Western nurse magazine November December 2017 by ANF WESTERN NURSE MAGAZINE

November – December 2017

incorporating western midwife

THE ANF PHOTO COMPETITION IS BACK

WIN holidays, laptops and more – Just for taking snaps at the ANF holiday units! Even Santa's excited! SEE PAGES 4-5

PLUS

Extra Xmas prizes including BBQ sets and a new Harry Potter book!

western nurse is the official magazine for ANF members in WA

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Secretary's Report November - December 2017 on the

cover

FEATURED 4 ANF Photo Comp is back! 8 ANF Humanitarian Fund: Making a difference

ANF Photo Competition is back!

14 Mark’s Q & A

FAVOURITES

The Minister has assured us he stands by his commitment to get rid of appraisals, and he has moved immediately to address this key issue.

18 ANF Out ‘N’ About 22 Across the Nation

31 ANF Contact Details

HOLIDAY ANF

In the meantime, I hope you, our members, take some time out to rest and enjoy the festive season with family and friends, and have a moment for real closure and reflection on the year that is ending.

30 Research Roundup

15 ANF Super Deal Margaret River 32 ANF Super Deal Kalbarri

Mark’s

Due to popular demand we’re bringing back Mark’s question and answer section as regular feature in western nurse. Tax deductions have been a common subject in many inquiries recently, so we’ll cover a repeatedly occurring question this edition.

Can we claim home internet costs as a tax deduction because we have to do CPD each year, much of which is online; and I also often need to access work emails and often I do most of my mandatory competencies at home because work is too busy? It’s a very good question given the amount of online learning now being done. And the answer is yes, a claim can be made – as long as the education is related to current employment, such as either keeping up-to-date or enhancing earning capacity. The education cannot be for a different field outside the scope of current work e.g. a nurse studying to be a doctor.

You may also be able to claim for some home office expenditure:

Home office – You can claim the set rate of 45c per hour for heating, cooling, lighting;

Mobile phone – percentage of bill for work purposes. You need to keep records for a 4-week representative period in each income year to claim a deduction of more than $50; Internet – percentage for work purposes; Specific office equipment – percentage claim based on work/private usage i.e. computer;

Consumables – percentage based on work usage. i.e printer cartridges, paper, pens etc;

You would need to ensure that any other people using the equipment, internet etc are factored into your calculations, so you only claim your own work-related usage as a deductible amount. 

update: Hypertension inQpregnancy Mark’s &A

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ned as han (or c blood mmHg.1 ension, psia, or creased should monitor entially ociated

WIN! 31 Extra Xmas prizes – BBQ sets, Blu-ray collections, and a new Harry Potter book

CLINICAL UPDATES 12 Carbapenemase-producing Klebsiella pneumoniae 16 Hypertension in pregnancy 24 Exploring the social determinants of health

URE

29 Insulin

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Hypertension in pregnancy

What’s for certain is the ANF won’t be accepting PDRs, appraisals or whatever else they want to call them. I know how much our members want to be rid of these appraisals/reviews that serve no good purpose, but are often used for bullying. So getting rid of them will continue to be a top priority for me and the ANF, and I will keep you updated as the situation evolves.

26 Around the Globe

ANF Humanitarian Fund: Making a difference

As you'd know by now, I’ve approached the WA Health Minister to inform him a lot of hospitals are not fulfilling his election promise to abolish annual performance appraisals. The Minister recently announced appraisals had been scrapped, but it appears those hospitals have simply relabelled performance appraisals as Professional Development Reviews (PDRs), or similar.

6 Internet Watch

State Secretary, Mark Olson

While we continue to chip away at our members’ objectives, what I know for sure is your ANF is closing this year better equipped than ever before to deal with existing and coming challenges. We’re now 31,000-members strong and growing each year – and next year will be the 14th straight year of no membership fee increase for ANF members in Western Australia. Despite keeping the membership price down, we enter 2018 with over $32 million in cash and assets, ready to be used for the benefit of members. Whether it's a major industrial campaign, or growing our ANF legal team, or expanding the iFolio services, or adding to the ANF Holiday Units portfolio to give you more options for a great getaway, we have more than enough capacity to get the job done, and well. Importantly, you’re part of an organisation that listens to you, and never stops asking this key question before every major decision: ‘What’s in it for our members, and the people they care for?’ On behalf of all the ANF team, I wish you a safe and happy Christmas and a terrific 2018.

ressure.1

comfortable the floor and

DON’T • Take a blood pressure lying supine as supine hypotension syndrome may occur

both arms

• Use an automated device in women with pre-eclampsia

when possible

• Use any device that has not been properly validated for use in that patient population*

2mm

sure reading

chines have been validated for use in pregnant women d pressure

CHRONIC HYPERTENSION Onset: before pregnancy or before 20 weeks gestation Characteristics: elevated blood pressure without any other systemic features. Potential complications: preeclampsia, foetal growth restriction, placental abruption, preterm birth, or stillbirth. Chronic hypertension may occur with, or without an underlying cause. Essential hypertension, without a known cause, may be diagnosed before pregnancy or twenty weeks gestation. Chronic secondary hypertension may occur in pregnancy as a result of chronic kidney disease, renal artery stenosis, systemic disease, endocrine disorders or coarctation of

November–December 2017 western nurse |

120 CHANCES TO WIN – JUST SEND US YOUR PHOTOS AT THE ANF HOLIDAY UNITS!

Win holidays, laptops, iPads and more, just by uploading your best vacation snap from your stay at the ANF’s Holiday Units in Kalbarri or Margaret River. The ANF’s photo competition is back which means even more opportunities to win prizes! First prize is a laptop, second prize is an iPad, and third prize is a week for two in the ANF resort of your choice. Starting from January, there will also be 10 other prizes a month – which means more than 120 chances to win each year, with entries for the main prizes closing at the end of the year. All you need to do is take some snaps at one of the ANF’s Holiday Units in Kalbarri or Margaret River. Then login to your iFolio and click the competition link and upload your favourite photo. (Exact instructions at the end of this article) ANF WA State Secretary Mark Olson said the ANF is always is thinking of ways to squeeze more members and their efforts into western nurse, and also ways to give out even more prizes. “We’d been missing seeing our members’ great photographs, so we thought, why not re-launch an old favourite – the ANF photo competition,” Mark said.

western nurse November–December 2017

So you get a triple bonus for staying at the ANF Holiday Units: 1. An opportunity to have a heavily discounted vacation – courtesy of the ANF, in a great location in a choice of two extremely popular holiday destinations: Margaret River or Kalbarri.

120 CHANCES TO WIN

2. You get to stay in spacious well-equipped ANF Holiday Units in specially chosen resorts, because we’ve always demanded quality accommodation for our members, not the usual shabby beach shacks offered by other organisations. 3. And you can win great prizes – just for taking holiday snaps. We often speak to guests at the ANF Holiday Units to see how they’re going, and last summer one of those chats coincided with the ANF’s photographer being onsite at Margaret River. When we caught up with registered nurse Karyn Perrie, her husband Roger and their children Emily, and Sarah, they were having a week away from it all in the ANF’s Margaret River Holiday Units.

“We’d been missing seeing our members’ great photos, so we thought, why not re-launch an old favourite – the ANF photo competition” Karyn, who works part-time at Osborne Park Hospital, has been to the ANF Holiday Units both at Margaret River and Kalbarri. “It’s our second time in Margaret River, and we’ve been up to Kalbarri once as well,” she said. “Roger loved the surf up there (Kalbarri). “Both places are lovely, they’re great for the kids, and the location is great – the town is just down the road, both in Margaret River and Kalbarri, and the pool’s great at both resorts.” Roger, a State manager at an electrical wholesaler, said: "The spa and pool and playground are great here, they can play and you can watch them easily. And the apartments are great – really spacious inside.” If you want to experience a holiday like Karyn and Roger, make sure you book well in advance so you get the dates you want, because the ANF Holiday Units are popular all year round. The photo comp will also be year-round – so whether it’s a mid-year break up in Kalbarri to catch some sun while everyone else is freezing back in Perth, or a summer holiday away from the searing heat down south in Margaret River, take some snaps and you’ll be in with a chance to win!

Registered nurse Karyn Perrie, her husband Roger, and their children Emily and Sarah.

EXCITING OPPORTUNITY FOR REGISTERED NURSES Hannah’s House is seeking enthusiastic and passionate Registered/Enrolled nurses with a minimum of 2 years’ experience, preferably in paediatrics or critical care, to provide in home care to children with complex care needs. Positions are casual and offer a flexible and reliable roster. We are a growing service, and are keen to develop a competent team to move forward. For more information call

Susan King on: 0413 372 943 or email your CV to info@hannahshouse.org.au

Just login to your iFolio, click on the Resources tab, and then click on the ANF Holiday Units Photo Competition link and upload your snap.  November–December 2017 western nurse |

InternetWatch AMAZING APPS + ONLINE NEWS

FIVESuperSites Australia Driving Tests This is great for people learning the rules of driving in Australia. Access more than 2600 current questions related to signs, laws and rules. Specify your state and away you go. Internet is not required after initial download, meaning you can use it anytime and anywhere. Free

MiFertility Plan MiFertility Plan is a calendar designed to help women through their fertility treatment. After information is entered, the plan provides a schedule of medicines, appointments, scans and blood tests. That can be shared with others as required. The information is not stored on a ‘cloud’, ensuring privacy. Free

This simple tool will derive the result for you and plot the result on a weight scale. Free

Australian Bites and Stings Summer’s here! Australia is home to many of the world’s most venomous creatures. There’s a checklist of the essentials, instructions on what to do if you are bitten or stung, an emergency services call button and an audio resuscitation guide. Free

Bubble Level A bubble or spirit level is an instrument designed to indicate whether a surface is horizontal (level) or vertical (plumb). Bubble Level is handy, accurate, simple to use and incredibly useful. Free

Color Switch Tap the ball carefully through each obstacle and your ball will switch colour. You must follow the colour pattern on each obstacle to cross it. Be careful not to pass through the wrong colour, or you’ll have to start again. Simple. Addictive. Free

Hearts Sounds (+ Lung Sounds) Confused by murmurs, rubs, gallops, wheezes, and crackles? Download this app for essential information, diagrams and a quiz on heart and lung sounds. Put your headphones on, the features sound like your listening through a stethoscope. $2.88

Smart BMI Calculator Body mass index is an estimate of body fat based on height and weight and is used throughout the world to estimate if someone is under or overweight.

Perth Airport Travel easy with the official Perth Airport App which gives you live flight information and status updates, helps you plan your trip to and from the airport and book parking right in the palm of your hand. Free

ellentube Welcome to Ellentube! The home for all things Ellen DeGeneres, on your phone. Watch your favourite clips, original series and her classic gags. Plus, you can submit your own photos and videos to Ellen's challenges and win giveaways. Free

ABC Listen The ABC listen app helps you discover your next favourite podcast, along with all the ABC live radio streams. Download today and hear the world differently. You’ll also find track and program information. News bulletins are updated hourly. Free

western nurse November–December 2017

ySafe

Kids and their online devices - It’s hard to tell what they’re watching at times. ySafe was founded ‘to give the power and control back to parents and provide them with the skills and knowledge that they need to keep their kids safe online’. Used extensively by schools and businesses. www.ysafe.com.au/

Sounds of Australia

Sounds of Australia is an archive of sound recordings. Each year, the Australian public nominates new sounds with final selections determined by a panel of industry experts. Check out the collection which includes audio from Strictly Ballroom, the Play School theme, songs, speeches and lots more. www.soundsaustralia.com.au/

WA Detective Trails

This is so cool - Take self-guided walks around Perth city, suburbs and WA at large. Each trail has a fictitious crime to solve. Each stop has you hunting for the answers to the clues which ultimately reveals the identity of an innocent suspect. www.puzzlewalks.com.au/

Guide Dogs Australia

So many dogs, so little time! Guide Dogs Australia contains amazing stories and profiles on these beloved animals. Read about ‘The Eyes Up’ campaign which urges mobile device users to look up when walking to help those who are blind or vision impaired stay safe. www.guidedogsaustralia.com/

Citizens Advice Bureau

CAB is an organisation connecting Western Australians with information and services so they can make independent and informed decisions. They provide information and referral, a low-cost legal advice service on a wide range of issues, and a mediation service. www.cabwa.com.au

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November–December 2017 western nurse |

ANF Humanitarian Aid

Making A Difference

On a rural home visit, Robyn met these two children who had never before seen a camera.

This is the finale of our series showing our members using their special skills to better the world – assisted by the ANF’s humanitarian fund. This time one of our members travelled to a Cambodian community terribly deprived of resources. When Perth nurse Robyn McMillan, née Hutchinson, and her Kiwi buddy Margaret Thompson decided to take their nursing skills to Cambodia, they found the trip life-changing – not just for the patients. Just over a year ago, they resolved that their combined 84-years of nursing experience should be used in a place where health care professionals are urgently needed.

“They offer a range of school classes for both children and adults, in subjects from English to dressmaking, to hospitality, and all children that take part are fed a healthy meal. These students from four to 12 years, are taught about hand and teeth hygiene, so when they go home, they can educate their families to try and cut down the incidence of gastro and related diseases. They get very excited having their own toothbrush and toothpaste, something we take for granted every day.”

“So off we went to Cambodia with 60 kilos of clothing and medical donations, enthusiasm and a sense of adventure,” said Robyn, a registered nurse from Armadale Hospital, who was assisted in her travels by an ANF Humanitarian Aid Volunteers Fund grant. “We spent our time in Siem Reap, at the Helen Bonner Health Centre located in one of the poorer communities in Cambodia, where the Sunrise New Hope Foundation aims to provide free medical care and education to those living in impoverished areas.

western nurse November–December 2017

Volunteer nursing staff with local monks about to get new glasses with Robyn McMillan far left and Margaret Thompson far right.

Volunteers Fund

Robyn photographed lunch time at a Cambodian school helped by the New Hope Foundation – healthy soup.

Robyn said the health centre is heavily reliant on volunteers, not only in the medical field, but also to teach classes and assist with outreach and fundraising. “The entire centre is kept running by an incredible staff who are completely dedicated to the local people and strive to make a real difference in their community,” she said. “But with only two doctors, a pharmacist, and interpreter and one RN, their workloads are heavy, and it is difficult to treat problems with a deficit of money and equipment, and traditional versus Western medicine.

“The most common health problems that we saw were diabetes and hypertension, which are controlled with free medicine, when the resources are available to them. Sometimes this is not possible due to funding and access concerns.” As part of their work, they did some rural home visits. “Seeing this type of living was a real shock and a massive eye opener,” Robyn said. “The housing was nothing more than corrugated iron sheets and tarps tangled together in a lean-to fashion. The

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November–December 2017 western nurse |

ANF Humanitarian Aid

“

Working alongside this woman and experiencing life in a developing country taught us a lot – not only about their paths, but about the human spirit

”

Robyn checking out the new volunteer-funded water pump in a local village.

10 |

western nurse November–December 2017

Volunteers Fund area had no sanitation, and had only just received running water from Western charities working in the area. What stood out the most, however, was their smiling faces. They did not have much in way of possessions, but what they did have they were grateful for.”

Robyn said she and Margaret are continuing work with the Sunrise New Hope Foundation, and encourage others to do the same. “The spirit of the Cambodian people touched us deeply and changed something inside of us that can never be undone,” she said.

The two friends were particularly inspired by an RN at the clinic, Sreyna. “I had never seen such dedication matched with such a difficult lifestyle,” Robyn said. “Sreyna worked every day at the clinic from 8am to 5pm, going above and beyond her call of duty. But that is not all. She gets up every morning at 3am, in order to go sell her family’s vegetables at the local market, and then drives an hour from there to get to the clinic.

The ANF fund is open to members who have done, or are about to undertake humanitarian volunteer work in Australia or overseas. Applications close December 15 each year, so members now have a full year to get their proposals ready. 

“After work each day, she then goes and spends two hours looking after a local village elder. That is except for Fridays – on Fridays she travels three hours to another city for the weekends to study midwifery to further assist her people. Oh and did I mention she is a single mum to a seven-year-old boy. “Working alongside this woman and experiencing life in a developing country taught us a lot – not only about their paths, but about the human spirit.”

Robyn McMillan left, with clinic staff and other volunteers in Cambodia.

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November–December 2017 western nurse |

update: Carbapenemase-producing Klebsiella pneumoniae Read this article and complete the online quiz to earn 0.5 iFolio hour

Klebsiella pneumoniae (K. pneumoniae) is a member of the genus Klebsiella, in the family Enterobacteriaceae.1 It is a gram-negative bacilli responsible for community and hospitalacquired infections including respiratory tract infections, necrotising pneumonia, pyogenic liver abscesses, endogenous endophthalmitis, urinary tract infections, and bloodstreamassociated infections.1 In 1996, it was discovered that K. pneumoniae could produce carbapenemase (KPC), an enzyme responsible for multidrug resistance. Since then, KPCpositive bacterial infections have been documented throughout the world.2 The rapid spread of antimicrobial resistance challenges our ability to effectively treat life-threatening infections. Greater adherence to microbial surveillance and infection control measures are required to prevent further harm.2

identification of CPKP can be difficult as low levels of resistance are often difficult to detect.4 Spectrophotometry assay is the gold standard for confirming CPKP.4 Unfortunately, it is time consuming and often requires verification from multiple laboratories.4 Other methods, such as the modified Hodge test, may also be used. Development of alternative diagnostic tools to enhance the speed and accuracy of multidrug resistant organism detection are underway.4 The ideal treatment for CPKP is unknown.1 Where possible, antibiotics should be tailored to susceptibility testing.1 Combination therapy may be used to maximise bactericidal activity, increase survival, and reduce further resistance (table 1).1,2 Source control, such as draining of an abscess or removal of an infected device, also helps to reduce the burden of infection and improve healing.1 Table 1. Antibiotics that have been used to treat CPKP in published case series and case reports.1

NAME

USE

Polymyxins (colistin or polymyxin B)

Last resort agent

TRANSMISSION

Tigecycline

Last resort agent

K. pneumoniae is transmitted through direct or indirect contact with a contaminated source. This includes person-to-person contact and transmission via an inanimate object.3 Individuals in hospital settings are at increased risk as a result of invasive devices such as ventilators, intravenous cannulas, and indwelling urinary catheters.3

Fosfomycin

Last resort agent

Rifampin

Last resort agent

SYMPTOMS

Aminoglycosides (e.g. Gentamicin)

K. pneumoniae naturally occurs in the human intestine and faeces, and generally does not cause disease in healthy individuals.3 However, extra-intestinal infections in compromised patients have the potential to cause complicated infections, sepsis and life-threatening illness.3 Infections with carbapenemase-producing Klebsiella pneumoniae (CPKP) are known to be particularly destructive as patients tend to have significant underlying comorbidities and treatment options are limited.1,3

DIAGNOSIS AND TREATMENT K. pneumoniae may be identified in cultures isolated from blood, urine, pleural fluid, and wounds. It grows on ordinary culture media, with or without oxygen. Despite this, laboratory

12 |

western nurse Novemberâ&#x20AC;&#x201C;December 2017

Nitrofurantoin Temocillin

Lower UTIs due to certain strains only

Carbapenem

With additional agents

Several new drug therapies, effective against multidrug resistant organisms are undergoing clinical trials. This includes broad spectrum, combination antibiotics such as ceftolozanetazobactam and ceftazidime-avibactam.5 Use of these agents is restricted in Australia in order to preserve utility; compassionate access may be granted as required.5,6

PREVENTION Carbapenemase-producing Klebsiella pneumoniae has the potential to spread rapidly in healthcare settings.7 Fortunately, in Australia and New Zealand, less than 1% of Enterobacteriaceae infections are KPCpositive.2 This is due to ongoing surveillance, antibiotic stewardship in ICUs, and the limited

transfer of patients from endemic regions.2 Transmission is best prevented through hand hygiene.4 Other preventive measures include contact precautions and single-use or patient-dedicated equipment.5 Research has demonstrated that excessive use of antibiotics is associated with an increased risk of CPKP colonisation.7 Therefore, the spread of resistant bacterium may also be limited by reducing global antibiotic use.5 Overall, the best infection control measures are multifaceted, and include ongoing prevention and early identification and treatment.2

CONCLUSION Carbapenemase-producing Klebsiella pneumoniae is a concerning resistant bacteria, associated with complicated infections and high rates of mortality. Developments are underway to improve detection and treatment. In the meantime, the spread of infection may be limited through hand hygiene, adherence to standard infection control precautions and restricted antibiotic use.

REFERENCES 1. Pitout JDD, Nordmann P, Poirel L. Carbapenemaseproducing Klebsiella pneumoniae, A key pathogen set for global nosocomial dominance. Antimicrob Agents Chemother. 2015 Oct;59(10): 5873-84. 2. Munoz-Price LS, et al. Clinical epidemiology of the global expansion of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2013;12:78586. 3. Centers for Disease Control and Prevention. Klebsiella pneumoniae in healthcare settings [Internet]. 2012 Aug 27 [cited 2016 Jun 10]. Available from: https://www.cdc.gov/HAI/ organisms/klebsiella/klebsiella.html#a2 4. Hirsch EB, Tam VH. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrugresistant infection. J Antimicrob Chemother. 2010;65(6):1119-25. 5. Zasowski EJ, Rybak JM, Rybak MJ. The B-Lactams strike back: ceftazidime-avibactam. Pharmacotherapy. 2015 Aug;35(8):755-70. 6. Mandrawa CL, et al. Carbapenemase-producing Klebsiella pneumoniae: a major clinical challenge. Med J Aust. 2016;204(7):277-8. 7. Sypsa V, et al. Transmission dynamics of carbapenemase-producing Klebsiella pneumoniae and anticipated impact of infection control strategies in a surgical unit. PLoS ONE. 2012;7(7): e41068. doi: 10.1371/journal.pone.0041068.

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Make tomorrow better. November–December 2017 western nurse |

Mark’s

If you’ve worked overtime on a public holiday in the public sector in the past six years read on – because you may have been underpaid. Overtime on a public holiday in the public sector is supposed to be paid at the rate of double time and a half. We recently discovered some members have only been paid time and a half.

Q: Is it really necessary to check my payslip? Yes. We encourage all members, wherever A:

you are working, to check your payslips to ensure you have been paid for the hours you worked, and at the correct rates.

How can I check my pay rate and Q: A:

14 |

entitlements are correct?

Your ANF iFolio has the current pay rates available in handy drop-down lists for your classification level – you can check your base rate, shift penalty rates, and overtime rates, as well as on-call and qualification allowance rates, all in one handy spot. You will find pay rates for all public sector workplaces, all large private hospitals and most aged care providers. Your iFolio also has copies of all these workplaces’ EBAs, so you can check on your other entitlements. Just login to your iFolio and click on the ‘Employment’ tab.

western nurse November–December 2017

Q: A:

What do I do if my workplace isn’t on iFolio? If you can’t find your workplace, simply send us a quick email to anf@anfiuwp.org.au and we will send you a copy of your EBA. Can you help me if I think I have been underpaid?

Of course – simply book a Helpline Appointment on your iFolio and an Industrial Officer will call you to assist. Checking your entitlements is a fundamental part of what the ANF does for members, so if you are not sure whether you have been underpaid, or you have any other questions about your entitlements, please book a Helpline Appointment – our ANF Industrial Officers are here to help you.

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.

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Novemberâ&#x20AC;&#x201C;December 2017 western nurse |

update: Hypertension in pregnancy

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

Hypertension in pregnancy is defined as a systolic blood pressure greater than (or equal to) 140 mmHg and/or a diastolic blood pressure greater than (or equal to) 90 mmHg.1 It may be classified as chronic hypertension, gestational hypertension, preeclampsia, or eclampsia, and is associated with an increased risk for perinatal mortality.1 Every effort should be taken to appropriately diagnose, monitor and treat hypertension to prevent potentially life-threatening complications associated with pregnancy.

MEASURING BLOOD PRESSURE DURING PREGNANCY In general, a woman’s blood pressure tends to fall in the first trimester and return to the pre-conception blood pressure in the third trimester.1 Baseline blood pressure should be measured with the confirmation of pregnancy, and routinely throughout the gestational period. When performing a blood pressure, optimal technique is required to prevent an inaccurate reading (see Table 1). Any abnormal findings should be confirmed over several hours.1 During the first half of pregnancy, 24 hour ambulatory blood pressure monitoring may be useful to rule out “white coat” hypertension (elevated blood pressure in the presence of a health professional) and avoid unnecessary treatment.1 Table 1. Performing an accurate blood pressure.1

DON’T

• Allow the woman to be seated in a comfortable position, with her feet resting flat on the floor and her arm at the level of heart • Perform the initial blood pressure on both arms • Use an accurate cuff size • Use a mercury sphygmomanometer when possible • Allow a rate of deflation of less than 2mm per second

• Take a blood pressure lying supine as supine hypotension syndrome may occur • Use an automated device in women with pre-eclampsia • Use any device that has not been properly validated for use in that patient population*

• Repeat a one off elevated blood pressure reading after 5-30 minutes * Few automated blood pressure machines have been validated for use in pregnant women with a normal or mildly elevated blood pressure

16 |

western nurse November–December 2017

Table 2. Investigations indicated with hypertension during pregnancy.1

Investigation

Description

Assessment for proteinuria

Dipstick urinalysis If >1+ for proteinuria: Spot urine PCR

Blood test screening for preeclampsia

Recommended tests include: • Full blood count • Electrolytes and creatinine • Liver function tests • Coagulation studies (as indicated)

Ultrasound

To assess for foetal growth, amniotic fluid volume and umbilical artery flow.

the aorta.1 While a complete investigation of chronic hypertension is not possible during pregnancy, a detailed evaluation is required following delivery.1 During pregnancy, it is important to test all women with chronic hypertension for proteinuria at each visit. A sudden increase in blood pressure or new onset proteinuria may suggest a need for blood test screening for preeclampsia.1

GESTATIONAL HYPERTENSION Onset: after 20 weeks gestation Characteristics: elevated blood pressure, without any other systemic features. Potential complications: preeclampsia or foetal compromise. Gestational hypertension is characterised by an elevated blood pressure, without systemic complications, after twenty weeks gestation. It typically resolves within three months of delivery. Persistent hypertension after three months is generally considered to be undiagnosed essential hypertension.1 The risk

of adverse pregnancy outcomes associated with gestational hypertension is dependent on the gestational age at onset and severity of hypertension. Assessment for proteinuria and blood test screening for preeclampsia is required weekly or biweekly, as indicated.1

PRE-ECLAMPSIA Onset: after 20 weeks gestation Characteristics: hypertension with involvement of one or more other organ system and/or the foetus. Potential complications: Eclampsia, HELLP syndrome (see Table 3), stroke, organ failure, pulmonary oedema, disseminated intravascular coagulation, or foetal morbidity and mortality. Preeclampsia is a multi-organ condition that may arise during pregnancy. Diagnosis is dependent on the presence of high blood pressure, with at least one other indicator of multi-organ involvement (see Table 3).1 Preeclampsia is progressive. The only definitive treatment is birth of the baby, with expulsion of

Table 3. Features of multi-organ involvement in preeclampsia.1

System involved

Clinical features

Neurological

• Convulsions (eclampsia) • Hyperreflexia with sustained clonus • Persistent headache • Persistent visual disturbances • Stroke

Respiratory

• Pulmonary oedema

Renal

• Proteinuria • Elevated serum or plasma creatinine • Oliguria, less than 500ml in 24 hours

Liver

• Raised liver enzymes (serum transaminases) • Severe epigastric or right upper quadrant pain

Haematological

• Thrombocytopenia • Haemolysis • Disseminated intravascular coagulation (DIC)

HELLP syndrome

• Haemolysis • Elevated liver enzymes (transaminases) • Low platelets

Foetus

• Foetal growth restriction • Placental abruption

the placenta. However, prolonging pregnancy may help improve foetal prognosis, despite a worsening maternal condition.1 Obstetric consultation is required for all women with severe preeclampsia. Close maternal and foetal monitoring is indicated. Women with severe hypertension (systolic blood pressure greater than 170mmHg or diastolic blood pressure greater than 110 mmHg) may benefit from anti-hypertensive therapy in order to prevent cerebral haemorrhage and eclampsia.1 Timing of delivery (Delivery plans) The timing of delivery in preeclampsia is dependent on the severity of the maternal condition and gestational age.1 Women with early onset preeclampsia may require termination of pregnancy and should be transferred to a specialist facility prior to delivery. For women with a gestation at onset of between 24-36 weeks, every attempt is made to prolong pregnancy. After 36 weeks, safe delivery is planned as early as possible.1

ECLAMPSIA Onset: after 20 weeks gestation Characteristics: Seizures, with or without acute hypertension, proteinuria, headache, visual disturbance, epigastric pain or an altered level of consciousness. Potential complications: Severe maternal or foetal compromise and an increased risk of morbidity and mortality. Eclampsia is a non-epileptic seizure that may occur during pregnancy, delivery or following the birth of a child. In Australia, it is a rare complication of pregnancy, which occurs in 0.1% of all births.1 The onset of a seizure may occur with or without traditional warning signs. As with preeclampsia, the only definitive treatment is delivery of the baby. Other goals of management include resuscitation, preventing recurrent seizures, and maintaining optimal blood pressure control.1

CONCLUSION Hypertensive disorders in pregnancy include chronic hypertension, gestational hypertension, preeclampsia and eclampsia. The primary goal of treatment is to control the blood pressure in order to prevent the onset of worsening conditions, with an increased risk of maternal and foetal compromise. In some cases, the safest intervention is delivery of the child. Postnatal care for all women with hypertension in pregnancy includes detailed investigation to rule out chronic conditions.

REFERENCES 1. Lowe SA, Bower L, Lust K, McMahon LP, Morton MR, et al. Guideline for the management of hypertensive disorders of pregnancy. 2nd Edition. Sydney; Society of Obstetric Medicine of Australia and New Zealand: 2015. 52p.

November–December 2017 western nurse |

ANF Out ‘N’ About This special four-page Out ‘N’ About brings the photo competition to a close for 2017. Now comes the tough job of choosing the best workplace pics. We’ve already started taking a look, and have decided that we like so many, we’re just going to have to give out extra prizes! And if you miss out this time, don’t worry, the competition will re-start in the new year. As announced elsewhere in western nurse, we’ve also got the members’ holiday unit photo competition starting, so there are plenty of chances to win terrific ANF prizes. We’ll select the Out ‘N’ About winners in the next few weeks – with announcements made in the January-February western nurse. We look forward to seeing you at various ANF visits throughout 2018, and from the Out ‘N’ About Team, we wish you a terrific holiday season.

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western nurse November–December 2017

A. FIONA STANLEY HOSPITAL Kerri Doust and Jackie Trimby B. ROCKINGHAM GENERAL HOSPITAL Jessica Rodrigues and Carly Papini C. ROYAL PERTH HOSPITAL Morag Lategan and Melvin Kwan D. ROYAL PERTH HOSPITAL Kayleigh Morrison and Joelle De Robertis E. ROYAL PERTH HOSPITAL Jeanette Stubbs and Sophia Khan D

Edith Cowan University School of Nursing and Midwifery

Are you a nurse who takes venous blood samples in Australia? Edith Cowan University researchers are seeking your participation in a survey looking at the prevalence of undertaking blood sampling, either through venepuncture, or peripheral intravenous cannulas. This is a great opportunity for all nurses to provide input into current practice in Australia. The survey takes only about 10 minutes to complete. All survey responses are anonymous. You can access the survey at this address: https://ecuau.qualtrics.com/jfe/form/SV_0NBFEwiQHBRhLg1

Or scan the QR code below.

THE SURVEY IS OPEN UNTIL 30TH DECEMBER, 2017. For further information, please contact Beth at: e.jacob@ecu.edu.au

Novemberâ&#x20AC;&#x201C;December 2017 western nurse |

ANF Out ‘N’ About

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western nurse November–December 2017

F. SIR CHARLES GAIRDNER HOSPITAL Heather Simmonds, Denise Fairclough, Bronwyn Innes and Natalie Goodman G. FIONA STANLEY HOSPITAL Amanda Stuart, Brenda Hudspith, Jackie Trimby J

H. GRAYLANDS Monet Tombides and Jessica Murray

I. FIONA STANLEY HOSPITAL Crystal Connelly, Marcelle Perrin, Wendy Lam J. FREMANTLE HOSPITAL Mary Rodrigues K. FIONA STANLEY HOSPITAL Gigi Thayil, Georgina Stocker, Jodee Harvey-Bridges

Novemberâ&#x20AC;&#x201C;December 2017 western nurse |

AcrossTheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA

WA: FUTURE ORGAN EXPORTER WA WA could soon be exporting

NEW SKIN CANCER WARNING SIGNS AUS The traditional ABCD method

organs to the eastern States if donations continue rising and local waiting lists stay short. Donor numbers are up by 40 per cent compared with this time last year – with 47 donors who each gave multiple organs, The Sunday Times recently reported. DonateLife WA State medical director Dr Bruce Powell expected our donation rate to go to more than 20 donations per million people, placing WA alongside the national average.

SCREEN ADDICTION DAMAGING SIGHT NSW Young Australians are suffering a condition that previously only affected the elderly because they spend too much time looking at computer and phone screens.

“We will get to a point where we move more organs out to other States than we have them coming in to WA,” Dr Powell said,

Dry eye syndrome has become so common in people in their twenties, a Sydney clinic has been established specifically to treat the irreversible damage it does to vision, The Daily Telegraph has reported.

But he encouraged more people to register on the national Organ Donor Register, adding that WA has 310,000 registered organ donors – less than 20 per cent of eligible residents.

Blurred vision, discharge, redness and easily fatigued eyes are symptoms. Left untreated, the condition can get progressively uncomfortable and possibly damage vision.

“It’s a tough thing for people to commit to,” he said. “So there’s a huge amount of work to be done. Unless you’ve been personally touched by a donation, you don’t necessarily realise what an amazing gift it is.”

It is estimated one in five Australians have the problem, The Telegraph reported. Dry Eye Institute principal optometrist Emma Furniss said: “Screen time is causing us to blink less and change our focal point less, which leads to corneal irritation and subsequent changes consistent with dry eye disease.

Federal Assistant Health Minister Ken Wyatt said the Commonwealth Government was considering having donor registration portals on computers in a national pharmacy chain. 

“We know that dry eye disease is a progressive condition. Many of the changes that occur within the eyelid glands are not reversible. It’s important that patients suffering from dry eye disease access treatment to prevent permanent changes resulting in a lifetime of symptoms.” Ms Furniss said numerous other factors can worsen the syndrome – including decreased intake of omega-3, larger consumption of saturated fats, “pro-inflammatory diets”, airconditioning, oral contraceptives, diabetes, contact lenses and hormonal imbalances. 

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of melanoma diagnosis focusing on asymmetry, border, colour and diameter of growths has been updated to help medicos identify dangerous atypical melanomas. EFG assessment, which also involves looking at elevation, firmness and growth of spots, is being promoted by Cancer Council Australia as summer approaches. And the point is also being strongly made that not all cancerous moles are dark. “Typically, a lot of people assume, wrongly, that melanomas are associated with dark pigmented moles,” Chris McMillan, the CEO of Cancer Council Queensland, recently told ABC News. “(But) realistically, we find that 20 per cent of melanomas are pale coloured lesions.” Melbourne woman Rachel Angus told the ABC she had a “near miss” nine years ago. She said she pointed out a pink spot on her leg to her doctor during a routine skin check, and he told her: “Oh, it doesn’t look like anything at all, but we’ll take it off just in case”. The biopsy result later showed the spot was a melanoma. Ms Angus said: “If I hadn’t have gone for the skin check-up, I would have died — that’s just the bottom line”. Head of research at Cancer Council Queensland, Professor Joanne Aitken, said: “Change is the hallmark of cancer, and it’s the hallmark of melanoma. So things that are changing are things that people should be having checked.” 

SUNSCREEN MYTHS BUSTED AUS Australians are becoming increasingly misinformed about sunscreen – with a major survey showing only 55 percent of adults believe it’s safe to use daily.

TV BINGEING DEADLY VIC Watching hours of your favourite television shows might eventually kill you, Australian researchers have found. Every extra hour per day spent watching television leads to a 12 per cent higher risk of death linked to inflammation, including Alzheimer’s and Parkinson’s diseases; diabetes; and respiratory, cognitive, and kidney diseases, according to Melbourne’s Baker Heart and Diabetes Institute. The Victorian researchers analysed survey data of 8933 Australian adults for the results, and found that even those watching moderate levels of TV – two to four hours per day – could benefit by cutting down viewing time. Lead author of the study and Senior Research Officer in the institute’s Physical Activity Laboratory, Dr Megan Grace, said inflammation is a normal response when the immune system senses danger such as stress or infection. It responds by activating proteins meant to protect cells and tissues. But inflammation can cause disease if those chemicals stay around for long periods. Dr Grace said the findings, recently published in the journal of Medicine & Science in Sports & Exercise, are an important step in finding out why prolonged sitting may be unhealthy, and also provide further evidence that chronic disease prevention strategies should focus on reducing sitting time, in addition to promoting physical activity. 

This figure is significantly down from 61 percent in 2014, according to the latest National Sun Protection Survey. Cancer Council Australia also revealed 17 percent of respondents are worried sunscreens contain unhealthy ingredients, while 20 percent believe using sunscreen regularly will result in not having enough vitamin D. Craig Sinclair, Chair of the Cancer Council’s Public Health Committee, said: “Two in three Australians will be diagnosed with skin cancer in their lifetime. Sunscreen has been proven to prevent skin cancer, including the most deadly type – melanoma … it’s time to bust the myths and get the right information out there”. He said the Therapeutics Goods Administration strictly regulates sunscreens to ensure their ingredients are safe and effective, so Australians “should be confident” they can use sunscreen daily. Additionally, studies show sunscreen use “has minimal impact on Vitamin D levels over time”. Most get enough Vitamin D through incidental sun exposure in summer. The biggest concern with sunscreen is Australians don’t apply it correctly and thus get burnt. At least one teaspoon is needed per limb, and one for the front of the body, one for the back, and one for the head – about 35ml in total. The Cancer Council also busted the myth that using water resistant SPF50+ means you can stay in the sun longer without reapplying lotion – saying any sunscreen should be reapplied every two hours, or after swimming, sweating or towel drying. 

TWINS AND YOUR HEALTH VIC It takes two to tango the old saying goes – and that’s certainly true of many key medical discoveries. Researching twins has led to big breakthroughs, including determining that smoking can cause osteoporosis, says a Melbourne University facility celebrating its 35th anniversary in the field. Twins Research Australia Director Professor John Hopper said: “Twins allow us to control perfectly for one of the main variables in our health – genetics. Then we can drill down on the role that environmental factors are playing. “For example, studying twin pairs where one smoked and the other didn’t revealed tobacco use is a major cause of osteoporosis.” The university said the facility has more than 35,000 pairs of twins on its database and is the largest volunteer twin registry in the world. “We have seen a massive leap forward in DNA technology since the early 80s, notably the human genome project and the new field of epigenetics,” Professor Hopper said. “Twin studies are very important for the translation of this new genomic knowledge into public health.” Significant discoveries to come from the facility’s 230-plus twin studies include identifying the genetic and epigenetic risk of breast cancer; uncovering that epilepsy can be inherited; revealing that the environment in the womb impacts our future health; and determining that maths and reading skills are largely genetic.  November–December 2017 western nurse |

update: Exploring the social determinants of health Read this article and complete the online quiz to earn 1 iFolio hour

“Our children have dramatically different life chances depending on where they were born. In Japan or Sweden they can expect to live more than 80 years; in Brazil, 72 years; India, 63 years; and in one of several African countries, fewer than 50 years. ...It does not have to be this way and it is not right that it should be like this. ... Reducing health inequities is...an ethical imperative. Social injustice is killing people on a grand scale.” – The World Health Organization

Commission on Social Determinants of Health.1

Living conditions, including access to healthcare, education, work conditions, quality of life, and urban proximity directly affect our overall health. Since the World Health Organization (WHO) published its 2008 report “Closing the gap in a generation,” the international healthcare community has been asked to recognise the threat that inequality poses to global health. Each country has been called on to address this issue by understanding the influence that social determinants have on the well-being of their populations.2 The Social Determinants of Health (SDH) are the political systems, economic systems, development agendas, social policies, and cultural norms that govern society. The WHO calls them the “Conditions in which people are born, grow, work, live, and age.”2 For example, poverty is known to increase susceptibility to alcohol and drug addiction and certain professions have been associated with a higher risk of coronary artery disease. Similarly, the social gradient of health illustrates a correlation between income, education and overall health. Well off people have greater access to high quality food, housing, healthcare, and a proclivity for healthier activities. The relationship between socioeconomic status and smoking exemplifies this gradient in Australia. People in the lowest socioeconomic areas are twice as likely to smoke as those in the highest.3

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THE SOCIAL DETERMINANTS OF HEALTH The social determinants of health include culture, affluence, social cohesion, social inclusion, political structure, natural environments, built environments, education, employment, income and wealth, family and neighbourhood, housing, access to services, migration/refugee status, and food security (see Figure 1).1-3 These determinants have been demonstrated to have a direct relationship with specific illnesses and/or an impact on overall health. For example, early childhood development has been associated with obesity, malnutrition, mental health problems, heart disease, and criminal activity.1 Further, dense urban living is linked to disease, injury, and death, and workforce patterns (i.e. part-time or temporary versus full-time work) have been associated with rates of mortality and mental health.1

THE SOCIAL DETERMINANTS OF RISKY HEALTH BEHAVIOURS In 2013, the Australian Institute of Health and Welfare (AIHW) published the National Drug Strategy Household Survey. Results from the survey found the key social determinants of health that affected smoking, illicit drug use, and alcohol risk amongst the population included remoteness, socio-economic status (SES), and employment. A number of additional SDH were also highlighted including marital status, household composition, education, and cultural and linguistic diversity (see Table 1).4 Survey respondents with characteristics including low socio-economic prosperity, rural living and underemployment were at increased risk of disease, risky health behaviours, increased mortality and overall poor health.4

HEALTHCARE INEQUITY IN AUSTRALIA The social determinants of health are significant, in part, because they contribute to healthcare inequity in the Australian population. Healthcare inequity refers to the wide disparities between the health status of different social groups. This is exemplified by the disadvantage experienced by Indigenous people in Australia and throughout the world. Indigenous Australians are generally less healthy than other Australians. They are more likely to die at younger ages, have higher levels of disease risk factors, and suffer more instances of illness than non-Indigenous Australians.1 Social determinants that affect

Table 1: Social Determinants of Health that affect smoking, illicit drug use, and alcohol risk in Australia.4 Key SDH

Additional SDH

Remoteness Socio-economic Status Employment

Marital Status Household Composition Education Cultural and Linguistic Diversity

Figure 1: A framework for the determinants of health.4 Note: Blue shading highlights selected social determinants of health.

the Indigenous population include housing, education, income and employment.5 In 2011, the rate of homelessness for Indigenous Australians was 14 times higher than nonIndigenous Australians. The rates of Indigenous people who have completed high school is also disproportionately low. However, there has been significant improvement in this area since the early 2000s. In 2012, the Australian unemployment rates were 17% for Indigenous Australians and 5% for non-Indigenous Australians.5 The impact of these social factors on health is acknowledged by the Indigenous population. Those with home ownership, higher incomes and higher levels of education were more likely to report their health status as good or excellent.5

AREAS FOR FUTURE IMPROVEMENT The impact of the social determinants of health can be limited through effective primary health care. Health prevention, immediate response to acute illness, and health protection through screening, early intervention and treatment, helps to ensure optimal health and well-being for the entire population.6 However, health is also profoundly affected by what lies outside

the control of healthcare practitioners and the health system.7 A broader appreciation for overall well-being is required to improve outcomes for the population. In order to mitigate the effects of health inequities, daily living conditions and the inequitable distribution of power, money, and resources in the majority of areas must be overcome. The WHO recommends an appreciation of health in all policy areas, with a focus on reducing inequality, preventing disadvantaged people from exposure to health-damaging factors, reducing the vulnerability of disadvantaged people and limiting the unequal consequences of illness in social, economic and health terms.8

REFERENCES 1. CSDH (2008). Closing the gap in a generation: health equity through action on the social determinants of health. Final Report of the Commission on Social Determinants of Health. Geneva, World Health Organization. 2. The World Health Organization. Social determinants of health [Internet]. Geneva: WHO; 2016 [cited 27 Aug 2016]. Available from http:// www.who.int/social_determinants/en/. 3. Australian Institute of Health and Welfare. Understanding health and illness [Internet]. Canberra: AIHW; 2014 [cited 27 Aug 2016].

Available from http://www.aihw.gov.au/ australias-health/2014/understanding-healthillness/. 4. Australian Institute of Health and Welfare. Specific population groups [Internet]. Canberra: AIHW; 2013 [cited 27 Aug 2016]. Available from http://www.aihw.gov.au/alcohol-and-otherdrugs/ndshs-2013/ch8/#t8_2. 5. Australian Institute of Health and Welfare. Indigenous health [Internet]. Canberra: AIHW; 2014 [cited 27 Aug 2016]. Available from Australian Institute of Health and Welfare. Understanding health and illness [Internet]. Canberra: AIHW; 2014 [cited 27 Aug 2016]. Available from http:// www.aihw.gov.au/australias-health/2014/ understanding-health-illness/. 6. Australian Health Ministersâ&#x20AC;&#x2122; Advisory Council. Aboriginal and Torres Strait Islander Health Performance Framework 2014 Report. Canberra: AHMAC; 2015. 246p. 7. Primary Health Care Research & Information Service (2016). Getting Started Guide: Social determinants. From phcris.org.au/guides/social_ determinants.php (Accessed 27 Aug 2016). 8. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. Social Determinants of Health Discussion Paper 2 (Policy and Practice).

Novemberâ&#x20AC;&#x201C;December 2017 western nurse |

AroundtheGlobe WORLD NEWS

JAMIE’S SUGAR TAX Celebrity chef Jamie Oliver imposed his own “sugar tax” in his restaurants – and then science proved it worked. On September 1 2015, Jamie’s Italian, a national chain of UK restaurants, added a £0.10 (0.17 AUD) levy to the price of nonalcoholic sugar-sweetened beverages (SSBs).

“I’ve seen first-hand the devastating effects that a poor diet and too much sugar is having on children’s futures and I firmly believe we need to take urgent action on this public health crisis,” Oliver said in the Independent newspaper in 2015, before imposing the levy. “This is why I have decided to impose a 10p ‘child health levy’ on all soft drinks with added sugar across my UK restaurants with the money raised going directly to fund food education for children.”

The number of SSBs sold per customer declined by 11.04 per cent after 12 weeks of the levy, said a study recently published in the BMJ (formerly British Medical Journal) Journal of Epidemiology & Community Health.

The researchers from London School of Hygiene & Tropical Medicine, and Cambridge University said: “… recent evidence from Berkeley, California, showed that changes of the magnitude reported here may be plausible even when price rises are relatively small (21 per cent decrease in sales in response to a penny-per-ounce tax).” 

Sales stayed 9.34 per cent lower than before the experiment, six months after it started.

BEING HEAVY CAN LEAD TO A HEAVY HEART Having a high Body Mass Index can make your heart bigger and heavier. New research has revealed, for the first time, the direct damage that carrying extra weight has on the heart’s weight and size. It also “implicates a range of other modifiable risk factors including blood pressure”, according to Queen Mary University of London. Queen Mary and University of Oxford researchers used cardiac magnetic resonance imaging to study the hearts of 4,561 people from the UK Biobank database – an international health resource following the health and well-being of 500,000 volunteers. They found that various lifestyle risk factors, including blood pressure, smoking status, BMI (weight to height index), exercise,

cholesterol, alcohol intake and diabetes, have differing effects on the heart, but that “increased heart weight was linked to overweight and obese individuals”. Queen Mary University said previous studies had “definitively proven the link between high BMI and heart disease but have predominantly shown how it increases blood pressure, cholesterol and the risk of developing diabetes, which are all independent risk factors for heart disease”. “This new study was able to see and measure the direct damage that modifiable risk factors have on the structure and function of the heart,” the university said. 

WORK SNACKS PACK ON THE POUNDS Eating more than 100,000 extra calories (418,400kJ) a year is possible just by snacking at work, according to a Dutch study. A survey of 1,000 women, conducted on behalf of Dutch organic food maker Kallø, found the subjects consumed an extra 2,240 calories (9372kJ) on average, in snacks every week. The resulting total of crisps, cakes, sweets,

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chocolate, and milky or sugary drinks, eaten over 45 working weeks, equals an additional 50 days of food intake, reported Daily Mail Online. That’s based on an adult woman’s ideal consumption of 2,000 calories per day. The annual total of 100,800 extra calories (421,747kJ) “is the same as 1,254 glasses of Prosecco, 193 double-stacked burgers or 502 bars of chocolate”, the website said. The Mail added that dietitians were “not surprised” by the findings, but “warned that consumption of just 500 extra calories a day could result in weight gain of 1lb (453g) a week”. The Kallø research found the women consumed at least three snacks during a typical working day, with an average of 135 bags of chips eaten at work annually. Individuals also ate about 135 biscuits, 90 slices of cake, 90 packets of sweets “and a staggering 45 doughnuts each year”. 

NEW HOPE FOR COMATOSE BRAIN INJURED PATIENTS The precise part of the brain responsible for keeping us awake has finally been discovered – ending a century long mystery. Researchers now believe the supramammillary nucleus (part of the caudal hypothalamus) is the exact location. This means electrical stimulation of this region may be used for “bringing some brain injury patients out of a comatose state”. This is the view of Nigel Pedersen, MD, assistant professor of neurology at Emory University in Atlanta, Georgia, and an epilepsy specialist, who is lead author of the study of the work, which involved mice.

LANGUAGE HOLDS HIDDEN CLUES ABOUT STRESS Sufferers of stress may be saying more about their affliction in everyday words than when answering specific questions from medicos. U.S. psychologists have tested this theory by collecting and analysing the natural speech of 143 volunteers over two days. They also genetically tested the subjects’ white blood cells, and asked the participants to self-report their levels of stress at particular times, as part of the study that was published last month in Proceedings of the National Academy of Sciences,.

OLD SCHOOL FOOD REMEDIES FIGHT ARTHRITIS It turns out grandma was onto something with her insistence on an apple a day and her obsession with administering numerous spoonsful of cod liver oil. Indian researchers have recently made a splash with a list of food designed to manage the debilitating autoimmune disease rheumatoid arthritis (RA) – and the fish oil and apples both made the cut. The academics from KIIT University, who examined various diets, said: “… an ideal meal can include raw or moderately cooked vegetables (lots of greens, legumes), with addition of spices like turmeric and ginger, seasonal fruits, probiotic yogurt; all of which are good sources of natural antioxidants and deliver anti-inflammatory effects.”

Activating the region in mice “using targeted chemical genetic techniques resulted in prolonged wakefulness during the animals’ normal sleep periods”. Assistant Professor Pederson said the supramammillary nucleus was known for its connections to the hippocampus – which is important for memory formation – and also parts of the frontal cortex involved in focused attention. “Given these connections, this region may be important for the voluntary maintenance of wake and attention, but more work is needed to study this,” he said. For more than 100 years neurologists have suspected a component of the “ascending arousal system” could be found in this part of the brain, “but the precise location had been a mystery”, the university said of the study that was published in the journal Nature Communications in November. 

The researchers found language features in the natural speech predicted conserved transcriptional response to adversity (CTRA) gene expression – activity indicating stress – “substantially better than did conventional self-report measures of stress, depression, and anxiety”. For example, CTRA gene expression corresponded with more frequent use of adverbs, e.g.: really, very, certainly. The researchers conceded the findings are subject to several limitations. These include: “The observed relationships involve spontaneous spoken language use sampled from the everyday life of American adults in the Atlanta metropolitan area, and it is unclear whether similar results would emerge in other language contexts (e.g., in writing or topically directed speech) or in other demographic, socioeconomic, or cultural contexts” 

They recommend sufferers avoid processed food, high salt, oils (other than those from derived from olives, fish and borage seeds), butter, sugar, and animal products. But dietary supplements like vitamin D, cod liver oil, and multivitamins get the thumbs up, along with “low impact aerobic exercises”. The list in their study, published in November in the journal Frontiers in Nutrition, includes dried plums, grapefruit, grapes, blueberries, pomegranate, mango, banana, and peaches. Recommended cereals, grains and legumes include oatmeal, whole wheat bread, whole flattened rice, wheat, rice, corn, rye, barley, millets, sorghum, and black soybean. 

November–December 2017 western nurse |

Learn to cook simple and affordable meals from scratch â&#x20AC;&#x201C; PLUS take home 2 meals each class! Classes are in Albany in January and February 2018! We are back at the Joondalup ECU campus from early March.

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western nurse Novemberâ&#x20AC;&#x201C;December 2017

update: Insulin: A drug update COMPARATIVE INFORMATION

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

Insulin has been used for the treatment of diabetes since its discovery in the 1920s. Despite being common in clinical practice, the various forms of insulin often make it difficult for nurses and midwives to differentiate between treatments. This update summarises the characteristics of insulin and offers a comparison of the varieties of insulin that are currently available in Australia.

METHOD OF ACTION Insulin enhances the cellular uptake of glucose and prevents endogenous glucose output and lipolysis. It is used to promote or restore the bodyâ&#x20AC;&#x2122;s ability to metabolise glucose and reduce serum blood sugar levels.1

Evidence suggests that conventional human insulin may be just as effective as analogue insulin for improving glycaemic control.3 Long-acting insulin analogues may be beneficial for individuals who experience recurrent hypoglycaemia with conventional human insulin.3

Human, bovine and insulin analogues are available in Australia. Human insulin is synthetic, made in a laboratory using human genes in bacteria or yeast. Bovine insulin, derived from cows, is rarely used. Insulin analogues are altered forms of human insulin, designed to be more rapid-acting or long-acting than natural forms of insulin.2

ADVICE FOR PATIENTS Management of diabetes may be complicated by a variety of factors including trauma, illness and alcohol intake.1 Insulin dose adjustments, regular meals and avoidance of binge drinking may help to prevent hyper or hypoglycaemia. Prior to commencing insulin, patients and families require education about the warning signs and interventions for hypoglycaemia.1

Types of insulin may be divided by their duration of action (see Table 1). Insulin may be ultra-short acting, short-acting, long-acting or biphasic (short and long acting).1-3 Generally, insulin of the same type (human, bovine or analogue) and duration of action may be used interchangeably if required. (see Illustration 1).

Table 1. Comparing different forms of insulin by classification and type.1,2

Classification

Insulin Type

Generic Name

Trade Name

Ultra-short-acting

Analogue

Insulin aspart Insulin lispro Insulin glulisine

NovoRapid Humalog Apidra

Short-acting

Human or Bovine

Neutral insulin

Actrapid Humulin R Hypurin Neutral

Intermediate Acting

Human or Bovine

Isophane insulin

Humulin NPH Protaphane Hypurin Isophane

Long-acting

Analogue

Insulin detemir Insulin glargine

Levemir Lantus

Short and Long-acting combination agents (Biphasic insulin)

Human

Mixed or biphasic insulin

Humulin 30/70 Mixtard 30/70 Mixtard 50/50 NovoMix 30 Humalog Mix25 Humalog Mix50

INDICATIONS Insulin is required for individuals with Type 1 diabetes mellitus and individuals with Type 2 diabetes mellitus that cannot be adequately controlled with diet, exercise and oral anti-diabetic agents. It may also be used for individuals with diabetes, when oral anti-diabetic agents are contraindicated, as in pregnancy, following the administration of some forms of contrast, or with surgery.1

CONTRAINDICATIONS There are very few contraindications to the use of insulin. It is safe in pregnancy and breastfeeding. However, it should be used with caution in individuals at risk of hypoglycaemia, such as those fasting prior to surgery.1

ADMINISTRATION Insulin is primarily administered via subcutaneous injection. Neutral insulins are water-soluble and can be used for intravenous administration, as in an insulin infusion.1

ADVERSE EFFECTS Mild adverse effects that may occur with the use of insulin include weight gain, allergic reactions, and local irritation following administration.1 Hypoglycaemia, a below normal serum blood sugar level, is a potentially life-threatening complication that may occur with inappropriate high dosages, inadequate oral intake or excessive physical activity. Symptoms include sweating, hunger, fainting, palpitations, tremors, headache, visual disturbance and altered mood.1

Analogue

Ultra-short-acting Onset: 0.25 hours Time to peak: 1 hour Duration: 4-5 hours Ultra-short-acting insulins are clear solutions, used to manage short-term hyperglycaemia, such as during meal times. Due to their very short time to onset, all ultra-short-acting insulins should be administered just prior to oral intake.1,3 Short-acting Onset: 0.5 hours Time to peak: 2-3 hours Duration: 6-8 hours Short-acting insulins are neutral insulins (human or bovine). They are clear solutions, used to manage short-term hyperglycaemia, such as during meal times. They are best administered within 30 minutes of oral intake.1,3 Long-acting Onset: 1-2.5 hours Time to peak: 1-12 hours Duration: Approximately 16-24 hours Long-acting insulin is clear in appearance. It is generally administered once or twice per day. Some types may be administered in combination with ultra-short-acting insulin (as in biphasic insulin), while others such as insulin glargine (lantus), must be given independently.1

illustration 1: Examples of insulin.

REFERENCES 1. Australian Medicines Handbook 2015 (Online). Adelaide: Australian Medicines Handbook Pty Ltd; 2015 July. 2. NPS MedicineWise. Types and forms of insulin available in Australia for type 2 diabetes [Internet]. Surry Hills: NPS MedicineWise; 2016 May 31 [cited 2016 Aug 12]. Available from: http://www. nps.org.au/conditions/hormones-metabolismand-nutritional-problems/diabetes-type-2/forindividuals/medicines-and-treatments/insulin/ types-and-forms-available-in-australia 3. Kees JG, van de Laar A, Janssen PGH, Houweling ST, Rutten GEH. Diabetes: glycaemic control in type 2 (drug treatments). Clin Evid. 2012;10:609.

Novemberâ&#x20AC;&#x201C;December 2017 western nurse |

ResearchRoundup LATEST AND GREATEST FROM SCIENCE

SHEEP’S STAR SPOTTING SKILLS HELPING HUNTINGTON’S Sheep mightn’t be as stupid as many think – and might even help us cure brain diseases. The woolly mammals can be trained to recognise human faces, and this talent indicates that studying them can help us understand brain disorders such as Huntington’s disease, which damage cognitive abilities. Scientists at the University of Cambridge trained eight sheep to recognise the faces of ex-U.S. president Barack Obama, actors Jake Gyllenhaal and Emma Watson, and TV presenter Fiona Bruce, from photographic portraits on computer screens.

The study of 755 men and women provides the clearest picture on gender differences for sleep, to date, according to lead researcher Kathleen Maddison. “There is a bit of research that suggests women are a little more anxious and have slightly higher anxiety levels because they think things over a little more,” she said. “But overall women were better sleepers, and went into the deeper sleep stage which is harder to wake from.” She theorised the difference was linked to glucose, the primary fuel source for the brain, saying that although women’s brains are generally smaller than men’s, they tended to need more glucose. “Sleep provides the brain with an important opportunity for metabolic recovery, so it may be that women sleep better specifically because they have to get that glucose refuel,” she said. 

Professor Jenny Morton, who led the study that was recently published in the journal Royal Society: Open Science, said: “Sheep are long-lived and have brains that are similar in size and complexity to those of some monkeys. That means they can be useful models to help us understand disorders of the brain, such as Huntington’s disease, that develop over a long time and affect cognitive abilities. Our study gives us another way to monitor how these abilities change, particularly in sheep who carry the gene mutation that causes Huntington’s disease.” Huntington’s is an incurable neurodegenerative disease usually beginning in adulthood, and initially affecting motor coordination, mood, personality and memory. Patients eventually find it hard to speak and swallow, lose motor function, and die relatively young. 

WOMEN BETTER AT SNOOZING Women sleep better than men – despite taking longer to fall asleep. Although women take an average five minutes longer than men to fall asleep, they wake less often, sleep longer overall, and also spend less time in early-stage “drowsy” sleep than men. These are findings of a University of WA study recently presented at the annual conference of the Australasian Sleep Association in New Zealand, The West Australian newspaper reported.

GIVING MAKES YOU HAPPY Generous people are happier, scientists have found. University of Zurich researchers, collaborating with other international researchers, studied how brain areas communicate to produce the “warm glow” many people get when doing something nice for someone else. They found that people who behave generously are happier afterwards than those behaving more selfishly, but the amount of generosity does not influence the increase in contentment. And even “simply promising to behave generously activated the altruistic area of the brain and intensified the interaction between this area and the area associated with happiness”. Zurich university neuroeconomist Philippe Tobler said: "You don't need to become a self-sacrificing martyr to feel happier. Just being a little more generous will suffice". The study, which was published earlier this year in the journal Nature Communications, saw 50 participants promised a sum of money they would receive in the next few weeks and were supposed to spend. Half the group – the experimental group – committed to spending the money on someone they knew, a “promise of generosity”, and the other half – the control group – committed to spending the money on themselves. 

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western nurse November–December 2017

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