Introduction: Neuromuscular training can help to prevent musculoskeletal injury among sports populations; however, it requires further investigation with military recruits. This study investigated whether six weeks of neuromuscular training, compared with usual training, leads to fewer lower limb injuries among New Zealand Army recruits undertaking basic training. Methods: This double-blind cluster-randomized controlled trial included army recruits from two consecutive intakes. Recruits received six weeks of neuromuscular or usual training two to five times per week. The primary outcome was incidence of lower limb injuries during basic training. Secondary outcomes included total health care encounters for injury, occupational endpoint achieved, and accumulated light-duty days because of injury. Results: Participants were 248 recruits (228 males, 20 females, mean age = 20.28 years). Cumulative injury incidence in the control and neuromuscular training groups was 63.2% and 52.8%, respectively ( p = 0.10). There was no between-groups difference in average number of injuries per recruit (control = 1.31, intervention = 1.10, p = 0.22). Average total health care encounters for injury per recruit was higher in the control group (control, mean = 4.83 intervention, mean = 3.45, p = 0.041). No statistically significant difference was found in occupational endpoint achieved ( p = 0.21). Accumulated light-duty days totaled 964 and 725 in the control and intervention groups respectively ( p = 0.10). Discussion: Simple, low-cost neuromuscular lower limb exercises did not change overall injury incidence but lowered number of health care encounters for injuries sustained by New Zealand Army recruits during basic training.

OBJECTIVE:Evaluate the impact of lung ultrasound (LUS) compared to current chest physiotherapy (CPT) outcome measures on clinical decision-making in the Neonatal Intensive Care Unit (NICU). DESIGN AND SETTING:Single-centre prospective observational study at the NICU, Mater Mothers Hospital (MMH), Brisbane. PARTICIPANTS:Infants admitted to the NICU who had a chest x-ray (CXR) within the preceding 24 h. Infants were excluded if LUS was not possible, were expected to be discharged from MMH in less than 24 h or had a plan for redirection of care. INTERVENTIONS:Infants were assessed using CXR and auscultation by a physiotherapist, who recorded a diagnosis and intervention plan. An examiner blinded to the initial assessment then performed a LUS assessment. After receiving the LUS results, the initial physiotherapist recorded a re-evaluated intervention plan. MAIN OUTCOME MEASURES:The primary outcome was the net reclassification improvement (NRI), which quantified how frequently physiotherapy diagnosis and treatment was reclassified after LUS. Secondary outcomes included diagnostic concordance between CXR/auscultation and LUS, and physiotherapist confidence in diagnoses. RESULTS:From 30 included episodes, NRI was -41% (SE 0.38; 95% CI -116% to 33%), indicating that LUS did not significantly result in reclassification of physiotherapy diagnosis and treatment. Diagnostic concordance was moderate at 0.595 (p < 0.001) observed in 21 (70%) cases, resulting in treatment alteration in nine instances. After LUS, physiotherapy confidence in diagnosis increased by 1.16 on a 7-point Likert scale (p < 0.001). CONCLUSIONS:Although LUS did not result in significant reclassification of physiotherapy diagnosis and treatment, it did result in treatment alteration and improved physiotherapy confidence in diagnosis. ANZCTR REFERENCE NUMBER:ACTRN12624000290594. CONTRIBUTION OF THE PAPER.

INTRODUCTION:Paramedics can experience a range of stressful and potentially traumatic events through clinical work, collegial relationships and organisational pressures. This can affect their mental health, including posttraumatic stress symptoms (PTSS). However, paramedics may also experience positive outcomes such as resilience and posttraumatic growth (PTG). This study aimed to examine levels of, and relationships between, paramedics' stress and trauma exposure, resilience, PTSS and PTG. METHODS:A cross-sectional survey was completed by n = 112 paramedics from Australian ambulance services. Data were analysed with descriptive and correlational statistics. RESULTS:Overall, 25.7% of paramedics met the threshold for probable posttraumatic stress disorder, and PTG was low (M = 35.49, SD = 23.84). Resilience was negatively correlated with PTSS (rs = -0.46, p < 0.01). Resilience subfactor Mastering stress was correlated negatively with PTSS (rs = -0.44, p < 0.01), and positively with PTG (rs = 0.24, p < 0.05). Colleague-related stress was related to PTSS (rs = 0.45, p < 0.01), resilience (rs = -0.31, p < 0.01) and PTG (rs = 0.25, p < 0.05). CONCLUSIONS:Paramedics experienced frequent stress and trauma exposure, with high PTSS and low PTG. To support their mental wellbeing, evidence-based resilience interventions are recommended. Wellbeing strategies should include exposure minimisation, targeting avoidable stressors related to colleagues (e.g. bullying, incivility) and organisational processes (e.g. promotion, shift flexibility).

Introduction Certain army recruits entering basic training may be at heightened risk of injury. It is unknown if risk factors for lower limb injuries could be identified upon entry to basic training for New Zealand Army recruits. This study investigates if personal, lifestyle and physical performance characteristics reported at entry to training could identify recruits who go on to sustain a lower limb musculoskeletal injury during New Zealand Army basic training.Materials and Methods Recruits' baseline personal (age, sex, and BMI), lifestyle (history of smoking and previous injury) and physical performance characteristics (2.4 km timed run outcome, ankle range of motion using the weight-bearing dorsiflexion lunge test and lower limb dynamic control using the Y Balance Test) were collected at entry to basic training. Backwards stepwise logistic regression analyses were undertaken to determine if baseline variables predicted the occurrence of an injury during basic training and to determine the optimal model of prediction. Significance was set to 0.10. This study was approved by Commander of TRADOC NZDF February 2012 and from Griffith University Human Research Ethics Committee May 2012 (PES/36/11/HREC).Results In total 248 recruits, 228 males and 20 females, were eligible to participate in the study. Forty-six (18.5%) recruits had missing data thus, 202 (81.5%) remained for analysis. There were 114 recruits who reported one or more injuries, and 88 recruits reported no injury. Two variables were associated with injury risk in the final model: passing the 2.4 km timed run and Y Balance Test average normalized posterolateral reach for the right limb. This model accurately predicted 60.9% of recruits with 36 correctly assigned as not injured and 87 correctly assigned as injured.Conclusions This study identified that 2 physical performance characteristics were associated with lower limb injury in New Zealand Army recruits commencing basic training; not passing the entry 2.4 km timed run, and low right posterolateral Y Balance Test score for lower limb dynamic neuromuscular control. These findings suggest that physical performance screening may be used to identify recruits at high risk of injury entering training so that mitigation measures could be implemented to lower future injury risk.

AIM:To describe the cumulative incidence and characteristics of hospital-acquired pressure injury in acute palliative patients. DESIGN:Secondary data analysis of hospital-acquired pressure injuries during 2019-2022. METHODS:The setting was a palliative care unit at a tertiary hospital in Queensland, Australia, including adult (≥ 18 years) acute-phase palliative inpatients. Retrospective data from four databases were used to identify and analyse hospital-acquired pressure injury cases from 2019 to 2022. Clinical characteristics of patients with and without hospital-acquired pressure injury were compared. RESULTS:The incidence of hospital-acquired pressure injury in acute palliative care patients was 3.9% over the 4 years. These patients were predominantly male, with an average age of 74 years, with 66 of 78 cases developing in the deteriorating palliative care phase. Using the Waterlow Score, 51.3% of patients were assessed as at very high risk of pressure injury. Ninety-five hospital-acquired pressure injuries were reported in 78 patients; 16.8% were medical device-related, 40% were Stage 1 injuries, and the most common injury sites were the sacrum, heels and genitals. Patients with hospital-acquired pressure injury had significantly higher (worse) scores on both the palliative care Resource Utilisation Group-Activities of Daily Living and Problem Severity Scores. Regression analysis identified a high Problem Severity Score on admission as a significant predictor for hospital-acquired pressure injury development. CONCLUSION:The incidence of hospital-acquired pressure injury in acute palliative patients is lower than in previous studies. However, many injuries occurred in those in the deteriorating phase, with higher scores for severity of symptoms. These findings suggest that acute palliative patients do require nursing care for pressure injury prevention, as well as for symptom management and activities-of-daily-living. Overall, this research contributes to a deeper understanding of pressure injury incidence and characteristics for acute palliative care patients. Future research should focus on population-specific pressure injury risk assessment to explore risk factors in greater detail. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE:Current pressure injury risk assessment tools, like the Waterlow Score, may not provide the comprehensive evaluation needed for the acute palliative care cohort. To better address the unique needs of this cohort, it may be necessary to refine existing tools or develop new instruments that integrate palliative-specific assessments, such as the Resource Utilisation Group-Activities-of-Daily-Living (RUG-ADL) and Problem (symptom) Severity Score (PSS). These adaptations could help improve pressure injury prevention care planning and enhance outcomes for patients in this setting. IMPACT:This study separated acute palliative care patients from those at end-of-life and found a 3.9% cumulative incidence of pressure injuries. There were no significant differences in age, gender, or cancer diagnosis between patients with and without injuries. Patients without injuries were more likely to be in the deteriorating phase, while those with injuries had higher (worse) RUG-ADL scores. Regression analysis showed that each one-point increase in the PSS (symptom severity) made patients 1.2 times more likely to develop a pressure injury. The findings suggest that combining a validated risk assessment tool with the RUG-ADL and PSS tools could provide a more accurate risk assessment for hospitalised acute palliative care patients. REPORTING METHOD:STROBE reporting guideline. PATIENT OR PUBLIC CONTRIBUTION:No patient or public contribution.

The COVID-19 pandemic and rapid shift to online learning have had ongoing impacts on nursing students’ wellbeing and resilience. We are yet to fully understand the implications for this emerging workforce in the post-pandemic era. The aims of this mixed methods study were to investigate wellbeing, coping and resilience of undergraduate nursing students in the pandemic; explore relationships between these variables and investigate predictors of wellbeing and coping, including differences between domestic and international students; explore how students experienced and managed adversity; understand how their mental distress and wellbeing were influenced by resilience resources used to deal with adversity, and identify implications for nurse wellbeing as they enter the workforce in the post-pandemic era. A convergent mixed methods design was used. An online survey investigated wellbeing (COMPAS-W), psychological distress (DASS-21), coping (Brief COPE) and resilience (ARM-R) was completed by n = 175 undergraduate nursing students. Semi-structured interviews with n = 18 students explored how they navigated challenges. Descriptive, correlational, and regression analyses, and thematic analysis, were conducted. Mixed methods analysis was used to integrate both sets of findings. Students reported high levels of mental distress, yet also moderate levels of wellbeing and resilience. Key findings included domestic students reporting significantly greater stress than international students, and wellbeing being predicted by lower mental distress and increased problem-focused coping. Students coped with challenges by being proactive, drawing on a range of coping strategies, and seeking technical and emotional support. From a social-ecological resilience perspective, access to and engagement with a range of personal, environmental and relational resources served as protective factors for their wellbeing. This study provides valuable new insights into protective factors for nurses during a period of extraordinary challenge. In the post-pandemic era, there is a need to strengthen the wellbeing and retention of new graduates now entering the workforce from university. Implementation of targeted strategies to strengthen graduates’ peer relationships and sense of belonging at work, and wellbeing and resilience education, are needed. Longitudinal follow-up of graduates’ wellbeing is recommended.

Older people are at risk of chronic oedema that increases morbidity and reduces quality of life. This retrospective study aimed to explore the prevalence, characteristics, and risk factors for chronic oedema in older community-dwelling people. Methods Non-health professionals completed routine screening of older people receiving community-age care between 2020 and 2022, including a 10-second pitting test to detect foot and ankle oedema, age, gender, comorbidities, mobility and care levels. Participant characteristics were described, and unadjusted analyses and logistic regression were completed to explore factors associated with oedema. Results There were 459 older adults receiving community care with a mean age of 80.3 years (SD 7.4), and 68.6% were female. Prevalence of chronic oedema was 38.1% (n=175) and 85.4% (n=147) had bilateral oedema. An increased risk of oedema was associated with having chronic heart failure (OR:3.73, CI 2.41, 5.79) and using a mobility aid (OR: 2.38, CI 1.51, 3.75). Conclusion Older people are at risk of chronic oedema and early detection may prevent complications. Non-health professionals can perform screening, boosting workforce capacity.

Background: Participation-focused physical activity (PA) interventions are increasing in rehabilitation but can be difficult to replicate if the components of what is delivered and what is received are not clearly described. This study evaluated the implementation of a participation-focused PA intervention by mapping programme content and participant experiences to the theoretical framework: Family of Participation Related Constructs (fPRC). Methods: A descriptive process evaluation, embedded in a single-case experimental design study, explored the extent to which the intervention (‘Run Club’) achieved the goal of being participation-focused, by exploring what was designed, delivered and received through each intervention phase: before, after, and 9-months following a twice weekly 12-week intervention. The programme was designed to provide both participation and activity-level intervention elements. The programme elements and experiences of participating adolescents with cerebral palsy and their parents were mapped to the fPRC constructs and transactional elements. Results: Eight adolescents and 12 parents participated. Mapping of the ‘intervention delivered’ indicated that the 24 1-hour sessions of expert coaching in community settings, with family support, and promotion of attendance and involvement at all study phases were designed and delivered as intended. Experiences of ‘programme received’ were mapped across all fPRC constructs and transactions, providing examples of the transactional influences among the person-level constructs (activity competence, sense of self, preferences), the environment and the individuals' attendance and involvement, in the programme and beyond. Conclusions: The findings demonstrated how a participation-focused intervention approach can be designed and evaluated using the fPRC.

PURPOSE:This research investigates the relative effectiveness of independent online and blended learning approaches for novice analysts' development of videofluoroscopic swallowing study (VFSS) analytical skills. The secondary aims were to explore the impact of training on decision-making and to describe learners' perspectives of training outcomes.METHOD:Undergraduate speech-language pathology students (n = 74) who had completed the dysphagia academic curriculum in an undergraduate speech-language pathology program were recruited for a randomised control trial. The ability to identify swallowing impairments in adults was compared pre- and post-training across three conditions: independent online (n = 23), peer-supported (n = 23), and expert-facilitated training (n = 28). The training comprised online VFSS training and practice with a commercially available digital video disc (DVD).RESULT:The three training approaches were equal in improving novice analysts' identification of impairments on VFSS. Participants' analysis improved pre- to post-training (p = <.001), with no statistical difference amongst training conditions (p = .280). However, the expert facilitation condition resulted in better decision-making skill for novice analysts, as well as higher levels of confidence and greater engagement in the learning.CONCLUSION:Well-designed independent online methods are appropriate to prepare novice analysts for VFSS analytical training. Expert facilitation and peer-supported environments may have benefits for more advanced skill development and engagement, and should be investigated in future studies.

DESIGN:A multi-methods, single-centre pilot comprising a quasi-experimental pre-/post-test design and an exploratory qualitative study. SETTING:A rural Australian hospital and health service. PARTICIPANTS:Men newly diagnosed with localised prostate cancer who were scheduled to undergo, or had undergone, radical or robotic prostatectomy surgery within the previous 3 months. INTERVENTION:The intervention comprised a 12-week virtual care program delivered via teleconference by a specialist nurse, using a pre-existing connected care platform. The program was tailored to the post-operative recovery journey targeting post-operative care, psychoeducation, problem-solving and goal setting. MAIN OUTCOME MEASURES:Primary outcome: program acceptability. SECONDARY OUTCOMES:quality of life; prostate cancer-related distress; insomnia severity; fatigue severity; measured at baseline (T1); immediately post-intervention (T2); and 12 weeks post-intervention (T3). RESULTS:Seventeen participants completed the program. The program intervention showed very high levels (≥4/5) of acceptability, appropriateness and feasibility. At T1, 47% (n = 8) of men reported clinically significant psychological distress, which had significantly decreased by T3 (p = 0.020). There was a significant improvement in urinary irritative/obstructive symptoms (p = 0.030) and a corresponding decrease in urinary function burden (p = 0.005) from T1 to T3. CONCLUSIONS:This pilot has shown that a tailored nurse-led virtual care program, incorporating post-surgical follow-up and integrated low-intensity psychosocial care, is both acceptable to rural participants and feasible in terms of implementation and impact on patient outcomes.

Objective: To determine if combining high-frequency oscillatory ventilation (HFOV) with additional sigh breaths would improve end-expiratory lung volume (EELV) and oxygenation in preterm infants. Design: Prospective interventional crossover study. Setting: Neonatal intensive care unit. Patients: Ventilated preterm infants <36 weeks corrected gestational age receiving HFOV. Interventions: Infants were randomly assigned to receive HFOV with sigh breaths followed by HFOV-only (or vice versa) for four alternating periods. Sigh breaths were delivered with an inspiratory time of 1 s, peak inspiratory pressure of 30 cmH(2)0 and frequency of three breaths/min. Main outcome measures: Electrical impedance tomography measured the effect of sigh breaths on EELV and ventilation distribution. Physiological variables were recorded to monitor oxygenation. Measurements were taken at 30 and 60 min postchange of HFOV mode and compared with baseline. Results: Sixteen infants (10 males, 6 females) with a median (range) gestational age at birth of 25.5 weeks (23-31), study weight of 950 g (660-1920) and a postnatal age of 25 days (3-49) were included in the study. The addition of sigh breaths resulted in a significantly higher global EELV (mean difference +/- 95% CI) (0.06 +/- 0.05; p=0.04), with increased ventilation occurring in the posterior (dependent) and left lung segments, and improved oxygen saturations (3.31 +/- 2.10; p<0.01). Conclusion: Intermittent sigh breaths during HFOV were associated in the short-term with an increased EELV in the posterior and left lungs, and improved oxygen saturations in preterm infants.

Mental health nurses (MHNs) experience a range of stressors as part of their work, which can impact their well-being and turnover intention. There is no prior evidence, however, on MHNs' mental health, well-being, resilience, and turnover intention during the COVID-19 pandemic. The aims of this online survey-based cross-sectional study, conducted during the pandemic, were to explore the psychological distress, well-being, emotional intelligence, coping self-efficacy, resilience, posttraumatic growth, sense of workplace belonging, and turnover intention of n = 144 Australian mental health registered and enrolled nurses; and explore relationships between these variables, in particular, psychological distress, well-being, and turnover intention. There was a higher percentage of MHNs with high (27.78%) and very high psychological distress (9.72%) compared to population norms as measured by the K10. Emotional intelligence behaviours were significantly lower than the population mean (GENOS-EI Short). Coping self-efficacy was mid-range (CSES-Short). Resilience was moderate overall (Brief Resilience Scale), and posttraumatic growth was mid-range (Posttraumatic Growth Inventory; PTGI). Sense of workplace belonging was moderate, and turnover intention was low. Higher levels of psychological distress were associated with higher turnover intention, and lower workplace belonging, coping self-efficacy, well-being, resilience, and emotional intelligence behaviours. Despite the levels of psychological distress, nearly half the sample (n = 71) was 'flourishing' in terms of well-being (Mental Health Continuum Short-Form). To help prevent staff distress in the post-pandemic period, organisations need to proactively offer support and professional development to strengthen staff's psychological well-being, emotional intelligence, and resilience skills. These strategies and group clinical supervision may also support lower turnover.

Purpose: To explore the experiences of involvement of adolescents living with cerebral palsy, and their parents, while participating in physical activity. Understanding involvement in physical activity may be used to guide future participation.Methods: Eight adolescents (mean age 13 years 11 months, SD 1 year 6 months) with cerebral palsy participated in a New Zealand-based high-level mobility programme (HLMP) focused on running skills, twice per week for 12 weeks. The adolescents and 12 parents were interviewed before, after the 12 weeks and 9-months following the HLMP. Guided by interpretative description, 38 interviews were coded, analysed, and interpreted.Results: Four themes were: "Turning up is not enough" ("There's no point being there if you're not involved"); "In it all the way", "Changes on a dime", and "What works for me." Perceptions of involvement varied between adolescents and parents. Being "very involved" related to high levels of focus, concentration, effort; but not always enjoyment.Conclusions: Focusing on enjoyment as the key experience of involvement understates the complexity and dynamic nature of involvement. "Being involved" is not always easy and may not mean the absence of discomfort or effort. Optimising the individuals' involvement continuum during physical activity may be essential to promote lifelong participation.IMPLICATIONS FOR REHABILITATIONAdolescents living with cerebral palsy and their parents have differing perspective of involvement and utilise different strategies to encourage being and staying active.Teaching adolescents living with cerebral palsy about their involvement continuum and optimal level of involvement for each activity, context and environment could promote sustained participation.To ensure adolescents are "being involved" in physical activity, opportunities for engagement, motivation and persistence are important; enjoyment is a possible, but not essential attribute of involvement.Encouraging involvement in physical activity can be a source of family conflict from a young age therefore clinicians have a role as an essential supporter, motivator and educator.

Purpose: To understand adolescents’ and their parents’ perspectives on ‘being active’, this study explored the experience of participation in physical activity (PA), the role of long-term participation in PA, and the importance of remaining active for life. Methods: Eight ambulant adolescents with CP (aged 11–16 years, seven male) participated in a high-level mobility programme twice per week for 12 weeks. Guided using interpretive description, adolescents and 12 of their parents were interviewed before, after and nine months following the programme. Thirty-eight interviews were coded, analysed, and interpreted, informed by audit information, reflective journaling, and team discussions. Results: Adolescents and their parents highly value being active now and into adulthood. Sustainable participation in PA requires adolescents and families to navigate complex environments (interpersonal, organisational, community, and policy). Core themes were: ‘Just Doing it’, ‘Getting the Mix Right’ (right people, right place, right time), ‘Balancing the Continua’ and ‘Navigating the Systems’. The continua involved balancing intra-personal attributes: ‘I will try anything’ through to ‘I will do it if I want to’ and ‘It’s OK to be different’ through to ‘It sucks being disabled’. Conclusions: The journey to sustainable participation was complex and dynamic. Experiences of successful journeys are needed to help adolescents with CP “stay on track” to sustainable participation.

There is global recognition that mental health nursing can be stressful and have detrimental effects on nurses' well-being and retention. With substantial nursing shortages, there is an urgent need to attract and retain nurses to sustain this workforce and provide effective mental healthcare. Mental health transition programs provide vital recruitment pathways and support novice registered nurses, enrolled nurses and experienced registered generalist nurses moving into this field. There is little evidence, however, on the well-being, resilience, and retention of nurses transitioning into mental health. The primary aims for this cross-sectional study were to describe demographic characteristics, perceived stress, well-being, resilience, mental illness stigma attitudes, work satisfaction, and turnover intention of four nurse cohorts entering mental health transition programs: generalist registered nurses, graduate and post-graduate registered nurses, and enrolled nurses; to explore relationships between these variables; and explore differences between these four nurse cohorts. Findings (n = 87) included overall moderate perceived stress, moderate well-being and resilience, high work satisfaction, low stigma, and low turnover intention. Higher turnover intention was associated with lower age and work satisfaction, and higher perceived stress. Generalist RNs had significantly higher stress and stigmatizing attitudes than Enrolled Nurses. Secondary analysis of well-being scores identified 14 nurses with scores indicating depression, with significantly lower resilience and work satisfaction, and significantly higher stress than the rest of the sample. To help prevent attrition, it is vital that mental health services provide tailored well-being initiatives during transition and intervene early to provide support for nurses with mental distress.

BACKGROUND:Respiratory failure or respiratory distress in infants is the most common reason for non-elective admission to hospitals and neonatal intensive care units. Non-invasive methods of respiratory support have become the preferred mode of treating respiratory problems as they avoid some of the complications associated with intubation and mechanical ventilation. High flow nasal cannula (HFNC) therapy is increasingly being used as a method of non-invasive respiratory support. However, the evidence pertaining to its use in term infants (defined as infants ≥ 37 weeks gestational age to the end of the neonatal period (up to one month postnatal age)) is limited and there is no consensus of opinion regarding the safety and efficacy HFNC in this population. OBJECTIVES:To assess the safety and efficacy of high flow nasal cannula oxygen therapy for respiratory support in term infants when compared with other forms of non-invasive respiratory support. SEARCH METHODS:We searched the following databases in December 2022: Cochrane CENTRAL; PubMed; Embase; CINAHL; LILACS; Web of Science; Scopus. We also searched the reference lists of retrieved studies and performed a supplementary search of Google Scholar. SELECTION CRITERIA:We included randomised controlled trials (RCTs) that investigated the use of high flow nasal cannula oxygen therapy in infants ≥ 37 weeks gestational age up to one month postnatal age (the end of the neonatal period). DATA COLLECTION AND ANALYSIS:Two review authors independently assessed trial eligibility, performed data extraction, and assessed risk of bias in the included studies. Where studies were sufficiently similar, we performed a meta-analysis using mean differences (MD) for continuous data and risk ratios (RR) for dichotomous data, with their respective 95% confidence intervals (CIs). For statistically significant RRs, we calculated the number needed to treat for an additional beneficial outcome (NNTB). We used the GRADE approach to evaluate the certainty of the evidence for clinically important outcomes. MAIN RESULTS:We included eight studies (654 participants) in this review. Six of these studies (625 participants) contributed data to our primary analyses. Four studies contributed to our comparison of high flow nasal cannula (HFNC) oxygen therapy versus continuous positive airway pressure (CPAP) for respiratory support in term infants. The outcome of death was reported in two studies (439 infants) but there were no events in either group. HFNC may have little to no effect on treatment failure, but the evidence is very uncertain (RR 0.98, 95% CI 0.47 to 2.04; 3 trials, 452 infants; very low-certainty evidence). The outcome of chronic lung disease (need for supplemental oxygen at 28 days of life) was reported in one study (375 participants) but there were no events in either group. HFNC may have little to no effect on the duration of respiratory support (any form of non-invasive respiratory support with or without supplemental oxygen), but the evidence is very uncertain (MD 0.17 days, 95% CI -0.28 to 0.61; 4 trials, 530 infants; very low-certainty evidence). HFNC likely results in little to no difference in the length of stay at the intensive care unit (ICU) (MD 0.90 days, 95% CI -0.31 to 2.12; 3 trials, 452 infants; moderate-certainty evidence). HFNC may reduce the incidence of nasal trauma (RR 0.16, 95% CI 0.04 to 0.66; 1 trial, 78 infants; very low-certainty evidence) and abdominal overdistension (RR 0.22, 95% CI 0.07 to 0.71; 1 trial, 78 infants; very low-certainty evidence), but the evidence is very uncertain. Two studies contributed to our analysis of HFNC versus low flow nasal cannula oxygen therapy (LFNC) (supplemental oxygen up to a maximum flow rate of 2 L/min). The outcome of death was reported in both studies (95 infants) but there were no events in either group. The evidence suggests that HFNC may reduce treatment failure slightly (RR 0.44, 95% CI 0.21 to 0.92; 2 trials, 95 infants; low-certainty evidence). Neither study reported results for the outcome of chronic lung disease (need for supplemental oxygen at 28 days of life). HFNC may have little to no effect on the duration of respiratory support (MD -0.07 days, 95% CI -0.83 to 0.69; 1 trial, 74 infants; very low-certainty evidence), length of stay at the ICU (MD 0.49 days, 95% CI -0.83 to 1.81; 1 trial, 74 infants; very low-certainty evidence), or hospital length of stay (MD -0.60 days, 95% CI -2.07 to 0.86; 2 trials, 95 infants; very low-certainty evidence), but the evidence is very uncertain. Adverse events was an outcome reported in both studies (95 infants) but there were no events in either group. The risk of bias across outcomes was generally low, although there were some concerns of bias. The certainty of evidence across outcomes ranged from moderate to very low, downgraded due to risk of bias, imprecision, indirectness, and inconsistency. AUTHORS' CONCLUSIONS:When compared with CPAP, HFNC may result in little to no difference in treatment failure. HFNC may have little to no effect on the duration of respiratory support, but the evidence is very uncertain. HFNC likely results in little to no difference in the length of stay at the intensive care unit. HFNC may reduce the incidence of nasal trauma and abdominal overdistension, but the evidence is very uncertain. When compared with LFNC, HFNC may reduce treatment failure slightly. HFNC may have little to no effect on the duration of respiratory support, length of stay at the ICU, or hospital length of stay, but the evidence is very uncertain. There is insufficient evidence to enable the formulation of evidence-based guidelines on the use of HFNC for respiratory support in term infants. Larger, methodologically robust trials are required to further evaluate the possible health benefits or harms of HFNC in this patient population.

BACKGROUND:Perceptual, cognitive and previous clinical experience may influence a novice Videofluoroscopic Swallowing Study (VFSS) analyst's trajectory towards competency. Understanding these factors may allow trainees to be better prepared for VFSS training and may allow training to be developed to accommodate differences between trainees.AIMS:This study explored a range of factors previously suggested in the literature as influencing the development of novice analysts' VFSS skills. We hypothesised that knowledge of swallow anatomy and physiology, visual perceptual skills, self-efficacy and interest, and prior clinical exposure would all influence VFSS novice analysts' skill development.METHODS & PROCEDURES:Participants were undergraduate speech pathology students recruited from an Australian university, who had completed the required theoretical units in dysphagia. Data assessing the factors of interest were collected-the participants identified anatomical structures on a still radiographic image, completed a physiology questionnaire, completed subsections of the Developmental Test of Visual Processing-Adults, self-reported the number of dysphagia cases they managed on placement, and self-rated their confidence and interest. Data for 64 participants relating to the factors of interest were compared with their ability to accurately identify swallowing impairments following 15 h of VFSS analytical training, using correlation and regression analysis.OUTCOMES & RESULTS:Success in VFSS analytical training was best predicted by clinical exposure to dysphagia cases and the ability to identify anatomical landmarks on still radiographic images.CONCLUSIONS & IMPLICATIONS:Novice analysts vary in the acquisition of beginner-level VFSS analytical skill. Our findings suggest that speech pathologists who are new to VFSS may benefit from clinical exposure to dysphagia cases, sound foundational knowledge of anatomy relevant to swallowing and the ability to see the anatomical landmarks on still radiographic images. Further research is required to equip VFSS trainers and trainees for training, to understand differences between learners during skill development.WHAT THIS PAPER ADDS:What is already known on the subject The existing literature suggests that no vice Video fluoroscopic Swallowing Study (VFSS) analysts training may be influenced by their personal characteristics and experience. What this study adds This study found that student clinicians, clinical exposure to dysphagia cases and their ability to identify anatomical landmarks relevant to swallowing on still radiographic images prior to training best predicted their ability to identify swallowing impairments after training. What are the clinical implications of this work? Given the expense of training health professionals, further research is required into the factors that successfully prepare clinicians for VFSS training, including clinical exposure, foundational knowledge of anatomy relevant to swallowing and the ability to identify the anatomical landmarks on still radiographic images.

Objective: The purpose of this study was to evaluate use of a short multi-factor falls-risk screening tool for older people within the emergency department, to enable rapid identification of falls-risk and triggers for multidisciplinary referral for further falls-specific assessment.Methods: Older people, aged >70 years, presenting to the emergency department with a fall-related injury or disease (n = 137) were recruited by a research nurse following randomisation. A short multi-factor screening tool was completed, comprised of 14 falls-risk-related assessment components.Results: Only one participant did not generate any referrals. Participants generated most referrals for medications (85.4%), social and housing (84.6%), vision (67.2%), podiatry (66.9%), or function and mobility (54.7%). Based on our results, the screening tool could be reduced to eleven components. The median time-to-screen was 11 min (IQR 9-15), with 736 triggers generated for referral and further assessment of falls-risk.Conclusion: Falls are a major cause of ED presentation for older people. A short multi-factor screening tool with eleven components could be adapted to local familiar falls-risk tools and be completed in less than 10 min. Further research to trial the feasibility of completing ED referrals based on screening results is required to confirm the usefulness of such screening and referral within the ED.