Supporting safe swallowing of care home residents with dysphagia: How does care compare with guidance?

Introduction Dysphagia affects up to 70% of nursing home residents, causes significant morbidity and increased hospital admissions. Speech and language therapists (SLT) make recommendations to reduce the risk of aspiration and support safe eating and drinking but have limited capacity to offer ongoing guidance to care home staff. This study aimed to measure the mealtime experience of residents with dysphagia, how this compared with SLT advice and what factors influenced care. Methods The safety of nutrition/hydration care of residents with dysphagia in 2 care homes was observed using a structured tool capturing 12 elements of expected practice. Observed practice was compared to recommendations in SLT/care-plans. Interviews with staff aimed to understand factors that contributed to how dysphagia care was delivered. Results SLT recommendations for 18 residents with dysphagia were predominantly focused on food/fluid modification, other safe swallowing strategies were mentioned less frequently. 66 episodes of mealtime care for 11 residents were observed. Adherence to SLT/care-plan recommendations for food texture, posture and alertness of the resident was observed on 90% of occasions, but on less than 60% of occasions for alternating food and drink, prompting resident during feeding, ensuring swallow completed and throat/mouth clear. Compliance with recommended fluid thickness was 68%; thickening was frequently not aligned to required IDDSI level. Nutrition care was less safe when residents were fed in the dining room when multiple care staff were present. Interviews with 11 care home staff found care-plans were rarely consulted, care needs were communicated verbally during handover, and training was targeted at fluid modification but not at other safer swallowing strategies. Limited knowledge about causes of coughing whilst eating/drinking drove inappropriate SLT referrals. Conclusions A safe swallowing culture that addresses system and workforce issues in care homes would improve the experience of residents with dysphagia and reduce their risk of aspiration

Supporting safe swallowing of care home residents with dysphagia: How does the care delivered compare with guidance from speech and language therapists?

Introduction Dysphagia affects up to 70% of care home residents, increasing morbidity and hospital admissions. Speech and language therapists make recommendations to support safe nutrition but have limited capacity to offer ongoing guidance. This study aimed to understand if recommendations made to support safe and effective care are implemented and how these relate to the actual care delivered. Methods Eleven mealtimes with residents with dysphagia were observed during 2020 using a tool capturing 12 elements of expected practice. Staff actions during mealtimes were compared with adherence to residents’ care plans and speech and language therapist recommendations. Results Written recommendations predominantly focused on food and fluid modification. Observations (n = 66) revealed food texture, posture, and alertness were adhered to on 90% of occasions, but alternating food and drink, prompting and ensuring swallow completed adherence was less than 60%. Thickened fluids frequently did not align with required International Dysphagia Diet Standardisation Initiative levels. Nutrition care provided in the dining room was less safe due to a lack of designated supervision. Conclusion Care homes need to be supported to establish a safe swallowing culture to improve residents’ safety and care experience. What this paper adds What is already known on this subject? - Dysphagia is associated with considerable morbidity and mortality and has been identified as an independent risk factor for mortality in nursing home residents. - There is evidence that compensatory swallowing strategies, safe feeding advice and dietary modifications can reduce the risk of aspiration pneumonia. - Care for nursing home residents at mealtimes is often task-centred and delegated to those with limited training and who lack knowledge of useful strategies to support the nutrition and hydration needs of residents with dysphagia. What this study adds? - Written advice from speech and language therapists on safe nutrition and hydration for residents with dysphagia is focused mainly on food and fluid modification. - Nurses and healthcare assistants have limited understanding of International Dysphagia Diet Standardisation Initiative levels or safe swallowing strategies and recommended practices to support safe nutrition care for residents with dysphagia are inconsistently applied especially when residents are eating in dining areas. - Care homes are not aware of Royal College of Speech and Language Therapists guidance on how safe nutrition care of residents with dysphagia should be supported. What are the clinical implications of this work? - Care homes need to prioritise a safe swallowing culture that ensures that residents with swallowing difficulties are assisted to eat and drink in a way that enhances their mealtime experience and minimises adverse events that may result in hospital admission. - Speech and language therapists could play an important role in training and supporting care home staff to understand and use safe swallowing strategies with residents with dysphagia. - The Royal College of Speech and Language Therapists could provide more assistance to care homes to support and guide them in how to implement safe feeding routines. - Care home staff have limited knowledge about how to implement safe feeding routines and need more guidance from speech and language specialists on how they can support residents with dysphagia to eat safely. - Creating a safe swallowing culture within care homes could help to improve nutrition care and enhance patient safety

Cyberbullying Victimization in Context: The Role of Social Inequalities in Countries and Regions

The phenomenon of cyberbullying is gaining ever more attention by media and policy makers in many countries. Theoretical frameworks using a socio-ecological approach emphasise the importance of contextual explanatory factors located at the societal level. It has been suggested that in addition to cross-national differences, the analysis of smaller units of more adjacent cultural contexts (i.e., regions) might yield more explanatory power. Leaning on previous findings and theory, the current paper aims to identify and compare contextual explanatory factors associated with social inequality (i.e., crime rates, GDP, life expectancy and population density) for variation in cyber- and face-to-face bullying victimisation rates within one sample. Moreover, corresponding explanatory factors are investigated across national and regional levels. Cyber- and face-to-face bullying victimisation of 15,813 9-16 year olds (50% female) from the cross-national survey data of EU Kids Online were linked with contextual variables of 18 countries and 179 regions obtained from data of the European Social Survey (ESS). Hierarchical multilevel-modelling analyses, adding first regional and then country level contextual predictors for bullying victimisation, were performed. Against expectations, differences for cyber- and face-to-face victimisation between regions within countries were smaller than differences between countries. Regional level life expectancy showed a negative and crime rates showed a marginal positive relation with both cyber- and face-to-face victimisation. Population density showed a negative and GDP a positive relationship with cyber- but not face-to-face victimisation. Adding the same predictors on the country level did not improve model fit. Possible research and policy implications are discussed

D10.2 – Research Data Management Plan, version 3.0:RAGE – WP10 – D10.2

What data will be collected, processed or generated during the RAGE project? Following what methodology and standards? And what data will be shared and/or made openly available, and how will it be curated and preserved? These issues are typically described in a Data Management Plan (DMP), outlining how research data is handled during the project and after the project is completed. The RAGE DMP specifically provides guidelines on ethics, data protection and open research data access to RAGE researchers involved in WP5 (Case experiments) and WP8 (Validation). Ethics and data protection are especially relevant in view of the games and audiences targeted by RAGE. Therefore, RAGE is one of the participating projects in the EU open research data pilot, an initiative under Horizon 2020 that aims at improving and maximising the access to and re-use of research data created in European projects.This document is the third and final iteration of the DMP

Internet use

Children’s use of the internet has been increasing tremendously in the past decade. Prevalence rates of children’s online time, devices and activities are outlined. Some insight is offered into digital divides by geographic region and socioeconomic circumstances. A typology of online opportunities and risks for children is presented, followed by a brief discussion of online risks, concluding with theoretical models proposing approaches to identify risk and resilience factors with regards to children’s internet use

Circulating MicroRNAs Are Not Eliminated by Hemodialysis

BACKGROUND: Circulating microRNAs are stably detectable in serum/plasma and other body fluids. In patients with acute kidney injury on dialysis therapy changes of miRNA patterns had been detected. It remains unclear if and how the dialysis procedure itself affects circulating microRNA level. METHODS: We quantified miR-21 and miR-210 by quantitative RT-PCR in plasma of patients with acute kidney injury requiring dialysis and measured pre- and post-dialyser miRNA levels as well as their amount in the collected spent dialysate. Single treatments using the following filters were studied: F60 S (1.3 m(2), Molecular Weight Cut Off (MWCO): 30 kDa, n = 8), AV 1000 S (1.8 m(2), MWCO: 30 kDa, n = 6) and EMiC 2 (1.8 m(2), MWCO: 40 kDa, n = 6). RESULTS: Circulating levels of miR-21 or -210 do not differ between pre- and post-dialyzer blood samples independently of the used filter surface and pore size: miR-21: F60S: p = 0.35, AV 1000 S p = 1.0, EMiC2 p = 1.0; miR-210: F60S: p = 0.91, AV 1000 S p = 0.09, EMiC2 p = 0.31. Correspondingly, only traces of both miRNAs could be found in the collected spent dialysate and ultrafiltrate. CONCLUSIONS: In patients with acute kidney injury circulating microRNAs are not removed by dialysis. As only traces of miR-21 and -210 are detected in dialysate and ultrafiltrate, microRNAs in the circulation are likely to be transported by larger structures such as proteins and/or microvesicles. As miRNAs are not affected by dialysis they might be more robust biomarkers of acute kidney injury

A model of online protection to reduce children's online risk exposure: empirical evidence from Asia

Children are surrounded by a variety of digital media and are exposed to potential risks that come with such easy accessibility. Learning how to be safe online is an important consideration for both children and their caregivers. The present study proposes an integrated model of online safety based on constructs from protection motivation theory and the health belief model, namely perceived severity of (and susceptibility to) risk, online self-efficacy, online privacy concern, and digital literacy. The study comprised a survey conducted among 420 schoolchildren aged 9–16 years. Using partial least squares-structural equation modelling, the results illustrated the presence of a negative effect of ‘perceived severity of online risk’ toward online risks, whereas the effect of ‘digital literacy’ was found to be positive. Children whose perception of online risks was more severe were less exposed to online risks if they had higher ‘online privacy concerns’ than the children with higher ‘digital literacy’ who are more exposed to online risk. Results of the study show that engaging in safe online behaviour requires children to have a high perception regarding severity of online risks as well as knowledge of online privacy concerns. Online risks and opportunities occur in parallel. Consequently, the factors that increase or decrease risk may also increase or decrease the benefits

What makes a bully a cyberbully? Unravelling the characteristics of cyberbullies across twenty-five European countries

The characteristics of bullies who act face-to-face and those who do so in cyberspace were compared directly in one sample across twenty-five countries. The role of cross-country differences in technological infrastructure was also explored. Cyberbullies compared to face-to-face bullies were more likely to engage in risky online activities, spend more time online, and found it easier to be themselves online. Private access to the internet did not make a difference. Gender differences showed girls more likely to be cyber- than face-to-face bullies if they have a profile on a social networking site. Age and internet ability beliefs were also positively but not independently associated with cyberbullying. Cross-country differences were small and patterns remained mostly stable across countries, suggesting that individual and not country-level characteristics are pivotal in explaining cyberbullying