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• Some patients may benefit from patient controlled analgesia in the emergency department. • Patient controlled analgesia is not appropriate for all patients. • Clinician's perspectives on patient controlled analgesia in the emergency department may be variable. • Rigorous staff education is required before introducing the patient controlled analgesia modality in this new setting. Despite pain being the most common reason for patients to visit the emergency department (ED), conventional pain management methods are often inadequate. Patient controlled analgesia (PCA), which allows patients to self-administer intravenous analgesia, is widely used across many hospital wards, however, is not routinely used in ED. We aimed to identify clinicians' perceptions of PCA use in the ED setting. A qualitative descriptive approach was employed using semi-structured individual interviews conducted with ED clinicians from two hospitals in Western Australia. Interviews were recorded and transcribed. Data was analysed using qualitative content analysis. Data saturation was achieved after 20 participant interviews. Five themes emerged from the interview data: sustainability and choosing the right patient; time; safety concerns and side effects; anticipating the patient's perspective (staff perception); facilitating PCA use in ED. Most participants perceived that patients would experience several benefits from PCA use in ED. Several perceived barriers and facilitators were also identified. To facilitate the use of PCA in ED, there is a need for staff education on PCA use, patient selection guidelines and effective change management strategies. Further research about the time it takes to administer analgesia via PCA compared with conventional methods is needed. [ABSTRACT FROM AUTHOR]

Objectives: Patient contributions (co-payments) for one months' supply of a publicly-subsidised medicine in Australia were increased by 21% in January 2005 (US$2.73-$3.31 for social security recipients and $17.05-$20.58 for others). This study investigates the relationship between patients' use of statin medication and hospitalisation for acute coronary syndrome and stroke, following this large increase in co-payments.Methods: We designed a retrospective cohort study of all patients in Western Australia who were dispensed statin medication between 2004 and 05. Data for the cohort was obtained from State and Federal linked databases. We divided the cohort into those who discontinued, reduced or continued statin therapy in the first six months after the co-payment increase. The primary outcome was two-year hospitalisation for acute coronary syndrome or stroke-related event. Analysis was conducted using Fine and Gray competing risk methods, with death as the competing risk.Results: There were 207,066 patients using statins prior to the co-payment increase. Following the increase, 12.5% of patients reduced their use of statin medication, 3.3% of patients discontinued therapy, and 84.2% continued therapy. There were 4343 acute coronary syndrome and stroke-related hospitalisations in the two-year follow-up period. Multivariate analysis demonstrated that discontinuing statins increased the risk of hospitalisation for acute coronary syndrome or stroke-related events by 18% (95%CI = 0.1%-40%) compared to continuing therapy. Subgroup analysis showed that men aged <70 years were at increased risk of 54-63% after discontinuing statins compared to those continuing, but that women and older men were not.Conclusion: Discontinuing statin medication after a large increase patient cost contribution was associated with higher rates of acute coronary syndrome and stroke-related hospitalisation in men under 70 years. The findings highlight the importance of continued adherence to prescribed statin medication, and that discontinuing therapy for non-clinical reasons (such as cost) can possibly have negative consequences particularly for younger men. [ABSTRACT FROM AUTHOR]

• Qualitative exploration of reasons for seeking care in the emergency department. • Uncovers perspectives of working age adults with common fractures. • Most care seeking is driven by convenience and ease of access to care. • Well-informed patients make deliberate choices between ED and GP services. • A sub-group of patients default to ED due to anxiety or poor service awareness. Background To investigate what factors contribute to a working age adult with a simple fracture seeking care in an Australian metropolitan Emergency Department (ED) Methods In this Qualitative Descriptive study, we interviewed ED patients with simple fractures including 5th metacarpal, 5th metatarsal, toe, radial head and clavicle fractures. Results We interviewed 30 patients aged 18-65. Two thirds of participants were aware they might have a minor injury. Many were well informed health consumers and convenience was the most important decision-making factor. Participants focussed on organising imaging, diagnosis and immobilisation. This sequence of care was often perceived as more complex and inefficient in primary care. ED was trusted and preferred to urgent primary care with an unknown doctor. Some patients defaulted to attending ED without considering alternatives due to poor health system knowledge or from escalating anxiety. Conclusions ED is safe, free and equipped to manage simple and complex injuries. Patients would attend primary care if comprehensive fracture management was easily accessible from a trusted clinician. To effectively divert simple fracture presentations from ED, primary care requires collocated imaging, imaging interpretation, orthopaedic expertise, and fracture management resources. Services need to operate 7 days a week and must have accessible 'urgent' appointments. [ABSTRACT FROM AUTHOR]

Post-treatment follow-up for lymphoma potentially fails to address the supportive care needs of survivors. A nurse-led lymphoma survivorship model of care was developed and tested in a phase II pilot pragmatic randomised controlled trial (RCT). The intervention comprised three face-to-face appointments, delivery of tailored resources and an individualised survivorship care plan and treatment summary (SCPTS), shared with the general practitioner (GP). Three months' post-treatment completion, eligible lymphoma patients were randomised 1:1 to usual care (control) or usual care plus intervention. Survivorship unmet needs (Short-Form Survivor Unmet Needs Survey), distress (Depression Anxiety Stress Scale 21), adjustment to cancer (Mini-Mental Adjustment to Cancer scale) and self-empowerment (Patient Empowerment Scale) were assessed at baseline, three and six months. Univariate and multivariate analyses examined changes within and between groups at the three time points. A GP evaluation survey sought information on the perceived utility of the SCPTS. Statistical significance was set at 0.05 (2-tailed). Although not statistically significant, by study completion, intervention participants (n = 30), reported less unmet needs (M = 21.41 vs M = 25.72, p =.506), less distress ((M = 13.03 vs M = 15.14, p =.558) and an increase in empowerment (M = 50.21 vs M = 47.21, p =.056) compared with control participants (n = 30). The SCPTS was rated good to very good by a majority of GPs (n = 13, 81%). The nurse-led lymphoma survivorship model of care may be a helpful intervention for lymphoma patients who had completed treatment. Survivors require individualised and tailored support and resources. A tailored SCPTS may promote survivor self-management and increase GP engagement. • Findings of a pilot RCT of a nurse-led lymphoma survivorship model of care. • Intervention group had downward trend of unmet need and increased self-empowerment. • A patient-centred survivorship care plan (SCPTS) may empower patients' wellbeing. • GPs rated SCPTS good - very good and 89% read the SCPTS on receipt. • Nurses can provide individualised support and resources at treatment completion. [ABSTRACT FROM AUTHOR]

Purpose To explore and describe lymphoma survivors’ thoughts and perceptions of the components of a nurse-led lymphoma survivorship clinic intervention. Methods An exploratory, qualitative descriptive study using interviews from 10 participants who had transitioned post-treatment into the survivorship phase via a nurse-led lymphoma survivorship clinic intervention. Results Thematic analysis revealed three major themes: Reassurance and individualised care; Information and support; and Empowerment. Participants described the reassurance they gained from having contact with a health professional post-treatment who individualised information and support. A survivorship care plan and treatment summary was developed for this study and was believed to be very patient-centred and helpful. This enabled participants to take back control of their health and well-being and to rebuild confidence. Conclusions In this study, participants expressed a need for patient-centred follow-up care that addressed their concerns and supported them in the survivorship phase to get their life back on track. Nurse-led follow-up may offer a viable model of post-treatment survivorship care to lymphoma cancer survivors. [ABSTRACT FROM AUTHOR]

Purpose To explore the post-treatment experiences and preferences for follow-up support of lymphoma survivors. Methods Two focus groups were conducted with 17 participants to explore informational, psychological, emotional, social, practical and physical needs, 6–30 months post-treatment for lymphoma. Perceptions regarding a potential model of survivorship care were also elicited. Results Thematic content analysis revealed five key themes: Information; Loss and uncertainty; Family, support and post-treatment experience; Transition, connectivity and normalcy, and Person-centred post-treatment care. Participants described a sense of loss as they transitioned away from regular interaction with the hospital at the end of treatment, but also talked about the need to find a “new normal”. Establishing post-treatment support structures that can provide individualised information, support, reassurance and referrals to community and peer support were identified as a helpful way to navigate the transition from patient to post-treatment survivor. Conclusions Participants in our study articulated a need for a flexible approach to survivorship care, providing opportunities for individuals to access different types of support at different times post-treatment. Specialist post-treatment nurse care coordinators working across acute and community settings may offer one effective model of post-treatment support for survivors of haematological malignancies. [ABSTRACT FROM AUTHOR]

The aims of this study were to evaluate establishing and operating a web-based community of practice (CoP) to lead falls prevention in a residential aged care (RAC) setting. A mixed methods evaluation was conducted in two phases using a survey and transcripts from interactive electronic sources. Nurses and allied health staff ( n = 20) with an interest in falls prevention representing 13 sites of an RAC organization participated. In Phase 1, the CoP was developed, and the establishment of its structure and composition was evaluated using determinants of success reported in the literature. In Phase 2, all participants interacted using the web, but frequency of engagement by any participant was low. Participatory barriers, including competing demands from other tasks and low levels of knowledge about information communication technology (ICT) applications, were identified by CoP members. A web-based CoP can be established and operated across multiple RAC sites if RAC management support dedicated time for web-based participation and staff are given web-based training. [ABSTRACT FROM AUTHOR]