Jessie McPherson Private Hospital

Australia, like other developed countries, is exhibiting a trend towards later childbearing and this trend has been particularly evident in the last three decades. Social trends of declining birth rates and small nuclear families mean that the contemporary adult has far less exposure to children than adults of former generations. Increasing female trends of employment and participation in higher education have also contributed to a postponement of childbearing, and more women than ever before are having a first baby over the age of 35 years. Mothering experiences for this group of women often occur in a situation of limited family or social support, geographical distancefrom family and with few links to the community. Together these factors make new mothering an isolating experience for some women. This paper reports on findings from a longitudinal qualitative study, outlining the importance of maternal & child health nurses in providing support and in facilitating links to the community for primiparae over the age of 35 years.

BACKGROUND: Pain control is recognised as a crucial post-operative measure for patients undergoing oesophagectomy with a thoracotomy incision for oesophageal cancer, where ineffective breathing due to pain is directly correlated with increased morbidity. The analgesic benefits of negative pressure wound therapy (NPWT) appear to be a relatively new and emerging finding. This pilot study aims to investigate the effects of NPWT on post-operative pain control and determine the feasibility of a larger trial. METHOD: Ten consecutive patients undergoing oesophagectomy were prospectively enrolled to have a PREVENA Incision Management System placed over a closed thoracotomy wound. This dressing was changed at post-operative day 5 and removed after day 10. Post-operative morbidity was recorded and analgesia was prescribed by the Acute Pain Service who were blinded to the study aims. Analgesia requirements were recorded in oral morphine equivalents (OME) and compared to 30 patients that had previously undergone oesophagectomy via thoracotomy. RESULTS: One patient was withdrawn from the study and there was no significant differences in patient demographics. The study group had less average daily analgesia requirements and reduced overall reported pain. Patients in the study group were less likely to develop pneumonia (44% and 57%) and less likely to require re-operation for complications of their surgery (0% and 10%). CONCLUSION: This pilot study shows reduced post-operative analgesia requirements and reduced morbidity when using NPWT over a closed thoracotomy wound, and affirms the feasibility of a future randomized control trial.

Despite advances in care, Congenital Diaphragmatic Hernia remains a complex and challenging condition to manage and is often associated with long term morbidity. Families are required to navigate considerable uncertainty, challenges in prognostication and communication, and must adapt to an evolving clinical trajectory. This review addresses considerations and practical tips for healthcare professionals to improve the family and patient experience from diagnosis to adult care, from the perspective of clinicians and CDH families. This paper emphasizes the importance of including those with lived experience with CDH in defining topics of priority in research and in clinical and support interventions.