Western Nurse Magazine September October 2019

September – October 2019

incorporating western midwife

HAPPY BIRTHDAY ANF MEMBER OFFERS One year ago, we relaunched our offers page as a brand new section on iFolio called ANF Member Rewards and Offers There are now more than 40 individual offers designed to save you money READ ALL ABOUT THEM ON PAGE 3

MORE PRIZES: Send us pics of you and your pets and WIN even more goodies!

PAGE 19

western nurse is the official magazine for ANF members in WA

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September – October 2019

FEATURED AND FAVOURITES 3 4 7 9 10 18 19

Secretary’s Report ANF Humanitarian Fund Mark’s Q & A: Jury Duty Internet Watch ANF Out ‘N’ About Recipe Corner Pet Page

CONTINUING PROFESSIONAL DEVELOPMENT: CLINICAL UPDATES 12 14

16 17

Care coordination Targeted temperature management after cardiac arrest HIV diagnostic tests Pre-exposure prophylaxis for HIV prevention

LATEST NEWS AND RESEARCH 20 Across the Nation 21 Around the Globe 22 Research Roundup HOLIDAY ANF 23 ANF Holiday Apartments –

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Editor Mark Olson Phone 08 6218 9444 Freecall 1800 199 145 Email editorwesternnurse@anfiuwp.org.au Web anfiuwp.org.au

Australian Nursing Federation 260 Pier Street, Perth WA 6000

Secretary's Report State Secretary Mark Olson

Lately, it seems every time I talk to you within this forum it’s about a fight we’ve just won for members or one we’re about to have.

I thought I might pause to remind you to enjoy some of the non-combative gains we’ve made for you in the past year and continue to make in the background – while we continue striving to resolve the pointier end of your industrial issues.

This time round I’d like to focus specifically on the fantastic ANF Member Rewards and Offers page, which is situated prominently on the homepage of your iFolio website.

This is a section that has just kept growing with special deals for ANF members since we relaunched our offers section almost exactly a year ago.

There are now more than 40 separate offers – ranging from deals on health cover, credit cards and home loans, to special prices on new and pre-owned cars, vehicle servicing, repairs and tyres, as well as car leasing and rental.

Discounts on wine tours, cinema tickets, sports tickets, cruises, theme park entry and restaurant meals are also included.

We’ve even found you deals on hairdressing services, quality footwear, glasses and eyewear, and self-defence classes.

A big favourite with members has been discounted whitegoods, appliances, electronics and home entertainment, under our ‘Home’ section on the offers page.

Our list also includes specially priced furniture and home and carpet cleaning, as well as offering discounts on power bills and solar energy systems.

And while you’re enjoying our high-quality, low-cost resort apartments in Kalbarri and Margaret River, you can find offers at a range of places in these locations where you can eat and drink at a special ANF member price – as well as discounted tours and safaris.

As I said last year when announcing the relaunch of our offers section, I started out just wanting to replace an electrical goods discounter who was demanding more than $15,000 of our members’ dollars each year merely to provide discounts.

Another such discounter wanted about $25,000 annually – with both fees increasing whenever our membership grew.

I thought: "Forget that. Let’s save all that cash and find our own discounts instead."

The result is the extensive discount list you now have on iFolio that doesn’t cost ANF members a cent and still gives you fantastic deals.

I’d encourage you to check out the offers regularly to see what’s new – and start saving.

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

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September–October 2019 western nurse |

3

ANF Humanitarian Aid CHANGING LIVES

Our members are being empowered to help the needy in Australia or overseas through the ANF Humanitarian Aid Volunteers Fund. Jessica Lal and Raelene Mariani are two of many ANF members who have used this fund to help them change lives.

“I felt so privileged to have had this opportunity to lend my skills for this cause”

JESSICA LAL’S STORY In October 2018 I was part of a self-funded volunteer medical team consisting of three registered nurses, a midwife, nurse practitioner and a doctor, as well as other volunteers who travelled to Iringa, Tanzania.

The organisation I went with is called Water for Africa (WFA). Their main mission is to provide clean drinking water through the installment of wells in villages.

The WFA team also ensure the in-country team run by locals visit existing wells to both repair and maintain them, which means the villages have sustainable quality water supply for years to come.

The effect of having clean, accessible water means better health and sanitation, and increased education attendance and releases women and children to a more productive future.

A typical day consisted of us heading out in a 10-seater Land Cruiser, driving for up to 2½ hours via very bumpy dirt tracks, to get to and from villages.

On arrival often, there would be lines of people eagerly waiting for us. We would set up a clinic in whatever building was available, sometimes a school classroom, at other times on a rubble floor of a recently built but not yet completed community centre.

Most of our supplies for the clinics were run out of a couple of cooler bags, like the ones you buy at Coles or Woolies.

We had a mini mobile pharmacy set-up as well, where we had stocks of bulk medications that we could draw from as needed for each condition that was identified.

The most common health issues we saw were intestinal parasites, head lice, fungal infections, extensive wounds, vomiting/diarrhoea and HIV/AIDS. Over the two weeks we were in Tanzania, we saw about 700 people through the clinics.

With some of the advanced stage wounds we saw, these patients had lived for years in a debilitating state – some never leaving their home until the day they heard we were running the clinic.

I felt so privileged to have had this opportunity to lend my skills for this cause, because these beautiful people shared their hearts with us through their stories and I was inspired by their resilience despite having been through so much difficulty.

SAVE

I am reminded yet again of how incredibly blessed we are in the West to have the abundance of resources that we do. Thank you ANF for helping me to do this important work.  on g

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western nurse September–October 2019

Volunteers Fund RAELENE MARIANI’S STORY In April 2019 I had the fortunate experience of being selected as a volunteer nurse for the Open Heart International (OHI) Burns Surgery team that travels to Nepal.

The Burns project focuses on contracture surgery, and some birth defect reconstruction.

The major aim of the project is that we work alongside the Nepalese nurses, transferring skills, education and best practice so that in the future they will become self-sufficient.

Reconstructive surgery is not freely available; there are very few skilled surgeons to provide this expertise in Nepal.

The surgery offered by the OHI Burns team is aimed at adults and children who wouldn’t otherwise receive treatment.

A team of 37 volunteers included registered nurses, surgeons, anaesthetists, a ward resident medical officer, occupational therapist, physio and support people.

On a Sunday we travelled by bus east of Kathmandu for about 1½ hours to a town called Banepa, and onto the Scheer Memorial Hospital.

Many of the patients come from very poor villages in the south of Nepal.

Burn injuries are a global public health problem causing significant morbidity and mortality, being the third most common cause of injury in Nepal.

Frequent use of open fire cooking, wearing loose fitting clothes like sarees and poorly regulated LPG cylinders increases the risk of burn injuries in Nepal.

Many patients treated by our team have experienced traumatic injuries and endured much pain throughout their life, some for many years.

The aim of the surgery is to restore function so adults are able to work again, children can attend school, and they are accepted in society.

Eight beds are squeezed into a space for six, there are no privacy screens, men, women and children are all in together.

Some equipment would probably be not considered in good working order in Australia. But you make do to keep the patients and staff as safe as possible.

Thirty-five surgeries were completed in six days. It’s so rewarding to see people transformed in such a short time, and able to live a happier, more functional life. 

“It’s so rewarding to see people transformed in such a short time, and able to live a happier, more functional life” The ANF Humanitarian Aid Volunteers Fund is open to members who have done or are about to undertake humanitarian volunteer work in Australia or overseas. Apply by December 15, 2019. See page 6 for more information.

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Are you an ANF member who does humanitarian volunteer work?

VOLUNTEER FUNDING

ANFIUWP Humanitarian Aid Volunteers Fund provides financial help to ANF members who are undertaking humanitarian volunteer work in Australia or overseas. The closing date for applications is the 15th December 2019.

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

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

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western nurse September–October 2019

Mark’s

Over the years I have answered various questions about jury duty. Therefore, I thought we should have a Q & A on the subject. This gives some general guidance only and is drawn from WA Department of Justice information.

For more specific information check on the Department of Justice website at www.justice.wa.gov.au/juryduty – this also has frequently asked questions sections. Or, contact the Department directly to ensure you are abiding by the latest regulations.

Q: Do I lose my normal penalties and/or allowances while I’m on jury duty?

Q: Does my employer have to release me for jury duty when it is requested of me?

Q: What happens if my employer reduces my pay because I’m on jury duty or threatens me with action such as the scenarios described in the previous two questions?

A: Yes. Employers have to allow an employee to attend jury duty and continue to pay their wages or salary. But an employee should alert their employer of the requirement for jury duty as soon as possible. Issues of serious inconvenience and/or hardship can then be discussed between the employee and the employer.

Q: What if I’m a part-time or casual employee, is my boss still obliged to let me do jury duty?

A: Yes. Employers must allow an employee to attend jury duty and continue to pay their wages or salary whether full-time, part-time or casual during that period.

A: No. Your employer must keep paying them. The Justice Department said: “Your employer is required by law to continue to pay your usual wages while you attend jury duty. This includes all employer types full time, part time and casual where there was an expectation of work. Your employer must also pay you any shift and other allowances that were due to you at the time.”

Q: What happens if my employer sacks me because I’m on jury duty?

A: There are serious fines of $10,000 for an individual and $50,000 for a corporation for any employer that acts in a prejudicial manner when you have been summoned for jury duty.

Q: What happens if my employer stops paying me because I’m on jury duty?

A: As above: There are serious fines of $10,000 for an individual and $50,000 for a corporation for any employer that acts in a prejudicial manner when you have been summoned for jury duty.

A: As above: There are serious fines of $10,000 for an individual and $50,000 for a corporation for any employer that acts in a prejudicial manner when you have been summoned for jury duty.

Q: Can I postpone my jury service to a more suitable date.

A: You may apply to defer. But this application must occur well in advance of the time you are due to do jury duty.

The information provided in this column is general advice only. For more specific information please contact the Department of Justice.

September–October 2019 western nurse |

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Oz Harvest While we are on the topic, here is the latest OzHarvest innovation to reduce food waste and feed hungry people in Australia. OzHarvest Food connects local businesses with surplus food, to nearby charities in need of food relief.

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September–October 2019 western nurse |

9

ANF Out 'n' About

Bunbury Regional Hospital Kathy Milner, Cheryl Richman and Lyn O’Neill

ECU student Sunghee Park

Our ANF bags turn up everywhere – even archaeological Incan sites in Peru!

ANF member Wilma Martins took hers to the world-famous 15th century Incan citadel Machu Picchu.

Wilma told western nurse that the ANF shopping bag she received at Christmas “stays permanently in my handbag as it's so light and doesn't take too much space. We even carried it overseas and it came handy when we were climbing Machu Picchu, as you can see.”

Closer to home, also on these pages we have photos from ANF visits to members at Royal Perth and Bunbury Regional hospitals and St John of God Murdoch, as well as Juniper Bethavon residential aged care in Northam and Edith Cowan University.

See you soon at your workplace where we’ll be bringing more goodies, including bags – and of course, every photo published gets entered in a big prize draw at the end of the year, so don’t be shy!

An ANF bag travels to Machu Picchu with Wilma Martins

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western nurse September–October 2019

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September–October 2019 western nurse |

11

CONTINUING PROFESSIONAL DEVELOPMENT

ANFClinical Updates

update: Care Coordination

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

Primary and community-based health care series Trials of care coordination have been underway in Australia since at least the late 1990s.1 Still, many health professionals and community members struggle to understand the concept and why it may be of use to them. In this series we look at the important questions; What is care coordination? Who does it? And how does it fit in the current health care climate of improved quality and reduced demand for health services?

WHAT IS CARE COORDINATION? Care coordination in primary and community settings is the process of organising clinical and social arrangements to meet the declared needs of consumers, carers, and families over time .2 It typically involves supporting consumers to navigate the health care system and sharing information between key stakeholders to ensure care is safe, effective, efficient, and person-centred.2 The goal of care coordination is to ensure appropriate and efficient health care delivery within one system, and during the transitions of care between multiple systems.2,3 Transitions in care occur when consumers move between entities in the health care system, move from inpatient to outpatient care, transfer between health care organisations, and are referred to different providers within a single care team.

They also occur over time, such as between episodes of care, across the lifespan, and over the course of an illness.3 Care coordination strategies include general approaches for the entire population, and specific interventions for a particular consumer and their carer(s).2 General approaches include improved team work, case management, medication reviews, digital health systems that support information sharing, and chronic disease self-management strategies. Examples of specific interventions are individualised action plans, improved communication strategies, goal-setting, health coaching, routine monitoring and follow-up, and referral to appropriate clinical and social services.2

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western nurse September–October 2019

HealthPathways is a portal used primarily by GPs to support them in navigating and managing local referral information. It is aimed at maximising health outcomes for people in the community and linking them to resources. Head to waproject.healthpathways.org.au for more information.

Box 1. A working definition of care coordination.4

Authors of one systematic review of care coordination found more than 40 definitions. They developed a broad definition that describes care coordination as the “deliberate organisation of patient care activities between two or more participants (including the patient) involved in a patient’s care to facilitate the appropriate delivery of health care services. Organising care involves the marshalling of personnel and other resources needed to carry out all required patient care activities, and is often managed by the exchange of information among participants responsible for different aspects of care.”

and community care, specialist services, and acute care. Often, consumers get lost in the mix leading to poorer outcomes and dissatisfaction, despite high costs. As a result, there is increasing demand on the health care system to provide high quality health care that improves health outcomes, the experience of care, and the efficiency of service delivery.

High quality care coordination has been demonstrated to reduce hospital admissions among patients with chronic disease and reduce emergency department visits among older people.4 It is thought that if the health care system can deliver the right care, in the right place, to the right patient, at the right time the value of services will be vastly improved.

CASE ONE

WHO DOES IT? Any health care professional can include care coordination as part of their daily work.

The specific role of a care coordinator, which involves providing clinical and supportive care to patients with complex needs, is typically performed by someone with a nursing background, but may also include those from a range of other health backgrounds such as allied health professionals. Experience in patient care and assessment is required to identify consumer and carer needs, communicate with other health professionals, and provide high quality education to consumers and carers.

Care coordination may be specific to a disease condition, such as cancer care coordination, or for consumers with a broad range of chronic and complex conditions.

HOW DOES CARE COORDINATION SUPPORT VALUE IN HEALTH CARE? Individuals with complex conditions account for a significant proportion of health service usage across Australia .6 Providing appropriate care for this population is difficult when services are fragmented and there are variable processes for accessing primary

Bridget is a 58 year old woman with osteoporosis and chronic back pain. She presents to her General Practitioner (GP) because she is experiencing an acute exacerbation of her pain. The GP orders blood tests as they have not been done in several years and prescribes an opioid analgesic. Bridget has the day off work so she drives herself to the pathology department, and then to the pharmacy to pick up her medications. Two days later, she calls back to the clinic to find out her results. After that, she returns to work.

Complexity of Bridget’s condition: low Potential for fragmentation in care: low Patient capacity: high Care coordination requirements: minimal Conclusion: Even though Bridget has a chronic disease and saw several health professionals who performed a range of activities, her care coordination needs were minimal as she is highly independent and capable of self-managing her condition.

CASE TWO

REFERENCES

Oscar is a 73 year old man with diabetes, chronic heart failure, and recurrent cellulitis.

He has just been discharged from hospital and sent home with new prescriptions, a referral to cardiac rehabilitation, and detailed instructions on how to look after himself. While in hospital, his treating doctor adjusted his insulin dose. He knows it has been changed, but cannot find anywhere that says the new dose. He tries to call the hospital but can’t get through to the ward he was on before. Then he calls the GP who cannot get him into an appointment until next week. Finally, he rings his daughter to take him to the pharmacy but by the time they get there it has closed for the day.

1. Marcus D. Coordinating care in an uncoordinated health system: the development and implementation of coordinated care trials in Australia [Internet]. Current Issues Brief 11 1998-99. Canberra: Social Policy Group; 1999 May 11. Available from: http://www.aph.gov.au/ About_Parliament/Parliamentary_Departments/ Parliamentary_Library/Publications_Archive/CIB/ cib9899/99CIB11 [cited 2017 May]

Complexity of Oscar’s condition: high Potential for fragmentation in care: high Patient capacity: moderate

2. Agency for Healthcare Research and Quality.

Care coordination [Internet]. Rockville: US Department of Health & Human Services; 2014 Jun [updated 2016 Jun]. Available from: https://www.ahrq.gov/professionals/ prevention-chronic-care/improve/ coordination/index.html [cited 2017 May] 3. Care Coordination Measures Atlas Update.

Content last reviewed June 2014. Agency for Healthcare Research and Quality, Rockville, MD. Available from: https://www.ahrq.gov/ professionals/prevention-chronic-care/ improve/coordination/atlas2014/index.html [cited 2017 May]

4. McDonald KM, Sundaram V, Bravata DM,et al.

Care coordination. In: Shojania KG, McDonald KM, Wachter RM, and Owens DK, eds. Closing the quality gap: A critical analysis of quality improvement strategies. Technical Review 9 (Prepared by Stanford-UCSF Evidence-Based Practice Center under contract No. 29002-0017). Vol. 7. Rockville, MD: Agency for Healthcare Research and Quality, June 2007.

AHRQ Publication No. 04(07)-0051-7.

5. Tricco AC, Antony J, Ivers NM, Ashoor HM, et al.

Effectiveness of quality improvement strategies for coordination of care to reduce use of health care services: a systematic review and metaanalysis. CMAJ. 2014 Oct 21; 186(15):E568-78.

6. Department of Health. Chronic conditions [internet]. Canberra: Commonwealth of Australia; 2017 May 16 [cited 2018 Mar]. Available from: http://www.health.gov.au/internet/main/ publishing.nsf/content/chronic-disease.

Care coordination requirements: high Conclusion: Oscar is involved in his health care and is trying to do all the right things.

However, without assistance during a transition in care many aspects of his chronic disease management have fallen through the gaps.

Care coordination could help to support the transition between inpatient and outpatient care, optimise self-management, and prevent hospital re-admission.

September–October 2019 western nurse |

13

CONTINUING PROFESSIONAL DEVELOPMENT

Targeted Temperature update: TargetedManagement temperature management After Cardiac Arrest after cardiac arrest Read this article and complete the online quiz to earn 1 iFolio hour

Targeted temperature management (TTM), previously known as therapeutic hypothermia, is a protective mechanism that aims to reduce the risk of neurological injury in unresponsive individuals following cardiac arrest.1,2 Despite use for more than decade, evidence to support many aspects of this intervention remain controversial.1 Best practice guidelines have recently been updated to reflect advances in research.2

BACKGROUND Cardiac arrest occurs when the heart is suddenly incapable of pumping blood throughout the body. It is a medical emergency that may arise in- or outof hospital. During an arrest, electrical conduction through the heart may be characterised as a shockable or nonshockable rhythm. Fatal shockable rhythms, including ventricular fibrillation and unstable ventricular tachycardia, may benefit from defibrillation (see Illustrations 1 and 2).

The aim of resuscitation is to restore the return of spontaneous circulation (ROSC).1 However, individuals who experience ROSC are still at significantly increased risk of adverse outcomes, including neurological dysfunction and death.1,2 Anoxic encephalopathy is a diffuse brain injury, which may arise as a result of an inadequate supply of oxygen to the brain during cardiac arrest. Its symptoms range from memory impairment, to poor neurological function, and the onset of a permanent vegetative state.1 Most deaths following ROSC occur as a result of neurological injury. Despite improvements in care, in-hospital mortality rates remain around 60%.1 Hypothermia may help limit neurological injury in individuals who survive cardiac arrest.

It reduces cerebral metabolism, dampens the inflammatory response, and prevents oedema and cell death associated with an anoxic brain injury.3 Therefore, routine use of TTM in postresuscitation care has been associated with improved neurological outcomes and survival following ROSC.

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REVIEW OF THE RELEVANT EVIDENCE Support for therapeutic hypothermia began more than a decade ago, after multiple randomised controlled trials demonstrated improvements in neurological outcomes and mortality rates of patients who were unresponsive following an out-of-hospital cardiac arrest with a shockable rhythm.1 In 2010, the European Resuscitation Council recommended induced hypothermia for comatose survivors of cardiac arrest with initial shockable or non-shockable rhythms, for up to 24 hours.1 Subsequent research has had conflicting findings. In 2013, a cohort study performed in Finland found there were no significant neurological benefits associated with induced hypothermia.4 Further, a large, international randomised trial found no significant difference between neurological outcomes or mortality in patients with a targeted temperature of 33°C versus 36°C, after out-of-hospital cardiac arrest.5 However, authors did highlight that there was no apparent harm associated with cooling.5 Unanswered questions include which patients should receive TTM, when, and for how long?1 There is limited data surrounding patients with in-hospital cardiac arrests and arrests with a non-shockable rhythm.1 Although it is

reasonable to assume TTM would have similar benefits for these populations, only very low quality evidence exists.2 The optimal timing for the initiation of cooling, method of cooling, and exact temperatures required remain unknown.1 Ultimately, there are few interventions with demonstrated positive outcomes following the return of spontaneous circulation after cardiac arrest. Therefore, despite inconclusive evidence, many organisations continue to promote TTM as potential benefits outweigh the costs and risks associated with treatment.2

CURRENT RECOMMENDATIONS The latest guidelines from the Australian and New Zealand Committee on Resuscitation (ANZCOR) recommend targeted temperature management between 32°C and 36°C for at least 24 hours.2 The decision to commence TTM is based on the underlying cause of cardiac arrest, the time taken to initiate chest compressions, the duration of CPR prior to ROSC, and patient prognosis.1 ANZCOR suggests the use of TTM for the majority of adult patients who remain unresponsive following ROSC after cardiac arrest. This includes out-of-hospital and in-hospital cardiac arrests, and those with shockable and nonshockable rhythms.2 Optimal temperatures can be achieved through the rapid infusion of ice-cold intravenous fluid (up to 30ml/kg) or the application of ice packs (see Box 1).2

Box 1. ANZCOR guidelines regarding targeted temperature management.2 Targeted temperature management

Select and maintain a constant target temperature between 32-36°C

Patient population

Adults who remain unresponsive after ROSC following out-of-hospital cardiac arrest with an initial shockable rhythm (recommendation) Adults who remain unresponsive after ROSC following an out-of-hospital cardiac arrest with a non-shockable rhythm (suggestion) Adults who remain unresponsive after ROSC following an in-hospital cardiac arrest with any rhythm (suggestion)

How to cool

Rapid infusion of ice-cold intravenous fluid, up to 30ml/kg. Additional means of cooling will be needed after infusing fluids Ice packs

Duration

At least 24 hours

Setting

Inpatient settings only (pre-hospital cooling is not recommended)

Illustration 1. Ventricular Fibrillation

SUPPORTIVE CARE The majority of patients require complex, multidisciplinary care following cardiac arrest.1 The patient will be intubated and ventilated in an Intensive Care Unit. Targeted temperature management should be initiated within a comprehensive plan for overall care.2 Several comorbidities may indicate a need for a warmer target temperature including recent head trauma, major bleeding or surgery, refractory hypotension, severe sepsis, and pregnancy.1 Adequate sedation, analgesia, and protection against shivering may be required (see Box 2).1 Box 2. Interventions to reduce shivering during TTM1

• Blankets and warmers against the skin • Intravenous magnesium replacement • Sedation and analgesia • Selective use of neuromuscular blockades

Illustration 2. Ventricular Tachycardia

REWARMING

REFERENCES

Slow rewarming may help to prevent complications including hypotension, hypoglycaemia, and hyperkalaemia.1 The goal should be a steady increase in temperature between 0.25-0.5°C per hour.1 Once normothermia has been achieved, it is best to avoid fevers in persistently comatose patients.2

1. Silverman MG, Scirica BM. Cardiac arrest and therapeutic hypothermia. Trends in Cardiovascular Medicine. 26(4);2016:337-44.

MOVING FORWARD Potential complications of TTM include bradycardia, hypotension, hyperglycaemia, electrolyte imbalance, and infection.1 Sinus bradycardia only requires treatment when it is associated with haemodynamic compromise.1 In general, hypotension should be avoided to prevent cerebral hypoperfusion.1 Hyperglycaemia may occur as a result of reduced insulin secretion and sensitivity.

Electrolyte imbalances may also arise. Frequent monitoring and replacement is required.1 Patients who develop an infection during TTM will not be febrile. Therefore, surveillance blood, urine and sputum cultures may be beneficial.1

Experts in post-resuscitation care, including ANZCOR, the American Heart Association and the International Liason Committee on Resuscitation advocate for the use of targeted temperature management as a standard of care for comatose survivors of cardiac arrest.1,2 Current limitations in optimal post-resuscitation care include a reliance on low- and very low-quality evidence to create recommendations and poor dissemination and uptake of best practice guidelines in practice.1-3 Research to address the benefits of TTM for in-hospital arrests and non-shockable rhythms, and outline specific therapeutic characteristics, will help to guide clinical practice and improve outcomes in the future.

2. Australian and New Zealand Committee on Resuscitation. ANZCOR guideline 11.8 – targeted temperature management after cardiac arrest [Internet]. ANZCOR; 2016 January [cited 2016 Apr]. Available from: resus.org.au/ download/section_11/anzcor-guideline-11-8ttm-jan16.pdf 3. Sidhu SS, Schulman SP, McEvoy JW. Therapeutic hypothermia after cardiac arrest. Curr Treat Options Cardio Med. 2016;18:30.

4. Vaahersalo J, Hiltunen P, Tiainen M, et al.

Therapeutic hypothermia after out-of-hospital cardiac arrest in Finnish intensive care units: the FINNRESUSCI study. Intensive Care Med. 2013;39:826-37.

5. Nielsen N, Wetterslev J, Cronberg T, et al.

Targeted temperature management at 33°C versus 36°C after cardiac arrest. N Engl J Med. 2013;369:2197-2206.

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CONTINUING PROFESSIONAL DEVELOPMENT

update: Human Immunodeficiency Human Immunodeficiency Virus – Virus – Tests for Diagnosis Tests For Diagnosis Read this article and complete the online quiz to earn 0.5 iFolio hour

Human Immunodeficiency Virus (HIV) infection is a global public health burden.1 Identifying HIV serostatus of an infected person early and accurately, plays an important role in HIV prevention and therapeutic intervention. This update provides an overview of the serological testing to determine HIV status.

Serological assays Diagnostic tests for HIV can be categorised into serological assays and nucleic acid test. Serological assays can be used to screen for HIV-1 or HIV-2 infection. Serological assays include rapid diagnostic tests, simple assays, and enzyme immunoassays.2-4

RAPID DIAGNOSTIC TESTS Rapid Diagnostic Tests (RDT) are based on immunochromatographic and immunofiltration techniques. These tests can detect the presence of HIV-1/2 antibodies and/or HIV-1 p24 antigen and are quick and easy to perform; less than 30 minutes for immunochromatographic assays and less than five minutes for immunofiltration assays. The specimen can be a finger stick/capillary whole blood, venous whole blood, serum, plasma, or oral fluid. Results for RDTs are read visually and are suitable for laboratories with limited equipment and where the number of daily specimens is less than 40.

SIMPLE ASSAYS Simple assays include combined immunoassays and particle or latex agglutination techniques that detect the presence of HIV-1/2 antibodies and/or HIV-1 p24 antigen. Phlebotomy is required to collect an appropriate specimen. Similar to RDTs, the test takes between 30 minutes to two hours to produce a visual result.

ENZYME IMMUNOASSAYS Enzyme immunoassays (EIA) are a laboratorybased method and can detect the presence of HIV1/2 antibodies and/or HIV-1 p24 antigen. These assays are more objective than RDTs and simple assays and are often used in laboratories with a high number of specimens. Skilled technicians and facilities are required to run these tests.

The specificity of the first generation EIAs was low due to the use of viral lysate as an antigen and the detection of immunoglobulin G antibodies (IgG) only. By using recombinant proteins and synthetic peptides as antigen, the second generation EIAs have a higher sensitivity and specificity, but they

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Figure 1. Progress of HIV markers and detectable ability of HIV diagnostic tests2 still detect IgG only. The third generation EIAs use labelled antigen as a conjugate and can detect both immunoglobulin M antibodies (IgM) and IgG. The fourth generation EIAs have a better sensitivity and specificity because they combine two different test principles to detect both HIV-1/2 antibodies and HIV1 p24 antigen.

WESTERN BLOT Western blot is also an antibody detection test that utilises enzyme-linked immunosorbent blot technique. Since western blot has a higher specificity than EIA, it is usually used as a confirmative test.

simple assays, and EIAs to confirm HIV infection.

The second generation EIAs have been widely used as confirmative tests. For children younger than 18 months, serological assays that detect p-24 antigen and NATs are used to diagnose HIV infection. There are no specific recommendations for children aged 18 to 24 months and a decision based on clinical presentation and history is used.2-3 Strategies of HIV testing in high (>5% of population) and low (<5% of population) prevalence countries are different and the strategies are provided in the World Health Organization HIV Assays-Laboratory Performance and Other Operational Characteristics.3

Nucleic acid test Nucleic acid tests (NAT) include qualitative and quantitative assays that detects the presence of HIV DNA/RNA. The qualitative test is used for diagnosing HIV infection, especially in children less than 18 months because maternal antibodies are passively transferred to these children. The quantitative test is used for monitoring HIV progress and the response of antiretroviral therapy. 2-3 A summary of the progress of HIV markers and detectable ability of HIV diagnostic tests is shown in Figure One.

Strategies of HIV testing First-line assays require a superior sensitivity while second-line and third-line assays require acceptable specificity. To diagnose HIV infection in adults and children aged 24 months and above, the fourthgeneration essays such as RDTs and EIAs are recommended as a first-line assay. If the first test is positive, confirmative tests should be performed and are technically different to the first-line test.

The common combination of EIA and Western blot can be replaced by the combination of RDTs,

REFERENCES 1. World Health Organization. HIV/AIDS. Global Health Observatory (GHO) Data 2017. Available from http://www.who.int/gho/hiv/en/ Accessed June 2017.

2. World Health Organization. Consolidated Guidelines on HIV Testing Services. 2015. Available from https://www.ncbi.nlm.nih.gov/books/ NBK316021/pdf/Bookshelf_NBK316021.pdf Accessed June 2017.

3. World Health Organization. HIV AssaysLaboratory Performance and Other Operational Characteristics. 2015. Available from http:// www.who.int/diagnostics_laboratory/ publications/15032_hiv_assay_report18.pdf?ua=1 Accessed June 2017.

4. National Health and Nutrition Examination Survey. Laboratory Procedure Manual. National Health and Nutrition Examination Survey 2014.

Available from https://wwwn.cdc.gov/nchs/data/ nhanes/2013-2014/labmethods/HIV_H_MET_EIA_ WB.pdf Accessed June 2017.

CONTINUING PROFESSIONAL DEVELOPMENT

update: Pre-exposure prophylaxis Pre-Exposure Prophylaxis for HIV prevention For HIV Prevention (PrEP) (PrEP) Table 1. Behavioural eligibility criteria for PrEP as per Australasian society for HIV2

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

Population

Medium Risk

High risk

Men who have sex with men

Having had at least one episode of any of the following in the last 3 months;

Having had at least one episode of any of the following in the last 3 months;

>1 episode of anal intercourse without optimal condom use with a partner who is HIV+* or whose status is unknown

CLAI with a regular HIV+ partner*

(If patient uncircumcised) more than one episode of insertive condomless anal intercourse (CLAI) with a partner who is HIV+* or whose status is unknown

Rectal gonorrhoea, chlamydia, infectious syphilis diagnosis

AND

Being likely in the next 3 months to have multiple episodes of CLAI with or without sharing intravenous drug equipment

Generic name: Tenofovir + Emtricitabine Trade name: Truvada Drug Class: Antiretrovirals

Being likely in the next 3 months to have multiple episodes of CLAI with or without sharing intravenous drug equipment

INDICATIONS Pre-exposure prophylaxis for Human Immunodeficiency Virus (HIV) prevention (PrEP) is a combination antiretroviral agent that can be taken daily to prevent HIV infection.1 In Australia, it may be considered for individuals with a medium or high risk of acquiring HIV (see Table 1).2

PRECAUTIONS AND CONTRAINDICATIONS Pre-exposure prophylaxis for HIV prevention is contraindicated in people with unknown, suspected, or positive HIV status and in people with impaired renal function (Creatinine clearance <60mL/minute).3

CLINICAL ELIGIBILITY Clinical assessment is required to determine eligibility. To be deemed eligible for PrEP in Australia, individuals at medium or high risk of HIV are required to have a negative HIV test, no signs or symptoms of HIV, normal renal function, and no concurrent use of contraindicated medications.2

AND

Trans and gender diverse people

As above, including both anal and vaginal condom-less intercourse in consideration of risk.

As above, including both anal and vaginal condomless intercourse and rectal or vaginal gonorrhoea or chlamydia in consideration of risk.

Heterosexual people

Having had any of the following in the last 3 months;

Having had any of the following in the last 3 months;

At least one episode of condomless intercourse with a heterosexual partner, not known to be HIVâ&#x20AC;&#x201C;, from a country with high HIV prevalence

MECHANISM OF ACTION

PrEP can be used alone or in combination with behavioural interventions to reduce the risk of HIV transmission. With regular use, it has the potential to reduce the incidence of HIV by up to 86%.1

Methamphetamine use

*not on treatment and/or detectable viral load

Pre-exposure prophylaxis for HIV prevention contains two antiretroviral agents; tenofovir (nucleotide analogue) and emtricitabine (nucleoside reverse transcriptase inhibitor).

Both agents prevent HIV replication by inhibiting reverse transcriptase, an enzyme that makes new viruses. They each act at different viral sites, which helps improve efficacy when used in combination.3

EFFICACY

Receptive CLAI with any casual HIV+ partner or male partner with unknown status

AND Being likely in the next 3 months to have;

People who inject drugs

Being a regular sexual partner of an HIV+ person (not on treatment and/or with detectable viral load) with whom condoms have not been consistently used At least one episode of receptive anal or vaginal condom-less intercourse with any casual HIV+ partner or a male homosexual or bisexual partner of unknown status A female patient in a sero-discordant heterosexual relationship, who is planning natural conception within the next 3 months

multiple episodes of condom-less intercourse with a heterosexual partner, not known to be HIV+, but at high risk of being HIV+ with or without intravenous drug equipment

AND

NA

Shared injecting equipment with an HIV+ individual or with a gay or bisexual man of unknown HIV status

Being likely in the next 3 months to have multiple episodes of condom-less intercourse with or without sharing intravenous drug equipment

AND Multiple events of sharing injecting equipment with an HIV+ individual or a gay or bisexual man of unknown HIV status and inadequate access to safe injecting equipment

ADVERSE EFFECTS Common adverse effects include gastrointestinal symptoms (nausea, vomiting, and diarrhoea), headaches, dizziness, and Other potential hypophosphataemia.3 complications that require monitoring include liver dysfunction, renal impairment, and loss of bone mineral density.1

DOSING AND ADMINISTRATION Truvada is administered as a once daily, oral dose of 300mg tenofovir and 200mg emtricitabine.3 A minimum of seven days of treatment is required for high levels of protection against HIV.1 Follow-up visits at one month and three-monthly intervals are

recommended to ensure safety and efficacy of treatment.1

REFERENCES 1. Tetteh RA, Yankey BA, Nartey ET, Lartey M, Leufken HG, DoDoo AN. Pre-exposure prophylaxis for HIV prevention: safety concerns. Drug Safety. 2017 Apr:40(4);273-83.

2. Wright E, Grulich A, Roy K, Boyd M, et al.

Australasian society for HIV, viral hepatitis and sexual health medicine HIV pre-exposure prophylaxis: clinical guidelines. Journal of Virus Eradication. 2017 Jul:3;168-184.

3. Australian Medicines Handbook 2017 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2017 July.

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BEETROOT SOUP WITH HIBISCUS Beetroot in a burger is quintessentially Australian, but there are a lot more tasty uses for this root crop beyond that. Vibrantly red and extraordinarily nutritious, the humble beetroot is perfect raw or cooked, and added to anything from salads to roasts or juices. You can also harness its intensely vivid colour by turning it into a delicious beetroot soup enhanced with hibiscus.

Beetroot gets its deep colouring from betacyanin, a pigment that is believed to help heart health. The vegetable also contains vitamin C, iron, folate, magnesium, and a load of fibre. So this soup is packed with nutrients – while also being a colourful and delicious addition to your repertoire of dishes.

EQUIPMENT • Le Creuset Signature Round Casserole • Food processor or stick blender • Peeler • Vegetable knife • Chopping board • Measuring spoons

INGREDIENTS • 1kg uncooked purple beetroot • 5 banana shallots • 2 cloves of garlic • 1 bulb of fennel • 4 tbsp of rapeseed oil • Salt and pepper to taste • Vegetable stock, homemade or store bought, enough to cover the vegetables • Dried hibiscus flowers to garnish • Crème fraîche to serve INSTRUCTIONS 1. Peel and slice the beetroot, shallots, garlic, and fennel. Add the rapeseed oil to the casserole and heat gently. Add the vegetables and garlic, and allow to sweat over a low heat until softened.

2. Cover the vegetables with enough vegetable stock and add 2 teaspoons of dried hibiscus flowers. (Alternatively, you can replace hibiscus flowers with fresh or dried marjoram or thyme.) Bring to the boil then simmer until the vegetables are cooked. Allow to cool a little then use a food processor or stick blender to blend it into a smooth consistency. Season to taste.

3. Serve with dried hibiscus flowers and a dollop of crème fraîche.

Recipe by Le Creuset, supplied by Kitchen Warehouse.

AUSTRALIA’S # 1 IN KITCHENWARE SHOP ONLINE AT WWW.KITCHENWAREHOUSE.COM.AU

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Send your photos now to marketing@anfiuwp.org.au to WIN one of 50 of these previously unreleased tags for your favourite furry friend!

We always try to get as many photos as possible of members into your western nurse. Because we know that West Aussies love their pets, we thought a pet page might be a fun way to get your picture here, showing you sharing a moment with your furry, feathered or perhaps even scaly companion!

Just email a photo of you and your pet(s) to marketing@ anfiuwp.org.au and all photos that get published win a prize each edition (members have to be in the photo to be eligible).

And, there’ll be a grand prize at the end of the year!

It’s not long till 2020, so if you enter now you’ll have a way better than normal chance of winning the big prize.

Your snaps need to include the member or members with their pet(s).

Photos need to be at least 1mb in size and no bigger than 3mb – use your phone to send the entry and that can help size the photos. Then, we just need your name, your pet’s name and no more than 50 words about your special friend.

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September–October 2019 western nurse |

19

LATEST NEWS AND RESEARCH

AcrosstheNation WA APPLES AND TEA EVERY DAY KEEP CANCER AWAY People can reduce their risk of dying of cancer or heart disease by regularly consuming apples, tea and other flavonoid-rich products, WA scientists believe.

This is especially true for smokers and heavy drinkers, according to the Edith Cowan University researchers who made the findings after analysing data about the diets of 53,048 Danes over 23 years.

The researchers said those “consuming about 500mg of total flavonoids each day had the lowest risk of a cancer or heart disease-related death”. “… one cup of tea, one apple, one orange, 100g of blueberries, and 100g of broccoli would provide a wide range of flavonoid compounds and over 500mg

of total flavonoids,” said lead researcher Dr Nicola Bondonno.

She said alcohol consumption and smoking increase inflammation and damage blood vessels, which can increase the risk of diseases. Flavonoids are “antiinflammatory and improve blood vessel function, which may explain why they are associated with a lower risk of death from heart disease and cancer”.

But she stressed flavonoid consumption does not counteract all the increased risk of death from smoking and high alcohol consumption.

“By far the best thing to do for your health is to quit smoking and cut down on alcohol,” Dr Bondonno said in August. 

ACT AUSSIE BLOKES LIVE LONGEST

Australia’s long-term stability and high standard of living influenced the results, according to ANU’s Dr Collin Payne, who co-led the study that used data from 15 countries across Europe, North America and Asia with high life expectancies.

Australian men live longest on average among groups of males worldwide – and local women are close to the top as well.

“Simple things like having enough to eat, and not seeing a lot of major conflict,” he said.

This is according to a new method of measuring life expectancy devised

by Australian National University researchers that considers “historical mortality conditions that today's older generations lived through”.

"Mortality was really high in Japan in the '30s, '40s and '50s. In Australia, mortality was really low during that time. French males, for example, drop out because a lot of them died during WW2, some from direct conflict, others from childhood conditions."

Australian men come in at number one with 74.1 years on average under this measure. Sweden is second place at 74.

Australian women’s average life expectancy of 78.8 is a close second to Swiss females, who reach 79.

The study grouped people “by year of birth, separating 'early' deaths from 'late' deaths, to come up with the age at which someone can be considered an 'above-average' survivor”. 

WA SLEEP APNOEA REVEALED BY 3D FACIAL PHOTOGRAPHY

photography were combined into a single predictive algorithm,” Dr Gilani said in August.

Detecting sleep apnoea has become easier with analysis of threedimensional facial photography.

The researchers believe “it might also be possible to predict the severity of a person’s sleep apnoea from these photographs”.

Researchers from the University of Western Australia’s Centre for Sleep Science conducted overnight sleep studies with 400 middle-aged men and women during a study examining whether the photography is effective for identifying the condition.

Dr Syed Zulqarnain Gilani, from UWA’s School of Computer Science and Software Engineering, then analysed their faces in 3D. “What we found was that we could predict the presence of obstructive sleep apnoea with 91 per cent accuracy when craniofacial measurements from 3D

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The work expands on previous research about how face, head and neck structure play a “key role in diagnosing sleep apnoea”.

Dr Gilani said: “This breakthrough has the potential to reduce the burden on hospitals and sleep clinics that currently run sleep studies for everyone. It can flag people at risk of sleep apnoea who can then be referred for diagnosis and treatment.”

The condition is associated with snoring and periods of choking during sleep, and is “strongly linked to sleepiness-related accidents, diabetes, cardiovascular diseases, and depression”. 

LATEST NEWS AND RESEARCH

AroundtheGlobe

MEAT-FREE NOT NECESSARILY HEALTHY Vegetarians and vegans might be at greater risk of stroke than meat eaters, UK researchers have found.

However, the vegetarians had a 22 per cent lower rate of ischaemic heart disease than meat eaters.

Meanwhile, a prominent maternal nutrition expert has warned that plant-based diet trends could be depriving infants of the “brainbuilding” nutrient choline.

Elsewhere, a piece in the journal BMJ Nutrition, Prevention & Health warns that current trends towards plant-based diets could be causing “a potential choline crisis in the United Kingdom” – with choline deficiency “linked to liver disease, offspring cognitive function and potential neurological disorders”.

And other research has revealed many flesh-free food alternatives are “packed with salt”.

An Oxford University study of 48,188 men and women, with no history of heart disease or stroke, consisting of meat eaters, fish eaters and vegetarians, including vegans, found the “vegetarians had 20 per cent higher rates of total stroke … than meat eaters”.

The researchers said this might be partially explained by the vegetarian and vegan participants having lower levels of several nutrients such as vitamin B12 – found abundantly in liver, beef and some seafood, and linked to reducing stroke risk.

“Eggs, milk and meat appear to be major dietary providers (of choline) and further movements away from the consumption of these could have unintended consequences for choline intake/status,” said the author, nutritionist Dr Emma Derbyshire.

And new research from Sydney’s The George Institute for Global Health, VicHealth and the Heart Foundation has revealed “many meat-free alternative products are highly processed and packed with salt”. One vegan pie variety contained “half of the daily recommended salt intake in just one serve”. 

VAPING LINKED TO DEATHS AND LUNGS ILLNESS Vaping has been linked to at least six deaths in the USA. And there have been “380 confirmed and probable cases of lung disease associated with e-cigarette product use, or vaping” reported among 36 states and the U.S. Virgin Islands.

These were the figures at September 11, according to the Centers for Disease Control and Prevention – a federal agency of the US Department of Health.

“All reported cases have a history of e-cigarette product use or vaping,” said the department on another official communique.

“Most patients have reported a history of using e-cigarette products containing THC. Many patients have reported using THC and nicotine. Some have reported the use of e-cigarette products containing only nicotine.

MEASLES DESTROYING IMMUNITY FOR OTHER DISEASES? The worldwide measles outbreak, which has occurred alongside stalled vaccination rates, may lead to other deadly epidemics.

Harvard Medical School’s Dr Michael Mina said evidence is mounting from various studies that the virus wipes out the immune system’s memory of how to fight other life-threatening infections – from gastro-intestinal bugs to respiratory viruses triggering pneumonia.

“All of [a] sudden you end up having not just more outbreaks of measles, but you might have more outbreaks of rubella or flu or any number of other diseases,” the prominent researcher of the measles "immune-amnesia" effect said on the National Public Radio US website.

“We do not yet know the specific cause of these illnesses. The investigation has not identified any specific e-cigarette or vaping product (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases.”

The CDC said until more is known, if you are concerned about these health risks, “consider refraining from using e-cigarette or vaping products”.

And regardless of the investigation, “anyone who uses an e-cigarette or vaping product should not buy these products (e.g., e-cigarette or vaping products with THC, other cannabinoids) off the street, and should not modify or add any substances to these products that are not intended by the manufacturer”, the CDC added. 

NPR illustrated Dr Mina’s hypothesis with an example of a twoyear-old girl who contracts a “particularly nasty case of flu”, with pneumonia, but survives. Her immune system learns how to produce antibodies against that virus.

“But then imagine that, at age four, that same girl comes down with a case of measles that erases her immune system’s record of how to produce antibodies against the flu strain she previously contracted,” NPR reported. “So if she encounters that particular flu virus again, she’s back to square one – likely to come down with pneumonia all over again.”

Dr Mina said just because the girl survived previously this does not mean she will survive again. He said immune amnesia is a hypothesis, but “it’s a hypothesis with really good data”.  September–October 2019 western nurse |

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LATEST NEWS AND RESEARCH

ResearchRoundup LATEST AND GREATEST FROM SCIENCE

TOOTH FILLINGS SOON UNNECESSARY Regrowing tooth enamel is becoming reality – following a discovery by Chinese researchers that may end the need for fillings.

The Zhejiang University researchers found that mixing calcium and phosphate ions (minerals found in enamel) with the chemical trimethylamine in an alcohol solution, “causes enamel to grow with the same structure as teeth”.

“When the mixture was applied to human teeth, it repaired the enamel layer to around 2.5 micrometres of thickness,” said a global communique from the university. “It also achieved the same structure of natural enamel within 48 hours”.

The materials used are “identical to the human tissue, thereby achieving complete structural regrowth”, said Dr Zhaoming Liu, a co-author of the study of the work published in the journal Science Advances.

Previous attempts to regrow enamel – which is the hardest tissue in the human body and contains the highest percentage of minerals – using

NEW PROSTATE CANCER TEST HELPS AVOID BIOPSY A new simple blood test could help men avoid unnecessary invasive biopsies, over-diagnosis and over-treatment.

If a patient has a prostate specific antigen (PSA) test and is found to have high PSA levels, instead of having a biopsy of the gland, in future they could have the new test, developed by Queen Mary University of London researchers.

The test detects early cancer cells, or circulating tumor cells (CTCs), that have left a tumour and entered the bloodstream before spreading around the body.

“By measuring intact living cancer cells in the patient’s blood, rather than the PSA protein which may be present in the blood for reasons other than cancer, it potentially provides a more accurate test for prostate cancer,” said the researchers.

The test was observed among 155 newly diagnosed prostate cancer patients and 98 pre-biopsy patients at St Bartholomew’s Hospital in London.

“The presence of CTCs in pre-biopsy blood samples were indicative of the presence of aggressive prostate cancer, and efficiently and non-invasively predicted the later outcome of biopsy results,” said the researchers.

When used in combination with the current PSA test, the new test predicted “the presence of aggressive prostate cancer in subsequent biopsies with over 90 per cent accuracy, better than any previously reported biomarkers”.

“Focusing on more aggressive prostate cancer may reduce overtreatment and unnecessary biopsies for benign and non-aggressive conditions,” the researchers said. 

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western nurse September–October 2019

materials such as “composite resins, ceramics and amalgam failed to achieve permanent repair because of the imperfect compatibility between these foreign materials and the native enamel”.

Human trials are planned for within two years. Another of the authors, Prof Ruikang Tang, may be among the earliest subjects, because he has a hidden crack on one of his teeth that has previously been unrepairable due to a too-thin crevice. “After this scientific breakthrough, I am bold enough to be a 'guinea pig' for a trial,” he said. 

JUST A LITTLE RED WINE GOOD FOR GUT HEALTH AND HELPS WITH OBESITY Drinking red wine as occasionally as once a fortnight can lead to a healthier gut – because of “increased gut microbiota diversity”.

Red wine consumption is also associated with “lower levels of obesity and 'bad' cholesterol” – also “in part due to the gut microbiota”, King’s College London researchers believe.

The researchers examined the effects of beer, cider, red wine, white wine and spirits on the gut microbiome (GM) and also on health among 916 UK female twins.

They found GM was more diverse among red wine drinkers, compared with non-red wine drinkers.

The researchers believe the benefits are due to red wine’s many polyphenols – “defence chemicals” present in many fruits and vegetables that have many beneficial properties, including antioxidant ones.

“Although we observed an association between red wine consumption and the gut microbiota diversity, drinking red wine rarely, such as once every two weeks, seems to be enough to observe an effect,” said Dr Caroline Le Roy, first author of the study, published in the journal Gastroenterology in August.

“If you must choose one alcoholic drink today, red wine is the one to pick as it seems to potentially exert a beneficial effect on you and your gut microbes, which in turn may also help weight and risk of heart disease. However, it is still advised to consume alcohol with moderation.” 

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To enter the Classic Night In competition, or to be in the draw for Kitchen Warehouse vouchers, simply log on to your iFolio and click through to ‘Resources’. The ‘Competitions’ section is there – that’s where you can enter the comp of your choice.

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ifolio.anfiuwp.org.au September–October 2019 western nurse |

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