goods discounter who demanded more than $15,000 of our members’ money each year just to provide discounts. We found three better options that cost members nothing, yet give you terrific deals.

Then we thought, why stop at electrical goods?”

September–October 2018 western nurse |

9

“The ANF already saves you lots of money on your work essentials, including your professional insurances and CPD. But our goal is to find savings for you everywhere.

“To see what deals are available, log onto iFolio and click the ‘ANF Member Rewards and Offers’ link on the home page. Or look under the ‘Resources’ tab and then go to the ‘Offers’ section.”

Here are the general categories and all the businesses up until we went to print – but check your iFolio for the latest offers, plus details of the specific discounts.

BANKING ME Bank P&N Bank

CARS Bayswater Mazda City Toyota

The Kingfisher Indian Restaurant/Café, Margaret River

LEISURE AND TOURS

The Larder, Margaret River

Kalbarri Quadbike Safaris

Upstairs Restaurant, Kalbarri

Margaret River Tours

HEALTH

Surf N Dirt Adventure Tours, Margaret River

HIF Nurses & Midwives Health

PERSONAL CARE

Royal Life Saving Society WA

Creative Heads Hair Design

Specs 2-4-1

Rutherford House Hair Salon

HOME

POWER

Appliances Online

Alinta Energy

Finlay’s, Kalbarri

Campbells

Kleenheat

Nando's, WA Stores

Home Clearance

Solargain

Pelican’s Café and Restaurant, Kalbarri

Sitting Pretty Furniture

Fleet Network

FOOD AND DRINK Barbara's Bakehouse, Kalbarri Colonial Brewing Co, Margaret River

Robert Oatley Vineyards, Margaret River

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western nurse September–October 2018

Winning Appliances

Exclusive ANF deal 10% discount off the Original and Best Wine Tours in Margaret River

ANF members receive 10% DISCOUNT on any online or instore purchase. Please enter or mention the code: ANF10.

For bookings and enquiries call Adam on 0419 917 166 or visit margaretrivertours.com

Excludes sales items.

Please enter or mention the code: ANF10

Perth’s largest range of designer chairs, stools & tables. View our full range at www.sittingprettyfurniture. com.au or visit our showroom warehouse at 7 Keegan Street, O’Connor. Ph: 6162 9356.

ANF members receive 20% OFF everything, plus buy one pair of prescription glasses and get a free pair of prescription sunglasses*.

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September–October 2018 western nurse |

11

A N INSPIRATION In Memoriam:

DIANNE RAE PEMBER

Vice-President of the Australian Nursing Federation in WA Born: Kalgoorlie, WA: 24 January 1951 There are certain people in life who will always be remembered with a smile.

That was Dianne Pember, who always brought humour to those around her, and yet fought unceasingly to do what is right for ANF members, her colleagues and those dearest to her.

“Di was fiercely passionate about getting the best for our members,” said ANF WA President Trish Fowler, who befriended Dianne early in her 18-year stint as ANF Vice-President.

“But she also had a really funny side.

We were at one of the first ANF Branch Conferences I chaired, and after the dinner I had gone to bed at around midnight, hoping to get enough sleep to function the next day.

“All of a sudden I was rudely woken by Di and the troupe of delegates she had brought back to our room to continue partying!

Died: Perth, WA: 6 October 2018 After more moves, including to Bunbury and Europe, she ended up at Derby Regional Hospital in 1976, working under Sister Ann, a Catholic nun who encouraged and mentored her to where she became the Charge Nurse.

Di also met her husband Steve Priddle in Derby and they married in 1978. They also moved to Bunbury the same year. This year was both their 40th wedding anniversary and Di’s 40 years of service at St John of God Bunbury Hospital.

It was in the thick of an enterprise bargaining agreement battle at St John’s Bunbury, that ANF WA State Secretary Mark Olson met Di nearly two decades ago.

“I’d found this incredibly hardworking job rep in Di. We were in this fight with St John’s and she had written an entire draft EBA, and it was as good as any I’d seen,” Mark said.

“Needless to say we didn’t make Councillors share rooms after that!

“Di was also heavily involved in working out logistics of the industrial action we were having. Her support was crucial because the staff trusted her – she had a fabulous reputation with them.

“She was funny, kind, generous and wise and I shall miss her so very much.”

“I thought at the time, we’ve got to get her as ANF VicePresident. But she didn’t feel she was ready.

Di’s brother Don said dating back to when she was a teenager “all she wanted as a career was to be a nurse”, even though she was talented in so many other areas.

“Anyway, many months later, we were standing in the Tradewinds pub in Fremantle after an ANF meeting and the wine had run out. I was holding a pretty large glass of wine in my hand.

“At school she was a very serious student who excelled at art and other general subjects,” Don said.

“My eyesight’s not great, but it seemed like Di was staring intensely at something on my face. I thought, ‘Have I got food on my lip or something?’. Then I realised she was actually staring at my glass of wine.

“She was also a State runner-up gymnast who excelled on the beam. Dianne also played netball and was a very good basketball player – she played right up to 1985 when she was pregnant carrying her youngest daughter.

“Dianne was also a prolific reader and it wouldn’t be unusual for her to have three books on the go at once, in addition to doing some medical research and arranging holidays. In her younger days her cousins would say ‘Dianne is coming around – hide the books!’.”

Don said Di was always very supportive of him and her other siblings Allan and Susan, and encouraged him in 1977 to work in administration at Derby Regional Hospital.

“I later became the head administrator of Derby hospital and eventually opened the first hospital in Mandurah, and that’s all because she gave me that initial support when I needed it,” Don said.

Di started her general nurse training at the then Fremantle School of Nursing in 1968 and after graduating as an enrolled nurse moved around various States, ending up in Tasmania. She returned to WA in 1973 and graduated as a registered nurse in March 1975 from the Kalgoorlie Regional Hospital School of Nursing.

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western nurse September–October 2018

“I said, ‘Would you like this glass of wine, Di?’. Without hesitation she said, ‘Yep’.

“I said, ‘Right, you run for Vice-President and I’ll give you this whole glass’. And that was that.

“She was just a terrific person, she was there during the ANF’s most difficult years when the ANF had little money and we were losing members. Everything she did as Vice-President was solely for the benefit of our members and it was a very rare event for her to miss a Council meeting.

“Di made the world a much, much better place for all who had the privilege and good fortune to spend any time at all with her, and we all miss her very much.”

Di had two daughters Shannon and Jenna, and three grandchildren, Bryar, Connor and Ivy. Shannon said watching her mum nursing while she was growing up inspired her to also become a nurse.

“She was pretty amazing, she was so organised and she was so good with people. She always made me want to be a better nurse,” Shannon said. “Even now she still inspires me.” 

Aged 17 in 1968 at Fremantle School of Nursing

update: Ross River virus

Read this article and complete the online quiz to earn 0.5 iFolio hour

INTRODUCTION Ross River virus (RRV) belongs to the genus alphavirus and was first identified at Townsville in Queensland in 1959 (see Box 1).1-4 The RRV infection is also known as Ross River fever and is the most common mosquito-borne disease in Australia.3 Although RRV infection is mild and does not cause death, the associated joint pain can be seriously debilitating.3,4 There is no specific treatment and protection against mosquito-bites is the most effective prevention strategy.4 Box 1. Alphavirus An Alphavirus of the family Togaviridae is comprised of nine viruses including Sindbis virus, Semliki Forest virus, Venezuelan Equine Encephalitis virus, Eastern Equine Encephalitis virus, Western Equine Encephalitis virus, Ross River virus, Chikungunya virus, O’nyongnyong virus, and Salmonid alphavirus. Of these viruses, RRV and Chikungunya virus are endemic to Australia.

BURDEN OF DISEASE Ross River virus is endemic to Australia and approximately 5,000 infected cases are officially reported annually.1,3 The incidence of RRV disease varies between and within regions; however, more cases are generally recorded in northern Australia.3 Notably, the burden of RRV is underestimated because several mild cases go undiagnosed due to the variability of clinical symptoms and the requirement of a laboratory test to confirm infection.3

SOURCE AND ROUTE OF TRANSMISSION Native mammals including wallabies and kangaroos are natural hosts for RRV.5 Other reservoirs include domestic and wild animals such as dogs, cats, possums, and horses.3 Mosquitoes become infected when feeding from an animal reservoir. The infection is subsequently spread by mosquitoes to humans. It is purported that mosquitoes may also spread the virus from infected people to other people during the outbreak of a RRV

infection.3,5 This human–mosquito–human transmission enables RRV to spread locally and probably outside of Australia, regardless of the presence of enzootic hosts.3 The virus can be transmitted by several mosquito genus and species. They include Culex annulirostris which breeds in freshwater habitats in inland regions and saltmarsh mosquitoes including Ochlerotatus vigilax and Ochlerotatus camptorhynchus in coastal regions.5

SYMPTOMS About 55% to 75% of infected people are asymptomatic.4 Symptomatic presentation of RRV is less frequent in children compared with adults. Symptoms usually become obvious from three to 21 days (Average nine days) after infection.5 The typical symptom of RRV infection is polyarthritis that mainly affects the ankles, fingers, knees, and wrists, but other joints may also be affected.5 Other symptoms include muscle pain, fever, tiredness, and rash.

Symptoms usually last within one month but may persist for months to years.5 Ross River virus infection is not fatal.4

DIAGNOSIS Blood tests are used to demonstrate an increased level of specific antibodies to RRV.5

TREATMENT There is no specific treatment for RRV infection.

Paracetamol can be used to manage pain and fever. It is advised that aspirin should not be given to children under the age of 12 years unless specifically recommended by a doctor to prevent Reye’s syndrome (see Box 2).5,6 Box 2. Reye’s syndrome Reye’s syndrome is a rare but serious condition in which the liver and brain swells. Symptoms include confusion, seizures, and loss of consciousness. Reye’s syndrome commonly affects children and teenagers recovering from a viral infection. Aspirin has been found to be linked with Reye’s syndrome.

PREVENTION Since there is currently no vaccine to prevent infection, preventing mosquito-bites is the most effective method.4,6 Prevention consists of active mosquito control and/or using personal protective measures.4,5 Active mosquito control includes the use of appropriate insecticides and habitat modification to reduce water availability where mosquitos breed.4,5 Personal protective measures include:4,5 • Avoiding known mosquito infested areas • Wearing long sleeved shirts and pants when outdoors, especially at dawn and dusk which are peak mosquito biting hours • Ensure that the house is adequately screened

REFERENCES 1. Yu W, Mengersen K, Dale P, et al. Epidemiologic Patterns of Ross River Virus Disease in Queensland, Australia, 2001–2011. The American Journal of Tropical Medicine and Hygiene. 2014;91(1):109-118.

2. Atkins GJ. The Pathogenesis of Alphaviruses.

ISRN Virology. 2013;2013:22.

3. Claflin SB, Webb CE. Ross River Virus: Many Vectors and Unusual Hosts Make for an Unpredictable Pathogen. PLoS Pathogens.

2015;11(9):e1005070.

4. Centers for Disease Control and Prevention.

Ross River Virus. Travelers’ Health 2015; Available at: https://wwwnc.cdc.gov/travel/diseases/rossriver-virus-disease Accessed May 2017.

5. Russell RC, Doggett SL. Ross River & Barmah Forest. NSW Arbovirus Surveillance & Vector Monitoring Program Available at: http:// medent.usyd.edu.au/arbovirus/viruses/ rossriverbarmahforest.htm Accessed May 2017.

6. Weiner DL. Reye Syndrome. Emergency medicine 2015. Available at: http://emedicine. medscape.com/article/803683-overview Accessed May 2017.

September–October 2018 western nurse |

13

Mark’s

The ANF Legal Team is one of the most significant benefits of your membership.

In western nurse we’ll periodically provide information about how you can make the most of this very valuable service. In this edition we’re dealing with coronial inquests.

Q. I’ve received a summons to appear as a witness in a coronial inquest. What do I do?

A. Immediately contact ANF Helpline and arrange to speak to our legal team, the sooner the better. Never ignore the summons – you have a legal obligation to attend and give evidence unless formally released.

Our legal team can assist you with the following aspects – liaising with the Coroner’s Court on your behalf, arranging for a suitable time for you to give evidence, obtaining all relevant court documents, assisting you with preparing a statement, appearing to represent you in the inquest and making submissions on your behalf.

Q. I’ve received a summons to give evidence in an inquest, but I’ll be overseas on the inquest dates. What do I do?

A. Again, contact the ANF Helpline at the earliest opportunity so arrangements can be made by our legal team. They’ll liaise with the court to see if your evidence can be heard on another date or by telephone. Our legal team has assisted nurses and midwives give evidence on alternative dates, by telephone and by video link.

Q. I’ve received a letter from the Coroner's Court which says I’m at risk of an adverse comment. What does this mean and what should I do?

A. This means the Counsel assisting the Coroner has seen evidence in preparing for the inquest that may suggest your nursing or midwifery practice could be criticised. Again, contact the ANF Helpline and get legal advice immediately.

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western nurse September–October 2018

Q. Can a Coroner take disciplinary action against a nurse or midwife?

A. No. However, a Coroner can make comments in a finding adverse to a nurse or midwife. The Coroner also has the power to refer a nurse or midwife to the Australian Health Practitioner Regulation Agency/Nursing and Midwifery Board of Australia for investigation. This is why it is important you get legal advice quickly in relation to deaths that may become the subject of a coronial investigation or inquest.

Q. Are witnesses allowed to watch the evidence of other witnesses?

A. Yes. Unless there is a specific order for witnesses to be out of court, they are allowed to be present at the entire inquest.

Q. What happens at a coronial inquest?

A. They take place in a court room and begin when the Coroner enters the room, at which time everyone must stand up and bow. The Counsel assisting the Coroner is a lawyer who helps the Coroner. They give an opening address outlining the inquest and issues to be examined.

Witnesses are then called. Everything a witness says is recorded. Witnesses are asked questions by the Counsel assisting the Coroner, other lawyers and even the Coroner.

After all witnesses have given evidence, the Coroner sometimes relays his or her conclusions and invites submissions from the lawyers on behalf of their clients.

Then the inquest is adjourned and we wait for the Coroner to issue a finding – that can occur after the inquest finishes.

The information provided in this column is general advice only.

If you want information specific to your circumstances you should contact the ANF Helpline or send us your questions by email.

ChloraPrep with Tint ™

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1

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41%.

2

Product code

Description

Packaging

Shelf life

600415

3 mL tint

25/bx., 100/cs. UOM cs.

24 months

600715

10.5 mL tint

25/bx., 100/cs. UOM cs.

24 months

600815

26 mL tint

25/bx., UOM cs.

24 months

Temperature-control recommendations3

Store below 25°C.

Please contact your local representative for more information.

References 1 Garcia R, Jendresky L, Landesman S, Maher A, Nicolas F. Three years experience in implementing HICPAC recommendations for the reduction of central venous catheter–related bloodstream infections. Manag Infect Control. 2003;10:42–49. 2 Darouiche RO, Wall MJ, Itani KMF, et al. Chlorhexidine-alcohol versus povidone-iodine for surgical-site antisepsis N Engl J Med. 2010;362:18-26. 3 CareFusion Data on file as per Instructions for Use (IFU). * Central venous catheter. ** When compared to 10% povidone-iodine.

ChloraPrep™ with Tint

Cutaneous Solution 2% w/v chlorhexidine gluconate (CHG) 70% v/v isopropyl alcohol (IPA)

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CareFusion is a wholly-owned subsidiary of BD. © 2016 BD. BD, the BD Logo and ChloraPrep are trademarks of Becton, Dickinson and Company. SU6146 (0316). Ref: IP006/v2/Feb16

September–October 2018 western nurse |

15

Combined oral contraceptives

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

Combined oral contraceptives (COCs or ‘the pill’) are a commonly used method of contraception.1 They were first introduced in Australia more than 50 years ago and now many formulations are available for Australian girls and women (see Table 1). Pills with either levonorgestrel or norethisterone and a low dose of oestrogen (35mcg or less of ethinyloestradiol) are considered first-line as they have the best safety profile.2

INDICATIONS The primary use of COCs is to prevent pregnancy. They may also be used to treat acne, menstrual disorders such as heavy bleeding or abnormal menstrual bleeding (dysmenorrhoea), and to manage symptoms of endometriosis, polycystic ovarian syndrome, and premenstrual syndrome (see Box 1).3 The oral contraceptives have also been demonstrated to reduce the risk of endometrial cancer, ovarian cancer, and benign breast disease.4 Box 1. Some of the non-contraceptive benefits of COCs.2,3

Acne. COCs improve acne for most women. Evidence to support the use of one pill over another for the treatment of acne is limited, however, pills with cyproterone acetate and ethinyloestradiol may be associated with improved outcomes.

Premenstrual syndrome (PMS). COCs are indicated for the management of PMS. However, some pills may also cause PMS. Monophasic treatments may be preferred.

Endometriosis. COCs help to minimise symptoms of endometriosis including dysmenorrhoea and pain, and may also help to delay disease progression.

MECHANISM OF ACTION Combined oral contraceptives contain two types of synthetic hormones; oestrogen and

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western nurse September–October 2018

progestogens. Synthetic oestrogens include ethinyloestradiol, mestranol, and oestradiol.2 Progestogens are a group of hormones that bind to progesterone receptors. Progesterone is the largest progestogen produced by the human body. Synthetic progestogens used in COCs include levonorgestrel, norethisterone, gestodene, drospirenone, and desogestrel.2 COCs inhibit the release of luteinising hormone and follicle stimulating hormone from the pituitary gland and prevent ovulation. They also alter the lining of the endometrium to reduce the likelihood of implantation, decrease fallopian tube motility, thicken the cervical mucus, and slow the movement of sperm.3

CONTRAINDICATIONS AND PRECAUTIONS There are many absolute and relative contraindications to COCs, as well as additional precautions with use. In short, COCs should not be used in breastfeeding women or those less than three to six weeks postpartum, depending on the risk of venous thromboembolism (VTE), as well as in women who are current smokers, over the age of 35 years, those with a history of (or current) ischaemic heart disease, stroke, complicated valvular or congenital heart disease, cardiovascular disease risk factors, hypertension, migraine with aura, breast cancer, VTE, liver dysfunction, systemic lupus erythematosus, or diabetes.4 See the Australian Medicines Handbook (AMH) for more information.

ADVERSE EFFECTS Common adverse effects include breakthrough bleeding, amenorrhoea (no menstruation), nausea, vomiting, breast tenderness, headache, mood changes, changes in libido, increased blood pressure, fluid retention, chloasma (skin pigmentation), acne, and thrush.3 Women who experience chest pain, severe headaches, blurred vision or loss of sight, pain or swelling in one leg while on the pill should stop taking it immediately and seek medical advice.3 The risk of VTE depends on the dose of oestrogen (higher doses are associated with increased risk), the type of progestogen, and the presence of other risk factors.1 The risk is highest in the first year of COC use, but less than the risk of VTE during pregnancy.1 The association between COCs and breast cancer is unclear. It is known to mildly increase the risk of cervical cancer, but that risk is reversed after 10 years without COC use.3 Overall, the use of COCs have been associated with lower rates of death from any cause, including cancer and cardiovascular disease.2

REGIMENS In general, women should use a COC with the lowest hormone dose possible to maintain adequate cycle control and prevent pregnancy.

It should be well tolerated, with the highest possible safety profile, and practical issues such as affordability should be discussed prior to selecting an agent.2 Pills are available in 21-day or 28-day packs.

28-day packs contain 21 active pills and

Table 1. Generic and trade names of combined oral contraceptives, with associated doses 3

GENERIC NAME

TRADE NAMES

DOSE

Cyproterone with ethinylosetradiol

Brenda-35 ED, Carolyn-35 ED, Diane-35 ED, Estelle-35 ED, Jene-35 ED, Laila-35 ED, Juliet-35 ED

Cyproterone 2mg Ethinyloestradiol 35mcg

Desogestrel with ethinyloestradiol

Madeline, Marvelon 28

Desogestrel 150mcg Ethinyloestradiol 30mcg

Dienogest with ethinyloestradiol

Valette

Dienogest 2mg Ethinyloestradiol 30mcg

Dienogest with oestradiol

Qlaira

Multiphasic Dienogest 0mg, 2mg, 3mg, 0mg Oestradiol 3mg, 2mg, 2mg, 1mg

Drospirenone with ethinyloestradiol

Petibelle, Yasmin

Drospirenone 3mg Ethinyloestradiol 30mcg Drospirenone 3mg Ethinyloestradiol 20mcg

Yaz, Yaz Flex

Gestodene with ethinyloestradiol

Minulet

Gestodene 75mcg Ethinyloestradiol 30mcg

Levonorgestrel with ethinyloestradiol

Monophasic: Eleanor 150/30 ED, Evelyn 150/30 ED, Femme-Tab 30/150 ED, Lenest 30 ED, Levlen ED, Microgynon 30 ED, Micronelle 30 ED, Monofeme, Nordette

Levonorgestrel 150mcg Ethinyloestradiol 30mcg Levonorgestrel 125mcg Ethinyloestradiol 50mcg Triphasic Levonorgestrel Phase one: 50mcg Phase two: 75mcg Phase three: 125mcg Ethinyloestradiol Phase one: 30mcg Phase two: 40mcg Phase three: 30mcg

Monophasic, high dose: Microgynon 50 ED Logynon ED, Trifeme, Triphasil, Triquilar ED

Nomegestrol with oestradiol

Zoely

Nomegestrol 2.5mg Oestradiol 1.5mg

Norethisterone with ethinyloestradiol

Brevinor, Norimin

Noresthisterone 0.5mg Ethinyloestradiol 35mcg Noresthisterone 1mg Ethinyloestradiol 35mcg

Brevinor-1, Norimin-1

Norethisterone with mestranol

Norinyl-1

Norethisterone 1mg Mestranol 50mcg

*For any pill, oestradiol may also be known as ‘estradiol’. seven placebo pills. It is important to review which pills are the active and placebo pills with women prior to commencing use. There are several ways to start taking the pill. For immediate contraception, women should begin taking the active pills within five days of their period.3 Pills may be monophasic (every pill has the same dose) or triphasic (with three different dose combinations in a 21-day pack). There is no evidence to suggest that either monophasic or triphasic types are advantageous. Some women prefer to take monophasic pills continuously for several months to delay or avoid withdrawal bleeding. General recommendations support continuous use for up to three months, while safety has been

demonstrated for up to 12 months.2 It is possible for failure to occur, resulting in pregnancy. The likelihood of failure depends on user-related factors. Strict use according to manufacturer’s instructions is associated with a 0.3% annual risk of pregnancy, while inconsistent or incorrect use is associated with a 9% risk.2 Effectiveness of the pill may be limited by not taking it at the same time every day, missing a pill, concurrent use of some medications, as well as vomiting and diarrhoea.3 For the latest evidence on medications that may affect COC efficacy check the AMH. For example, at present, there is no evidence to support the longstanding belief that anti-infective agents impact COC effectiveness.3

REFERENCES 1. Bateson D, Butcher BE, Donovan C, Farrell L, et al. Risk of venous thromboembolism in women taking the combined oral contraceptive: A systematic review and meta-analysis. Aust Fam Physician. 2016 Jan; 45(1):59-64.

2. Stewart M, Black K. Choosing a combined oral contraceptive pill. Aust Prescr. 2015 Feb;38:6-11.

3. Australian Medicines Handbook 2017 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 Jan. 4. King Edward Memorial Hospital. Combined oral contraceptive pill (COCP) [Internet]. Perth: Department of Health Western Australia; 2015 Jul [cited 2017 Jun]. 7p. Available from: http:// www.kemh.health.wa.gov.au/development/ manuals/O&G_guidelines/sectiona/9/a9.3.2.pdf.

September–October 2018 western nurse |

17

ANF Out 'N' About

St John of God Subiaco Queenie Rimando and Anneline Hammond

Fiona Stanley Hospital Shelley Martin (Evans) and Derin Librizzi

Entrants for this edition’s Out 'N' About Photo Competition hail from Joondalup, Fiona Stanley and St John of God Subiaco hospitals. Remember, we’ll have a grand prize draw at the end of the year – so make sure you get your photo snapped when we’re next at your workplace. See you next time round!

And don’t forget the ANF Holiday Units Photo Competition.

We award 10 prizes monthly for the best snaps at one of the ANF Holiday Units in Margaret River or Kalbarri – with additional major prizes in the big end-of-year prize draw.

Upload your photo in the photo competition link in the iFolio’s resources section.

Joondalup Health Campus Colleen Schmid, Elisha Craig and Sharon Mathew

Maxine has a great caring but ‘no fuss’ approach for our son and I always know he is safe there. Daycare to the Max has a fabulous backyard, chickens, play equipment and space to run around. Caroline from Morley

DAILY OR CASUAL WEEKEND & OVERNIGHT CARE 0407 890 590

daycaretothemax@amnet.net.au 16 Farman Place, Hamersley Registered with Nature Alliance.

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western nurse September–October 2018

Fiona Stanley Hospital Wendy Stacy and Blossom Innocent

WINNERS Here’s one of our recent winning photos in the ANF Holiday Units Photo Competition – ANF member Emma Crowe’s nephew Oliver and niece Evie, from the UK, enjoying the spa at the ANF’s Leeuwin Apartments in Margaret River.

Joondalup Health Campus Donna Lodge and Fiona O’Connell

Seeking Trainer/ Assessor - Diploma of Nursing The Institute of Health & Nursing Australia is a nationally Registered Training Organisation (RTO). We are currently seeking Full-time and Parttime Trainer and Assessors (Nurse Educators) to join our Academic Team to deliver the Diploma of Nursing program in our Perth Campus.

Minimum skills and experience required · Bachelor or Master Degree in Nursing · Certificate IV in Training and Assessment - TAE40110 or TAE40116 · Minimum one year's experience in a clinical setting, as RN Div 1 Additional skills and experience advantageous for this role · Current experience in teaching nursing or other related health courses · In-depth understanding of ASQA/ANMAC regulatory guidelines and standards Candidates should submit expressions of interest to atif@healthcareers.edu.au

September–October 2018 western nurse |

19

Prazosin

Read this article and complete the online quiz to earn 0.5 iFolio hour

Generic name: Prazosin Brand name: Minipress Drug class: Selective alpha-blocker

INDICATIONS Prazosin is a longstanding medication, used to treat hypertension.1 It may also be indicated for the management of prostate complications including benign prostatic hyperplasia (BPH), Raynaud’s disease, and specific types of heart failure.2 There is some evidence to suggest that off-label use of prazosin may also be helpful for limiting nightmares and sleep disturbances caused by post traumatic stress disorder (PTSD).3

MECHANISM OF ACTION Prazosin works by selectively inhibiting alpha 1 (a1 or A1) receptors in the sympathetic nervous system. A1 receptors are responsible for contraction of the vascular smooth muscle in response to catecholamines. By selectively inhibiting these receptors, prazosin causes vasodilation, a reduction in overall blood pressure and decreased resistance to urinary flow in the bladder neck and prostate.1,4

PRECAUTIONS Prazosin is contraindicated for individuals with heart failure due to mechanical obstruction, such as in those with aortic stenosis.1 It is best avoided in elderly people as they may experience complications associated with orthostatic hypotension (such as falls). prazosin should also be used with caution in individuals with known volume depletion, renal impairment, or concurrent treatment with diuretics, beta-blockers, or calcium channel blockers due to an increased risk of hypotension.1 There may be an increased risk of complications associated with cataract surgery for patients taking any selective alphablockers (even when scheduled doses are withheld).1 An alternative approach to surgery may be required.1

ADVERSE EFFECTS Prazosin has the potential to cause dizziness, drowsiness, floppy iris syndrome in cataract surgery, nasal congestion, urinary urgency,

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western nurse September–October 2018

headaches, fainting, orthostatic hypotension, and first-dose hypotension.1 Other less frequent complications include tachycardia, palpitations, oedema, blurred vision, nausea, vomiting, urinary incontinence, mood changes, dyspnoea, and increased sweating.1 First-dose hypotension tends to be most severe in older adults with fluid depletion or concurrent medication use that may contribute to hypotension.1 It is best avoided by commencing treatment at a low dose and adjusting slowly based on the desired response.1 Diuretics, calcium channel blockers, and beta-blockers may need to be reduced or withheld while commencing prazosin, until patients are comfortable with treatment.1

DOSAGE Prazosin is started at a low dose to prevent adverse effects. Standard maintenance doses are dependent on the clinical indication and patient tolerance (see Table 1). Doses are best administered at the same time every day, usually at night before bed.2 In the event that multiple doses are missed, titration is required when re-commencing treatment.1 Additional anti-hypertensive medications should be added more cautiously in patients on prazosin as there is potential for sudden-onset, severe hypotension.1

PRAZOSIN AND PTSD Nightmares and sleep disturbances associated with PTSD are difficult to manage and have a significant impact on quality of life.3,4 Evidence from randomised controlled trials suggest that prazosin effectively reduces these symptoms, with limited side effects.3 It works by inhibiting excessive norepinephrine stimulation in the brain.5 High doses are required to effectively manage symptoms. However, there is a risk of first-dose syncope with initial doses greater than 2mg.3 Therefore, patients are

recommended to commence treatment at 1mg, every second night, and gradually increase dosing until symptoms are well controlled. Once titrated correctly, treatment is generally well tolerated. The maximum recommended daily dose of prazosin is 40mg.

The average dose required for PTSD is 19.6mg for males and 8.7mg for females.3 Although there is evidence to demonstrate efficacy of this treatment, it remains off-label. All patients with known or suspected PTSD require a referral to a psychiatrist prior to commencing treatment.3

REFERENCES 1. Australian Medicines Handbook 2016 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2016 July.

2. NPS MedicineWise. APO-Prazosin tablets [Internet]. Surry Hills: NPS MedicineWise; 2016 Nov 2 [cited 2016 Dec 23]. Available from: http://www.nps.org.au/medicines/heart-bloodand-blood-vessels/blood-pressure-loweringmedicines/prazosin-blood-pressure-loweringmedicines/apo-prazosin-tablets 3. Togno J, Eaton S. Is there a role for prazosin in the treatment of post-traumatic stress disorder? AFP. 2015 Sep;44(9):647-49.

4. Nash DT. Alpha-adrenergic blockers: mechanism of action, blood pressure control, and effects of lipoprotein metabolism. Clin Cardiol. 1990 Nov;13(11):764-72.

5. Koola MM, Varghese SP, Fawcett JA. High-dose prazosin for the treatment of post-traumatic stress disorder. Ther Adv Psychopharmacol. 2014 Feb;4(1):43-7.

Table 1. Prazosin dosing.1,2 Indication

Initial dose

Titration

Maintenance

Hypertension

0.5mg, twice daily

Titrated every 2-3 days according to clinical response

4-20mg daily, divided into 3-4 doses per day

Heart failure

0.5mg

-

4mg daily, divided into 3-4 doses per day

Raynaud’s disease

0.5mg, twice daily

-

1-2mg, twice daily

Benign prostatic hyperplasia (BPH)

0.5mg, twice daily

-

2mg, twice daily

Are you an ANF member who does humanitarian volunteer work?

VOLUNTEER FUNDING

ANFIUWP Humanitarian Aid Volunteers Fund provides financial help to ANF members who are undertaking humanitarian volunteer work in Australia or overseas. The closing date for applications is the 15th December 2018.

The fund may be used for planned or completed volunteer work.

For more information about the fund or to get a copy of the application form and selection guidelines, call the ANF office on 6218 9444, email anf@anfiuwp.org.au or log on to iFolio.

September–October 2018 western nurse |

21

AcrosstheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

VIC DAILY DOSE OF ASPIRIN DOESN’T REDUCE RISKS FOR SENIORS

(ASPREE) trial of 19,000-plus participants in Australia and the US. Principal investigator Professor John McNeil, of Monash University, said the results of the sevenyear trial will result in a “rethinking of global guidelines” relating to aspirin use for preventing common conditions associated with ageing.

Popping aspirin every day won’t do much to improve your health when you’re elderly – unless you’re taking it for existing conditions on medical advice.

Victorian researchers said their analysis of a comprehensive study of low-dose (100mg) aspirin consumption revealed “an aspirin-a-day did not prolong life free of disability, or significantly reduce the risk of a first heart attack or stroke among participants” who were 70 years of age and older.

But “an increase in the number of cases of serious bleeding among the aspirin-takers (3.8%) compared to the placebo group (2.8%),” was ascertained from the ASPirin in Reducing Events in the Elderly

WA SPECIAL BREW TESTS SUPER BUGS An ingredient used in beer production is boosting the fight against antibiotic-resistant ‘super bugs’.

The WA-developed innovation uses brewer’s yeast to test bacteria for antibiotic resistance – with “millions of yeast working on designing new drugs at once”, according to the Harry Perkins Institute of Medical Research in Perth Louis Scott, from the institute, engineered the strains of brewer's yeast to be “addicted” to antibiotics which allows for the far quicker testing.

“He has made a library of millions of different antibiotic resistant variants and added them to the antibioticdependent yeast,” the institute said in September.

“Millions of healthy older people around the world who are taking low dose aspirin without a medical reason, may be doing so unnecessarily, because the study showed no overall benefit to offset the risk of bleeding,” he said.

But he stressed patients should follow their doctor’s advice about aspirin use and cautioned the results do not apply to those with existing conditions such as a previous heart attack, angina or stroke – where aspirin is recommended as a preventive drug. 

“The yeast dies if the material added truly causes antibiotic resistance because it will effectively destroy the antibiotic that the yeast is reliant upon.

“Dr Scott's approach tests how antibiotic resistance works on tens of millions of samples at a time. Previously, testing whether bacteria were resistant to antibiotics was done one molecule at a time.”

The institute said his method gives insights into how resistance works and how to design new drugs to overcome it.

“Sometimes the addicted yeast does not die,” the institute said.

“When this happens, it's possible to analyse the changes that caused the antibiotic resistance mechanism to fail, to inform how new antibiotics could bypass these mechanisms.

“This system effectively has millions of yeast working on designing new drugs at once.” 

WA CHOC-FLAVOURED MEDICINE FOR CHILDREN A formula that makes it easier to treat sick children by making medicine taste like chocolate has been created in Perth.

And kids love it, according to a study by the University of WA where researchers developed it.

Published by the journal Anaesthesia, the study tested 150 children aged three to 16 years and found the vast majority who tried the new chocolate-tasting medicine indicated they would take it again.

UWA Clinical Senior Lecturer Dr Sam Salman said: “Many children struggle with taking medicine, including medicine (Midazolam) used at the time of surgery that has an extremely bitter taste that is often hard to mask.

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western nurse September–October 2018

“This can result in distress for the sick child, their parents and the healthcare team and ultimately risks reducing the effectiveness of medicines and ongoing poor health.”

Other benefits of the formula – which does not reduce the effect of the medicine – include its accuracy in dosing compared to liquid medicines, its ability to be chewed or melted for children with swallowing difficulties and its long storage life without refrigeration.

After the success of the initial trial, a second medicine using the new formula is showing similar positive preliminary results in an ongoing trial at Perth Children’s Hospital, and there are plans to develop other medications, including antibiotics.

The team is now looking for industry partners to help take the new formula to the world. 

QLD TOP TIPS FOR LASTING WEIGHT LOSS Forming healthy habits rather than strict dieting can be key to longlasting weight loss, say Bond University researchers.

A study of 75 volunteers aged 18-75 and classified as overweight or obese was divided into a control group and two other groups asked to break old habits or form new ones, respectively.

Members of the habits groups lost an average of 3.1kg in 12 weeks, and a further 2.1kg at the 12-month mark, the researchers reported earlier this year.

A well-known “Ten Top Tips” weight-loss program based around healthy lifestyle changes rather than meal plans was effective in the habit-forming group. The tips were:

• Maintain consistent meal times.

• Enjoy small amounts of healthy fats from nuts, avocado and oily fish, instead of fast food and high-fat meats.

• Try walking 10,000 steps daily through habits such as using stairs and walking up escalators.

• If snacking, choose healthy options such as fresh fruit or a small handful of nuts.

• Check food labels to help select healthier options lower in calories, fat and sugar and higher in fibre.

• Don’t overload your plate unless with vegetables and avoid seconds.

• Try standing 10 minutes every hour.

• Have no more than one small glass a day of alcohol, juice, fizzy drinks or energy drinks.

• Eat slowly in order to eat less.

• Have fruit or vegetables at every meal. 

NSW SCHIZOPHRENIA BREAKTHROUGH – LINK WITH IMMUNE CELLS Immune cells have been found in greater amounts in the brains of some people with schizophrenia – a discovery that may unlock a cure for the debilitating illness affecting one in every 100 Australians.

“This discovery shows that specific immune cells are in the brains of some people with schizophrenia in close enough proximity to the neurons to do damage,” said a statement by NSW’s Neuroscience Research Australia (NeuRA), where the work was done.

NeuRA said the study, which was published in September in the journal Molecular Psychiatry, “has the potential to transform global schizophrenia research and open new avenues for developing targeted immune cell therapies”.

Professor Cynthia Shannon Weickert, who made the discovery, said: “In our study, we challenged this (long-held) assumption that immune

cells were independent of the brain in psychiatric illness and made an exciting discovery. We identified immune cells as a new player in the brain pathology of schizophrenia.

“To find immune cells along the blood brain barrier in increased amounts in people with schizophrenia … suggests immune cells themselves may be producing these inflammatory signals in the brains of people living with schizophrenia.” 

VIC NEW BLOOD TEST WARNS OF SECONDARY HEART ATTACK Identifying if a person is likely to have a secondary heart attack will soon be possible with a simple blood test.

Plasma lipid biomarkers (fats in the blood) that improve upon traditional risk factors in predicting heart disease and stroke have been identified at the Baker Heart and Diabetes Institute.

The knowledge is being incorporated into a new blood test currently under development “proposed to be trialled in Australia over the next two-three years as part of a broader personalised precision health program”, according to the institute’s head of metabolomics, Professor Peter Meikle.

Professor Meikle, who with his team did the blood research, said “eventually a GP will be able to request this test in order to better assess a patient’s risk of developing heart disease”.

“The test will be a simple blood test, similar to the process and cost of having a cholesterol test, and could be operated out of hospital pathology laboratories that already contain the necessary equipment,” a statement by the institute said in September. “(But) to date, a prototype of this test has been trialled in America, yet the prototype only provides GPs and patients with limited information on the basis of 2 lipid markers.” 

September–October 2018 western nurse |

23

Hypertension - back to basics

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

Hypertension is a complex, chronic medical condition where blood pressure is consistently above the normal range. Hypertension is an important and treatable risk factor for cardiovascular disease and end-organ damage, and a significant determinant of an individual’s overall cardiovascular risk.1.2 Blood pressure is a measure of the force exerted on the arterial walls by the blood that is pumped around the body.1 It is dependent on the volume of blood pumped by the heart (cardiac output) and the diameter and elasticity of the artery walls.1,4 Readings are measured in millimetres of mercury (mmHg) and are made up of two-parts, usually expressed as systolic, the pressure as the heart contracts, and diastolic, the pressure when the heart is relaxed between beats.1,4

Table 1: Classification of blood pressure levels in adults2

Optimal

Systolic BP (mmHg) Less than 120

Diastolic BP (mmHg) Less than 80

Presentations of hypertension include;

Normal

120–129

80–84

• Primary, idiopathic or essential hypertension: persistent high blood pressure with no specific cause. This usually develops over several years and is the most common presentation in adults.

High-normal

130–139

85–89

Grade 1 (mild) hypertension

140–159

90–99

Grade 2 (moderate) hypertension

160–179

100–109

• Hypertensive emergency: asymptomatic presentation with a systolic reading above 200 mmHg or a diastolic reading above 130 mmHg.

Grade 3 (severe) hypertension

180 or more

110 or more

Isolated systolic hypertension

More than 140

Less than 90

• Isolated systolic hypertension: systolic reading of 140 mmHg or more and diastolic reading of less than 90 mmHg. • Secondary hypertension: hypertension caused by another disease (Such as heart or kidney disease), or as a side effect of medication. Responsible for two to five percent of cases.

• White coat hypertension: blood pressure is high in the presence of health care professionals, but normal during daily activities1.

DIAGNOSIS In practice, cut-off values to diagnose normal blood pressure and hypertension are used to assist with diagnostic and management decisions. Any diagnosis of hypertension

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Diagnostic category*

* When systolic and diastolic blood pressure levels are in different diagnostic categories, the higher category should be used.2 should be based on multiple measurements taken on at least two separate occasions, one or more weeks apart, or sooner in suspected severe hypertension (see Table 1).2

MANAGEMENT Nurses play a significant role in educating patients on blood pressure targets and how they may be achieved. Targets are individualised based on the patient’s cardiovascular risk and comorbidities and management should be part of a holistic approach to managing cardiovascular risk.1,2 A combination of medication, lifestyle modification, blood pressure checks, and good self-management are usually required

to achieve blood pressure control.1 The timing and intensity of interventions are determined by the severity of the hypertension, the patient’s absolute risk for cardiovascular disease, and the presence of comorbidities or end-organ damage.2 Moderate reductions in several risk factors may be more effective than a major reduction in an isolated risk factor.2

BLOOD PRESSURE MONITORING Clinic blood pressure measures remain the ‘gold standard’ for diagnosing hypertension, and is the only blood pressure measure validated for estimating absolute cardiovascular risk using currently available risk assessment calculators.1,2

Ambulatory blood pressure monitoring (ABPM) and home blood pressure monitoring (HBPM) are used outside the clinic to help build a broader, more accurate blood pressure profile to support diagnostic and therapeutic decisions.1,2 It is often the role of the nurse to advise patients on an appropriate monitor, train the patient in its use, and ensure the monitor is calibrated on a regular basis.1 To increase reliability, a device that automatically records data is preferred.1

Ilustration 1 - Ideal positioning for blood pressure measurement

In 24-hour ABPM, the patient wears a portable, automated measuring device on their nondominant arm, while going about their normal activities.1,2 The patient also records information on symptoms and events that could affect blood pressure readings.2 When the cuff automatically inflates, patients should be advised to remain quiet and still throughout the reading. Measurements are taken and downloaded every 15 to 30 minutes.

The result is a cost-effective profile that is particularly useful when white-coat or masked hypertension is suspected, or clinic-based readings fluctuate.1,2 Home blood pressure monitoring involves selfmeasurement of blood pressure levels by the patient.1 It is particularly useful for long-term follow-up as it assists patients to understand their hypertension, promotes involvement in self-management, and can improve adherence to treatment strategies.2 It can also be used to investigate relationships between episodic symptoms and variations in blood pressure (for example light-headedness due to medicationinduced hypotension), and in the diagnosis of masked or white-coat hypertension.1,2 It requires the patient to be trained in the use of their machine, and regular calibration of the device.1 Clinic measurements, ABPM, and HBPM are all predictors of cardiovascular risk. However, HBPM and ABPM are stronger predictors of outcomes, providing more prognostic information.2 Treatment decisions should be based on ABPM or HBPM where available.2 The choice between methods will depend on indications, availability, ease, cost of use, and patient preference.2

TAKING A BLOOD PRESSURE READING Automated blood pressure devices (electronic devices) are the preferred device for measuring an blood pressure.5 An inappropriately sized blood pressure cuff is the most common device-related error when assessing blood pressure.1,2 The cuff bladder should be long enough to cover 80% of the circumference of the mid-upper arm and have a width at least 40% of the arm’s circumference.1,2 Using a cuff that is too large or too small can artificially underestimate or overestimate blood pressure, respectively.1,2 The optimal conditions for taking a blood pressure remain the same whether taken inside or outside the clinic (see Illustration

1). These should be included in the training provided to patients; • A quiet environment at room temperature • Device readout clearly visible • Patient seated comfortably and relaxed for several minutes before measurement. Back is supported, legs not crossed, and upper arm bared without constrictive clothing • Arm supported so the cuff is level with the heart • No talking during the reading • Patients should avoid caffeine and smoking for at least two hours before the measurement2

MEDICATION In Australia, the most commonly prescribed antihypertensive classes are angiotensinconverting enzyme inhibitors, angiotensin receptor blockers, calcium channel blockers, beta-blockers, and diuretics.5 Selection is based on the severity of the hypertension, level of cardiovascular risk, and presence of comorbidities, and it is common for two or more medications to be prescribed.1,2 It is estimated that 50% of patients do not take their medication as prescribed and emphasis should be placed on regular education and support for compliance.2

LIFESTYLE MODIFICATION Lifestyle modification can delay or prevent the onset of hypertension, reduce blood pressure levels in patients with existing hypertension, and possibly reduce or abolish the need for antihypertensive medications.1,2 Nurses have a unique opportunity to work with patients

to examine their lifestyle, identify risks and potential areas for change, and develop individualised, collaborative management plans to assist patients to reach their goals.1 Lifestyle factors to consider include diet, exercise, weight management, smoking, and alcohol use.1.2 Using the 5As approach (ask, assess, advise, assist, arrange), and motivational interviewing can support behaviourial change.2

REFERENCES 1. Heart and Stroke Foundation of Ontario and Registered Nurses’ Association of Ontario.

Nursing Management of Hypertension. Toronto, Canada: Heart and Stroke Foundation of Ontario and Registered Nurses’ Association of Ontario; 2005, updated 2009.

2. National Heart Foundation of Australia.

Guideline for the diagnosis and management of hypertension in adults – 2016. Melbourne: National Heart Foundation of Australia; 2016.

3. Zwar N, Hermiz O, Halcomb E, Davidson PM, Bodenheimer T. Improving blood pressure control in general practice: A pilot study of the ImPress intervention. Australian Family Physician.

2017;46(5):306–311.

4. Thomas AJ. 3 Types of Blood Pressure Monitoring Devices – Sphygmomanometers. April 3, 2016 [cited October 2017]. Available from: https:// www.medicwiz.com/medtech/diagnostics/3types-of-blood-pressure-monitoring-devicessphygmomanometers 5. Health Direct. February 2017 [cited October 2017]. Available from: https://www.healthdirect. gov.au/blood-pressure-medication 6. High blood pressure Research Council of Australia. [cited October 2017]. Available from: http://www.hbprca.com.au/hcp/ambulatorybp-monitoring-collaborative/

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AroundtheGlobe WORLD NEWS

HIGH PRICE OF HEALTH IN USA Don’t get sick and go to hospital in the United States without insurance – especially with heart problems.

A recent analysis of the 35 conditions with the highest average cost per hospital stay shows exactly how pricey US hospital care is.

Top of the list is cardiac and circulatory congenital anomalies, which include congenital heart disease and heart murmurs, with an average cost per stay of $63,460.

Just the “average hospital stay” costs more than $10,700, according to the analysis by Business Insider’s UK website.

Number two is heart valve disorders, which will see you slugged an average cost per stay of $42,647. This is “a catch-all term for any

CHOWING DOWN CHOC BARS COULD CUT YOUR RISK OF HEART FAILURE “Moderate chocolate consumption” can reduce your risk of heart failure by as much as 23 per cent, US and Thai researchers believe.

While dark chocolate and cocoa are associated with a reduced risk of cardiovascular disease and cardiovascular mortality, no research previously specifically examined the relationship between chocolate intake and heart failure (HF), the researchers said in a report recently presented at the European Society of Cardiology conference in Munich.

VAPING ‘NOT HARMLESS’, SAY BRIT RESEARCHERS E-liquid fluid that has been vapourised by an electronic e-cigarette boosts “production of inflammatory chemicals and disables key protective cells in the lungs”.

University of Birmingham researchers said the protective cells disabled by vaping are ones that keep the air spaces in your lungs “clear of potentially harmful particles”.

“Vapour impairs the activity of cells, called alveolar macrophages, which are key to the immune response within the airways,” the university reported in August. “Alveolar macrophages engulf and remove dust, bacteria and allergens that have evaded the other mechanical defences of the respiratory tract.”

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illness stemming from the improper use of any of the four heart valves that controls blood flow”.

At number three is aortic, peripheral and visceral artery aneurysms, with an average cost per stay of $34,656.

Coronary atherosclerosis is next up at $20,936, followed by acute myocardial infarction (heart attack) costing $20,246.

The data for the analysis comes from the Healthcare Cost and Utilization Project – “a family of health care databases and related software tools and products developed through a Federal-StateIndustry partnership and sponsored by the Agency for Healthcare Research and Quality”. 

So they examined data from five studies involving 575,852 individuals and 24,649 HF events, and found “moderate chocolate consumption (1–3 servings/month) was associated with a 23% lower risk of HF”.

This compared with no regular chocolate intake.

But the scientists also said “high chocolate consumption” – one or more servings daily – “was associated with a 17% higher risk of HF”.

Lead researcher Dr Chayakrit Krittanawong, from New York’s Icahn School of Medicine at Mount Sinai, said on The Telegraph’s UK website that he believes “chocolate is an important dietary source of flavonoids which are associated with reducing inflammation and increasing good cholesterol”.

“Most importantly, flavonoids can increase nitric oxide (a gas which expands blood vessels, helping circulation),” he said. “However, chocolate may have high levels of saturated fats. I would say moderate dark chocolate consumption is good for health." 

Professor David Thickett, of the university’s Institute of Inflammation and Ageing, said: “It has been suggested electronic cigarettes are safer than traditional cigarettes, and this narrative is increasingly supported by tobacco companies that have established research institutes devoted to generating supportive data.

“E-cigarette users have been given advice based on relatively little information. We hope that by disseminating this data as widely as possible the public can at least make an informed choice; the public must be aware that these devices are not harmless.”

The research was published in the BMJ journal Thorax. 

LOW CARB LOWERS LIFE SPAN Eating a low carbohydrate diet has been linked to a higher mortality rate than if you consume a moderate amount of carbs.

And the effect is worse when the low carb diet is rich in animal-derived substitutes rather than plant-based ones, according to US researchers who studied information from a 25-year period provided by 15,428 American adults, aged 45–64 years.

“Both low carbohydrate (<40% of energy from carbohydrate) and high carbohydrate (>70% of energy from carbohydrate) consumption were associated with increased mortality risk and shorter residual life span,” said the researchers in a report of their work published recently in the Lancet Public Health journal. “Minimum risk (was) observed with 50–55% of energy from carbohydrate.”

But they said “low carbohydrate dietary patterns favouring animalderived protein and fat sources, from sources such as lamb, beef, pork and chicken, were associated with higher mortality”.

However, low carb diets that “favoured plant-derived protein and fat intake, from sources such as vegetables, nuts, peanut butter and whole-grain breads, were associated with lower mortality”.

The researchers said the data provides “further evidence that animalbased low carbohydrate diets should be discouraged. Alternatively, when restricting carbohydrate intake, replacement of carbohydrates with predominantly plant-based fats and proteins could be considered as a long-term approach to promote healthy ageing”. 

DINING ON DAIRY DAILY DECREASES DISEASE DANGER

Similar higher intake of whole-fat dairy also resulted in lower rates of total mortality (3.3 per cent vs. 4.4 per cent) and major cardiovascular disease (3.7 per cent vs. 5 per cent), compared with consuming less than half a serving of whole fat dairy every day.

Consuming dairy products every day – even whole-fat ones – can lower your risk of cardiovascular disease and mortality, according to Canadian researchers.

“Our findings support that consumption of dairy products might be beneficial for mortality and cardiovascular disease," lead author of the study, Mahshid Dehghan, of the Population Health Research Institute of McMaster University and Hamilton Health Sciences, said in September.

Data from 136,384 people from 21 countries was used in a study that found that those who had more than two servings of dairy daily had lower rates of total mortality than a no intake group (3.4 per cent vs 5.6 per cent).

The dairy consumers also had lower rates of noncardiovascular mortality (2.5 per cent vs 4 per cent), cardiovascular mortality (0.9 per cent vs 1.6 per cent), major cardiovascular disease (3.5 per cent vs. 4.9 per cent), and stroke (1.2 per cent vs. 2.9 per cent).

DISINFECTANTS CONTRIBUTE TO KIDS OBESITY Frequent use of household disinfectants and even baby wipes containing antimicrobial or antibacterial agents likely increases the risk of obesity in young children, say Canadian scientists.

The researchers found that “infants living in households with disinfectants being used at least weekly were twice as likely to have higher levels of the gut microbes Lachnospiraceae” (bacteria linked to obesity-related metabolites) at three to four months of age.

“When they were three years old, their body mass index was higher than that of children not exposed to heavy home use of disinfectants as an infant,” said Anita Kozyrskyj, University of Alberta pediatrics professor and principal investigator on

One standard serving of dairy was a 244g glass of milk, 244g of yogurt, 15g of cheese, or 5g of butter. 

the SyMBIOTA project, an investigation into how changes in the infant gut microbiome affects health.

“Our ‘mediation’ statistical analysis suggests that a gut microbiome enriched with Lachnospiraceae early in infancy was likely directly responsible for children becoming overweight or obese.

“We recommend against frequent use of disinfectant cleaners in households with infants and that parents consider alternatives.”

She said infant exposure likely occurs through aerosol or touching surfaces, and that some baby wipes also contain disinfectants.

The study, published in the Canadian Medical Association Journal in September, used data from 757 infants, examining exposure to three categories of cleaners –disinfectants, detergents and eco-products.

Only disinfectants were linked to the risk of obesity. 

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SERVES 2

MUSHROOM, MISO, & SOBA NOODLES RECIPE The humble button mushroom is underrated, they have so many minerals and health benefits, including immune system-boosting properties – and they add tasty flavour.

Combine them with fermented miso and soba noodles, and you have the perfect dish to keep you happy and healthy.

Soba noodles work great with any Asian greens, even chicken or beef added to the broth. The shiitake mushroom powder listed in the ingredients is made simply by dehydrating fresh shiitake mushrooms, then blitzing them to a powder – making it a super easy umami powder to have in your pantry for any broths, soups or risottos.

Come and learn Jamie Oliver’s hints, tips and shortcuts to cooking delicious and affordable meals from scratch!

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Courses run at Joondalup from 1 November to 18th December 2018 st

For more information and to book: jamiesministryoffood.com.au

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EQUIPMENT

INSTRUCTIONS

• • • • • • • •

1. In a large saucepan, heat a little olive oil and sauté the crushed garlic slightly. Add 3 cups of water to the pan along with the mushroom powder and bring to a simmer.

Saucepan Pot Knife Grater Garlic press Colander Measuring cups and measuring spoons Bowls, for serving

2. Slice the mushrooms and add them to the broth.

3. Slice the broccolini lengthways and again in half and set aside.

4. Cook your soba noodles in a large pot of boiling water according to the packet. Be sure not to overcook them as they can become very stodgy. Once they have cooked, drain the water and top up the pot with cold water to prevent them from sticking together and cooking further.

INGREDIENTS • • • • • • • • •

1 ½ cups of mushrooms Olive oil 2 cloves of garlic, crushed ½ a bunch of broccolini 1 tbsp of shiitake mushroom powder 1 ½ tbsp of white miso 1 heaped tsp of grated ginger 1 tbsp of soy sauce Soba noodles

5. Add the broccolini, soy sauce and grated ginger to the broth and simmer for 5 minutes.

6. In a small bowl add the miso and half a cup of warm water, give it a good mix until there are no more lumps of miso. Remove the broth from the heat and add the miso.

GARNISH • • • •

7. Divide the soba noodles between two bowls then add the mushroom broth and veggies. Top with a handful of baby spinach, fried shallots for a delicious crunch, sesame seeds and a really good splash of sesame oil.

1 cup of baby spinach Sesame oil Fried shallots Sesame seeds

Recipe published courtesy of Kitchen Warehouse

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September–October 2018 western nurse |

29

ResearchRoundup LATEST AND GREATEST FROM SCIENCE

CAT PARASITE MAKING YOU AMBITIOUS

RECYCLED JEANS TO HELP PEOPLE WALK AGAIN

Feeling a bit gutsier with business ventures lately – it might be because of your cat.

Artificial cartilage for joint reconstruction could be made from old denim jeans under textile recycling methods pioneered by Australian researchers.

Prevalence in humans of the cat-spread parasite Toxoplasma gondii is “a consistent, positive predictor of entrepreneurial activity and intentions at the national scale”, researchers from the USA, Europe and Hong Kong have found.

“Nations with higher infection also had a lower fraction of respondents citing ‘fear of failure' in inhibiting new business ventures,” said the researchers recently in the British journal Proceedings of the Royal Society B. Furthermore, among nearly 1293 US university students assessed, the odds of being a business major were 1.4 times higher for antibody-positive students.

Infected business major students were also 1.7 times “more likely to have an emphasis in ‘management and entrepreneurship' over other business-related emphases”.

The denim is dissolved and its remains are turned into an aerogel – “a low density material with a range of uses including cartilage bioscaffolding, water filtration and use as a separator in advanced battery technology”.

The process worked because denim was made from cotton, a natural polymer comprised of cellulose, said Deakin University scientist Dr Nolene Byrne, who with PhD candidate Beini Zeng discovered the method.

“Cellulose is a versatile renewable material, so we can use liquid solvents on waste denim to allow it to be dissolved and regenerated into an aerogel, or a variety of different forms,” Dr Byrne said.

“When we reformed the cellulose, we got something we didn't expect – an aerogel with a unique porous structure and nanoscopic tunnels running through the sample.”

The parasite, which infects about two billion people worldwide, is found in more than 100 vertebrates, but can only reproduce sexually in wild and domesticated cats.

Dr Byrne believed the sticky nature of the denim cellulose solution was likely responsible for the unique aerogel structure that resulted, something “ideally suited for use as synthetic cartilage”.

It potentially amplifies “impulsivity, sensation-seeking, and risktaking behaviours, as well as an individual’s focus on ego, ambition, material possessions and self-achievement (at least in men) – characteristics often associated with entrepreneurial activity”. 

“We are now entering pilot-scale trials and look to be at commercial scale within three to five years with industry support,” she said. 

WRINKLES MAY SHOW DEATH RISK

“The higher your wrinkle score, the more your cardiovascular mortality risk increases,” concluded study author Yolande Esquirol, associate professor of occupational health at France’s Centre Hospitalier Universitaire de Toulouse. He presented the findings in August at the European Society of Cardiology annual conference in Munich.

Professionals attending entrepreneurship events who had T. gondii were 1.8 times “more likely to have started their own business compared with other attendees”.

Having deeper forehead wrinkles than is typical for your age might mean you have an increased risk of dying of a heart attack.

French researchers investigated horizontal forehead wrinkles in a group of 3,200 healthy working adults over 20 years, to see if this marker helped assess cardiovascular risk.

Physicians scored subjects depending on numbers and depth of wrinkles – with a zero indicating no wrinkles and three meaning “numerous deep wrinkles”.

During the study 233 participants died of various causes. Of these 15.2 per cent had score two and three wrinkles, 6.6 per cent had score one and 2.1 per cent had no wrinkles.

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The researchers are unsure about reasons for the link, but said changes in collagen protein and oxidative stress seem to have a role in both atherosclerosis and wrinkles.

Also, forehead blood vessels are so small they might be more sensitive to plaque build-up – “meaning wrinkles could (be) one of the early signs of vessel ageing” and “forehead wrinkles may be a marker of atherosclerosis”. 

WIN A WALLACE & GROMIT BLU-RAY MOVIE COLLECTION – PLUS SHAUN THE SHEEP! If you already know Wallace & Gromit and other Aardman classics, then you’ll simply enter this competition. If you’ve never seen a Wallace & Gromit segment, this is your chance to enjoy one of the most loved kids/adults clay animation creations. It’s the adventures of a man, his dog and their crazy inventions – with a lovely bit of cheese and crackers thrown in!

You can win one of 30 Wallace & Gromit The Collection Blu-ray sets – plus Shaun the Sheep: The Movie.

The collection includes the old favourites A Grand Day Out, The Wrong Trousers, A Close Shave and A Matter of Loaf and Death. Meanwhile, Shaun The Sheep: The Movie introduces us to two new Aardman characters; Trumper, the animal warden who rules the city’s animal shelter with a rod of iron, and Slip, an inner city orphan dog who helps Shaun save the day. 

WIN one of 30 Kitchen Warehouse vouchers The popularity of our Recipe Corner section got the team at western nurse thinking – should we give members yet another chance to get hold of some great gear to help you whip up the recipes on our pages? We say: YES! So we’re giving away another 30 gift vouchers valued at $25 to spend on the wonderful products in Kitchen Warehouse stores.

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