Australian Metropolitan Research Articles

Palliative care in the context of immune and targeted therapies: A qualitative study of bereaved carers’ experiences in metastatic melanoma

Background: Immune and targeted therapies continue to transform treatment outcomes for those with metastatic melanoma. However, the role of palliative care within this treatment paradigm is not well understood. Aim: To explore bereaved carers’ experiences of immune and targeted therapy treatment options towards end of life for patients with metastatic melanoma. Design: An interpretive, qualitative study using a social constructivist framework was utilised. Interviews were recorded, transcribed and analysed using grounded theory methods. Setting/participants: Participants (n = 20) were bereaved carers of patients who had received some form of immune and/or targeted therapy at one of three Australian metropolitan melanoma treatment centres. Results: Carers struggled to reconcile the positive discourse around the success of immune and targeted therapies in achieving long-term disease control, and the underlying uncertainty in predicting individual responses to therapy. Expectations that immune and targeted therapies necessarily provide longer-term survival were evident. Difficulty in prognostication due to clinical uncertainty and a desire to maintain hope resulted in lack of preparedness for treatment failure and end of life. Conclusion: Immune and targeted therapies have resulted in increased prognostic challenges. There is a need to engage, educate and support patients and carers to prepare and plan amid these challenges. Educational initiatives must focus on improving communication between patients, carers and clinicians; the differences between palliative and end-of-life care; and increased competency of clinicians in having goals-of-care discussions. Clinicians must recognise and communicate the benefit of collaborative palliative care to meet patient and family needs holistically and comprehensively.

Pressure injury development in critically ill patients with a cervical collar in situ: A retrospective longitudinal study.

Trauma patients with a serious injury to the head or neck can remain immobilised with a cervical collar (C-collar) device in situ and are subsequently exposed to device-related skin integrity threats. This study aimed to determine the incidence and risk factors associated with the development of C-collar-related pressure injures (CRPIs) in an intensive care unit. This retrospective longitudinal cohort study was conducted in an Australian metropolitan intensive care unit. Following ethical approval, data from patients over 18 years, who received a C-collar were retrieved over a 9-year period. Chi square and t-tests were used to identify variables associated with CRPI development. A logistic regression model was employed to analyse the risk factors. Data from 906 patients were analysed. Nine-year pressure injury incidence was 16.9% (n = 154/906). Pressure injury development directly associated with a C-collar increased by 33% with each repositioning episode (odds ratio 1.328, 95% confidence interval 1.024-1.723, P = .033). Time in the C-collar (10.4 to 2.5 days, P = .002) and length of stay in intensive care unit (ICU) (20.1 to 16.1 days, P < .001) were associated with pressure injury development. Patients with C-collar devices are a vulnerable group at risk for pressure injury development because of their immobility and length of ICU stay.

Opioid Use and Appropriateness of Supply After Total Knee or Hip Arthroplasty: An Australian Perspective.

Effective pain management after joint arthroplasty is essential for optimal participation in rehabilitation. However, this needs to be balanced with potential risks associated with opioid use and community exposure. The aim of this study was to evaluate opioid use and appropriateness of supply on discharge after total knee arthroplasty or total hip arthroplasty at a major Australian health service. A prospective observational study was undertaken at an Australian 980-bed metropolitan health service. Patient interviews were conducted 3 weeks after hospital discharge to evaluate analgesic management and functional outcomes. The primary end point was the number of hospital-supplied opioid pills remaining 3 weeks postdischarge. Secondary end points included (1) factors associated with opioid use 3 weeks postdischarge, (2) opioid use in patients with poor functional outcomes, and (3) proportion of opioid naive patients who became chronic opioid users. One hundred forty patients were included, and 137 were supplied opioids on discharge. At 3 weeks postdischarge, the median number of opioid pills remaining was 0 (interquartile range 0 to 8). There were 77 patients (56.2%) still taking opioids; surgery type, opioid use before admission, and the number of "as required" doses used 24 hours before discharge were independent predictors of opioid continuation. Patients with poor functional outcomes were supplied with more opioids on discharge, often not satisfied with the quantity supplied and more likely to be taking opioids 3 weeks postdischarge. There were 5 of 93 opioid naive patients (5.3%) who developed chronic opioid usage. More than half of the patients undergoing total knee arthroplasty or total hip arthroplasty were still using opioids at 3 weeks postdischarge. Most patients were not supplied with excessive quantities at discharge. Future research should focus on identifying patients at risk of prolonged opioid use and improving the transition of these patients into the community. Level II-Prognostic study = prospective observational study.

Investigating the assessment practices within an Initial Teacher Education program in an Australian university: Staff perceptions and practices

Effective assessment design and subsequent assessment practices are essential for student success in the higher education sector. A plethora of research on assessment in higher education exists which tends to focus primarily on the student experience. This paper shares results from a 3 phased study that explored staff perceptions related to assessment practices in an undergraduate Initial Teacher Education program within an Australian metropolitan university. First, course learning objectives, activities and assessment items were mapped to identify the presence of constructive alignment. Second, staff were invited to complete a survey and a follow-up interview in relation to understanding of assessment knowledge and skills. Fink’s Taxonomy of Significant Learning (2013) was used to analyse the qualitative data and findings suggest that staff are highly committed to quality assessment practices but often work in silos rather than teams. Additionally, a lack of professional development and learning was available at the school level, particularly for casual staff. Further research about assessment practices in higher education in relation to staff rather than student experience is warranted.

Swipe right: the emergence of dating-app facilitated sexual assault. A descriptive retrospective audit of forensic examination caseload in an Australian metropolitan service.

The use of dating 'apps' to facilitate real-word social encounters between strangers is culturally mainstream. Sexual assaults facilitated following dating-app meetings have been reported in the media, and anecdotally noted at increasing frequency by clinical forensic physicians. Limited empirical data suggests there has been a marked increase in real life sexual offences facilitated in this manner. There is little additional information known about the circumstances of these alleged incidents. This retrospective audit of a small forensic examination caseload from an Australian metropolitan clinical forensic medicine service identified that 14% (11 of 76) of alleged sexual assaults where complainants underwent a forensic examination were facilitated following a dating-app meeting. Further analysis of these cases identified that all complainants were female, most under 30years of age. All alleged a single male perpetrator and in over half of the cases the complainant was impaired. In all cases where it was asked (n = 9), the alleged incident occurred at the first face-to-face meeting. More than half of the incidents occurred at the alleged perpetrator's private residence. Anogenital injuries were observed at the time of forensic examination in 60% of cases, and 70% had visible body injuries. There was no reported condom use. Only one complainant had no observable injury. This small case series quantified a high proportion of forensic sexual assault examination caseload as being facilitated by dating-app meetings, and identified some common features that may be characteristic of alleged sexual assaults occurring in this manner. The authors propose a larger prospective period of data collection at the time of forensic medical examination, to characterize the features of sexual assaults allegedly occurring following app-based meetings.

Is urbanisation also the culprit of climate change? – Evidence from Australian cities

In this study, daily maximum and minimum air temperature (Tmax and Tmin), evaporation and rainfall data (1960–2011 period) were analysed for three Australian metropolitan cities, viz., Sydney, Melbourne and Brisbane, to understand whether urbanisation has influenced temperature, evaporation and rainfall in these cities and thus had an influence on the longer-term local climate variability. A total of nine key locations in each city were considered and one location in each city was a control. A modified segmented regression analysis was employed to understand the overall climate change and linear regression analysis to evaluate the impacts of urbanisation.The study indicates a significant overall climate change during the 1986–2011 period when compared with the 1960–1985 periods, and urbanisation added to the overall climate change. There were statistically significant increases in Tmax and Tmin for Sydney and decreases for Melbourne, decrease in Tmax and increase in Tmin for Brisbane. On the other hand, evaporation values decreased for Sydney and Brisbane but increased for Melbourne. There was a statistically significant increase in rainfall for Brisbane only. The study suggests that climate change adaptation strategies and policies need to consider urbanisation, alongwith greenhouse gases, to cope with future climate change scenarios.

Game changer: Pharmacy students' perceptions of an educational “Party Hat” game to enhance communication and collaboration skills

Background and purposeEducational games can be utilized as a tool to enhance communication and collaboration skill development and to bridge the gap between classroom learning and the practice environment. This study explores pharmacy students' perceptions of a game to enhance communication and collaboration. Educational activity and settingPre-licenced pharmacy students from an Australian metropolitan university engaged in a “Party Hat” game, where the goal was to communicate and collaborate with their peers to provide a discharge plan for a patient. “Party hats” with different instructions (e.g., agree with everything they say) were randomly provided to all students. Students were not privy to the instruction on their own party hat. The other students in the group were required to adhere to the instruction on their peers' hats while communicating. To gauge barriers to effective communication and collaboration, a debriefing session was conducted and written feedback was obtained. The debriefing session was transcribed verbatim and thematic analysis was conducted. FindingsForty-nine students participated in the game. All students provided written feedback, and 15 students participated in the debriefing session. Emergent themes included: (1) inherent biases affecting communication and patient outcomes, (2) importance for an effective group leader, (3) importance for respect for other opinions, and (4) words can affect people. SummaryEffective communication and collaboration between healthcare professionals is an important skill. Using educational games to engage students is one of the ways in which educators can teach students the importance of delivering effective communication and of engaging in collaboration with their peers for better patient outcomes.

Assessing the Concurrent Validity and Interrater Reliability of Patient-Led Screening Using the Malnutrition Screening Tool in the Ambulatory Cancer Care Outpatient Setting

BackgroundThe prevalence of malnutrition in cancer patients is reported as high as 65%; however, malnutrition screening is often substandard. The Malnutrition Screening Tool (MST) has been validated for use by health care professionals to detect at-risk patients; however, there is a gap in the literature regarding validation of patient-led MST screening. ObjectiveThe aim of the study was to assess the concurrent validity of patient-led MST against the Subjective Global Assessment (SGA) and the interrater reliability of patient-led MST against dietitian-led MST in patients attending ambulatory cancer care services for chemotherapy or supportive treatments. Design/participantsA single-site diagnostic accuracy study of 201 patients between May and June 2017 attending the ambulatory cancer care setting at an Australian metropolitan tertiary hospital in Queensland. Main outcome measurementsThe primary outcome measures were concurrent validity and interrater reliability of MST scores as determined by patients (patient-MST), dietitians (dietitian-MST), and SGA as completed by the dietitian. Statistical analysisConcurrent validity of patient-led MST scores against the SGA was determined using specificity, sensitivity, positive predictive values, and negative predictive values. Interrater reliability of patient-MST and dietitian-MST was assessed using κ coefficient. ResultsThe ability of the patient-led MST scores (0 to 1 vs 2 to 5) to indicate nutrition status was found to have a sensitivity of 94% (95% CI 81% to 99%), a specificity of 86% (95% CI 79% to 91%), and an area under the receiver operating characteristic curve of 0.93 (95% CI 0.89 to 0.96). The positive predictive value was 59% (95% CI 45% to 71%), and the negative predictive value was 99% (95% CI 95% to 100%). A weighted κ of 0.83 (95% CI 0.82 to 0.87) between patient-MST and dietitian-MST was found. ConclusionPatient-led MST screening is a reliable and valid measure that can accurately identify ambulatory cancer care patients as at risk or not at risk of malnutrition.

Long-term oxygen therapy-related adverse outcomes resulting in hospitalisation: 3-year experience of an Australian metropolitan health service.

The aim of this study was to evaluate the incidence of long-term oxygen therapy (LTOT)-related adverse outcomes in our health service. LTOT patients retrospectively recruited had their medical records reviewed for the period of 1 January 2014 to 30 June 2018. Burns, physical injuries, any falls attributable to LTOT requiring admission were the outcomes measured. Of 291 patients, four patients required admission due to LTOT-related adverse events where three admissions were related to falls secondary to tripping over oxygen tubing.

Diabetes coverage in Australian newspapers (2013‐2017): A computer‐based linguistic analysis

This study analysed diabetes coverage in 12 Australian metropolitan/national newspapers over a period of 5years (2013-2017). It aimed to describe quantitative tendencies in diabetes coverage (amount of articles per newspaper and over time) and to identify potential discrepancies between diabetes coverage and societal prevalence of diabetes. The study addressed the following research questions, with a focus on language use: How frequent are mentions of different types of diabetes? How are people with diabetes referred to? How frequent and how distributed are mentions of Aboriginal and Torres Strait Islander people and matters? Data were collected in electronic format, manually classified and processed using a specialised software program, with a focus on quantitative analysis. 577 articles were classified as news and 117 were classified as "non-news." The Australian Financial Review published the fewest items, followed by the NT News, while the West Australian and the Advertiser published the most. References to "type 2" appear slightly more frequent and more distributed than to "type 1" diabetes. The labelling of people with the noun diabetic/s occurs in about a quarter of the dataset. References to Aboriginal and Torres Strait Islander people or matters appear to be extremely rare in the analysed dataset. Diabetes coverage does not fully align with incidence of diabetes among Australians, and problematic language practices such as the labelling of people as "diabetics" continue to occur. SO WHAT?: Given the agenda-setting function of the news media, new strategies may be needed to change how Australian metropolitan and national newspapers cover diabetes, especially in relation to incorporating Aboriginal and Torres Strait Islander voices and perspectives.

University Teachers’ Perceptions of Screening Students’ Communication Skills: A Case Study from Speech Pathology

Excellent communication and interpersonal skills are necessary for allied health professionals to provide effective care/treatment and underpin the practice-based competencies allied health students must develop. Communication skills of first year speech pathology (SP) students are screened at the major Australian metropolitan university where this study took place. Final year students screen their first year peers as part of their practice-based education experience. Although this identifies first year students with communication difficulties, the perceived value to university teachers (academics and practice educators) has not been investigated. This study described university staff perceptions of screening the communication skills of first year SP students. The qualitative, descriptive design included two focus groups. The dataset was analysed thematically. The analysis revealed the staff perception of value in screening communication skills to inform student support. Two sub-themes contributing to this perception were ‘purpose of the screener’ and ‘content and administration of the screener’. Both staff groups strongly valued the screening process, stating that it is positive and useful. A similar screening process could identify first year students from a range of health fields with less skilled communication, who may require additional support to achieve competency.

Older People With Type 2 Diabetes-Individualizing Management With a Specialized (OPTIMISE) Community Team: Protocol for a Safety and Feasibility Mixed Methods Study.

BackgroundThe prevalence of diabetes is rising in older people. In 2018, over 574,000 Australians reported having diabetes. The highest prevalence (19.4%) of diabetes has been observed in people aged 85 years and older. Clinical guidelines recommend that diabetes management should be individualized; however, there is limited information regarding the current management patterns of diabetes in older people, given most clinical trials exclude participants from this age group. Available data identify that few individuals achieve optimal glycemic levels in the general population, potentially leading to adverse health outcomes and impact on quality of life. The data on glycemic profiles of older population are limited.ObjectiveThe aim of this study is to examine individualized diabetes management intervention for older people through home visits with a credentialed diabetes educator (CDE) and telehealth consultations with an endocrinologist located at a tertiary hospital.MethodsThis paper describes the design and methodology of a mixed methods feasibility and safety study to identify the current management of type 2 diabetes in people aged 65 years or older. We will implement and evaluate a personalized approach to management in the community of an Australian metropolitan city. This management approach will utilize flash glucose monitoring and home visits with the support of a community home nursing service CDE and telehealth consultation with an endocrinologist located at a local tertiary hospital.ResultsThe study commenced in February 2017 and has recruited 43 participants, with final data collection to be completed by July 2019. Data analysis will commence after final data collection, with results expected to be published by the end of 2019.ConclusionsThis study is the first of its kind to explore individualized diabetes management for community-dwelling older people, with an aim to achieve optimal glycemic levels (glycated hemoglobin between 53 and 69 mmol/mol [7%-8.5%] depending on the fitness and frailness of the older individual). The data drawn from this study may be used to inform policy makers, service providers, clinicians, and older adults living with diabetes.International Registered Report Identifier (IRRID)DERR1-10.2196/13986

Exploring network structure and the role of key stakeholders to understand the obesity prevention system in an Australian metropolitan health service: study protocol

IntroductionLittle progress has been made to address the increasing obesity prevalence over the past few decades, and there is growing concern about the far-reaching consequences for health and well-being related...

Contextual factors to registered nurse research utilisation in an Australian adult metropolitan tertiary intensive care unit: A descriptive study

BackgroundOrganisational and unit-level context can have a significant impact on implementation of evidence in practice, the latter being particularly important in the complex intensive care context. Evaluating the context may allow modifiable characteristics to be identified and addressed. ObjectivesThe objective was to examine the relationship between dimensions of the context and research utilisation in one intensive care unit. MethodsThis study used a quantitative cross-sectional survey. All registered nurses working in one Australian quaternary referral hospital intensive care unit were surveyed using the Alberta Context Tool and research utilisation instrument. Descriptive statistics were used, and bivariate analysis was undertaken to determine associations among demographic data, dimensions of context, and research utilisation. ResultsThe survey response rate was 33% (67/205). Most respondents were women with a mean of 8 years of intensive care nursing experience. The dimensions of culture, evaluation, informal interactions, structural/electronic resources, and organisational slack (time and space) were positively correlated with research utilisation. ConclusionsResearch utilisation was associated with numerous context dimensions, emphasising their effect on knowledge translation in this setting. Intensive care nurses are in a unique position to impact care delivery and provide evidence-based care to ensure optimal outcomes to patients at high risk of morbidity and mortality. Identified dimensions may be targeted and developed in future strategies to optimise the context for translating evidence into this complex practice environment.

Physical activity levels of allied health professionals working in a large Australian metropolitan health district - an observational study.

PurposeThe aim of this observational cross-sectional study was to determine if allied health professionals working in a large metropolitan health district were meeting the minimal physical activity (PA) recommendations and the proportion that occupational PA contributed to the recommended PA levels. A secondary aim was to determine possible relationships between self-report questionnaire measures of PA and PA measured by accelerometry.Materials and methodsAllied health professionals, working in the Sydney Local Health District (SLHD) in 2016–2017, completed the Active Australia Survey (AAS), Occupational Sitting and Physical Activity Questionnaire (OSPAQ), International Physical Activity Questionnaire Long form (IPAQ-L), and wore the ActiGraph GT1M accelerometer for 7 days consecutively.ResultsBased on accelerometry results, allied health professionals (N=126) spent a mean (SD) of 51 (23) minutes in moderate-to-vigorous physical activity (MVPA)/day, representing 171% of the total recommended MVPA/day, with work contributing 76% to this recommendation. Participants walked a mean of 10,077 (2,766) steps/day, meeting 100% of the recommended 10,000 steps/day, with work contributing 54% to this recommendation. Sedentary behaviors were predominant throughout the entire day and work day. Compared with the ActiGraph MVPA time measurements, AAS MVPA time showed a fair level of agreement [intraclass correlation coefficient (ICC)=0.44, P<0.01], while OSPAQ and IPAQ-L MVPA time showed no agreement (ICC=0.05, P=0.27; ICC=0.13, P=0.10, respectively).ConclusionAllied health professionals working in a large metropolitan health district met the daily PA recommendations based on accelerometry measures but tended to overreport their MVPA on self-report questionnaires.

Symposium I:Recent Change in Australian Metropolitan Areas

Symposium I:Recent Change in Australian Metropolitan Areas

‘A Source of Sanity’: The Role of Social Support for Doctoral Candidates’ Belonging and Becoming

Aim/Purpose: This paper investigates the role of social support in the PhD. Despite universities’ efforts to provide a collegial PhD experience, candidates report isolation and loneliness in doctoral education – a factor contributing to attrition. Background: Previous research (Mantai &amp; Dowling, 2015) defined social support in four categories: moral, emotional, guiding and mentoring, companionship, and collegiality. Social support is facilitated in various formal and informal groupings. Socialisation into scholarly communities promotes researcher identities through a sense of belonging. Developing a strong researcher identity through social connections benefits a student’s physical and emotional well-being, PhD progress, and investment in researcher careers. Methodology: This paper is based on thematic analysis of focus groups and one-on-one interviews with 64 PhD candidates from two Australian metropolitan universities. Contribution: Students’ perspectives on social support during PhD study are largely missing in the literature, as more importance is placed on academic support. This paper provides rich empirical evidence to show that support afforded by candidates’ personal, social, and professional relationships is critical in doctoral candidates’ identity development. Findings: First, investigating social support from the student perspective shows that it promotes students’ researcher identity development, sense of belonging, and community. Second, the paper extends our understanding of what social support means as it examines this concept in the context of student diversity. This paper confirms social support in the PhD extends beyond the institutional higher degree research environment and includes outside support by family, friends as well as online communities. Recommendations for Practitioners: Promote and improve support services, networking opportunities, and social connections within academia and beyond. Invest in understanding students’ diverse backgrounds and individual circumstances as well as goals. Recommendation for Researchers: Evaluate existing social support structures in place and identify social support needs of doctoral candidates at your particular institution. Impact on Society: Institutions, governments, and individuals heavily invest in PhD degrees financially and psychologically. This research aims to improve outcomes for society by developing skilled and confident graduates. Future Research: Future research ought to focus on the issues experienced by students of particular demographic backgrounds and on how to best support them.

Pregnancy outcomes for women with pre-pregnancy diabetes mellitus in Australian populations, rural and metropolitan: A review.

Historically, pre-pregnancy diabetes (PPDM) is a recognised risk factor for poor pregnancy outcome. Co-existing pathology and adverse social determinants including rural-metropolitan inequities in health and healthcare access may confer additional risks. Multidisciplinary care before, during and after pregnancy can improve outcomes for women with PPDM and their infants. The extent to which rural Australian women and their families share in improved outcomes is unknown. We aimed to summarise maternal characteristics and pregnancy outcomes for women with PPDM, including women in rural settings and examine applications of existing clinical guidelines to rural Australian practice. We sought English language population and cohort studies about PPDM using Medline, Embase, PubMed, Australian epidemiological and international clinical practice guidelines. Women with PPDM are changing: older, more obese, of lower parity, less likely to smoke, more likely to have type 2 rather than type 1 diabetes and shorter duration of PPDM. Women with PPDM continue to experience excess adverse pregnancy outcomes, including maternal morbidity, complicated birth, perinatal loss, congenital anomalies and mother-infant separation. On face value, clinical guidelines appear relevant to women living in rural settings but there are only a few, conflicting outcome studies for rural women with PPDM. PPDM is changing. A significant minority live in rural locations, and although perinatal mortality/morbidity seems to be improving, it is unclear if this is also true for rural women due to a lack of recent Australian studies. Further research is necessary to achieve excellence everywhere for women with PPDM and their babies.

A model of access combining triage with initial management reduced waiting time for community outpatient services: a stepped wedge cluster randomised controlled trial

BackgroundLong waiting times are associated with public community outpatient health services. This trial aimed to determine if a new model of care based on evidence-based strategies that improved patient flow in two small pilot trials could be used to reduce waiting time across a variety of services. The key principle of the Specific Timely Appointments for Triage (STAT) model is that patients are booked directly into protected assessment appointments and triage is combined with initial management as an alternative to a waiting list and triage system.MethodsA stepped wedge cluster randomised controlled trial was conducted between October 2015 and March 2017, involving 3116 patients at eight sites across a major Australian metropolitan health network.ResultsThe intervention reduced waiting time to first appointment by 33.8% (IRR = 0.663, 95% CI 0.516 to 0.852, P = 0.001). Median waiting time decreased from a median of 42 days (IQR 19 to 86) in the control period to a median of 24 days (IQR 13 to 48) in the intervention period. A substantial reduction in variability was also noted. The model did not impact on most secondary outcomes, including time to second appointment, likelihood of discharge by 12 weeks and number of appointments provided, but was associated with a small increase in the rate of missed appointments.ConclusionsBroad-scale implementation of a model of access and triage that combined triage with initial management and actively managed the relationship between supply and demand achieved substantial reductions in waiting time without adversely impacting on other aspects of care. The reductions in waiting time are likely to have been driven, primarily, by substantial reductions for those patients previously considered low priority.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12615001016527 registration date: 29/09/2015.

301. Effect of non-steroidal anti-inflammatory drugs (NSAIDs) on post-operative analgesia after ceaserean section: Randomised controlled trial

Introduction NSAIDs can cause an elevation in BP but are administered regularly post operatively after caesarean section. The effectiveness of NSAID in this setting was assessed. Objective Assess the effectiveness of oral NSAIDs on patient perceived pain compared to placebo in healthy women following caesarean section. Methods A multicentre, prospective, stratified randomization (with minimisation), double blind parallel placebo controlled trial was undertaken in 4 Australian metropolitan hospitals. Commencing immediately post operatively after the caesarean section, women received either diclofenac orally, 50 mg three times a day with food or placebo for a maximum of 5 days. All women received paracetamol 1 g four times a day and had access to a variety of opioid analgesia. The amount of opioid analgesia was converted to morphine to allow for comparisons. A visual analog scale (VAS) assessing the ’usual’ amount of pain and the ’worst’ pain each day of admission was completed by each participant. Results Of 284 women randomised, the results of 270 women were analysed- 136 women in the placebo and 134 in the NSAID group. Women were well matched at baseline. There was no difference in the simple analgesia administered to the NSAID and placebo group (p > 0.05). There was a reduction in pain over time in both groups; however women in the placebo group had higher VAS scores compared to the NSAID group for all days expect Day 5 post-partum (eg Day 1: Placebo 52.6 (95%CI 48.9–56.5) vs NSAID 46.0 (95%CI 42.1–49.9); p = 0.008). The placebo group also required greater amounts of narcotic based analgesics. Discussion NSAIDs resulted in less patient assessed pain and a reduction in the amount of narcotics administered post caesarean in women with uncomplicated pregnancies.