Cross–cultural care program for aged care staff : workbook for staff

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license .Cultural and linguistic diversity between residents and staff is significant in residential aged care homes in Australia. Residents are from over 170 countries with 31% born overseas and 20% born in a non-English speaking country (AIHW, 2016). Staff who care for residents are also from culturally and linguistically diverse backgrounds. It is estimated that 32% of staff were born overseas and 26% were born in a non-English speaking country (Mavromaras et al., 2017). The majority of overseas-born residents come from Europe while the majority of overseas-born staff come from Asian and African regions (Mavromaras et al., 2017, AIHW, 2016). This diversity generates many opportunities for aged care organisations to address equitable and culturally appropriate care for residents. However, the diversity can also be a challenge to achieving high-quality care for residents and to staff cohesion. The program is developed from a 2-year action research project entitled ‘Developing the multicultural workforce to improve the quality of care for residents’. The project is funded by the Australian Government Department of Health under the ‘Service Improvement and Healthy Ageing Grants’ in 2015. During the project life, the project team worked with residents and staff in four participating residential aged care homes to implement and evaluate the program. The details of the research project are presented in the project final report (Xiao et al., 2017). The program has been adapted into an online self-learning program using the Massive Open Online Course (MOOC) and is free to access. Instruction for accessing the online program is attached as Appendix 1: Instructions for accessing the online Cross-cultural Care Program for Aged Care Staff

Progression of Carotid Artery Intima-Media Thickness During 12 Years in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study

OBJECTIVE This study investigated the long-term effects of intensive diabetic treatment on the progression of atherosclerosis, measured as common carotid artery intima-media thickness (IMT). RESEARCH DESIGN AND METHODS A total of 1,116 participants (52% men) in the Epidemiology of Diabetes Interventions and Complications (EDIC) trial, a long-term follow-up of the Diabetes Control and Complications Trial (DCCT), had carotid IMT measurements at EDIC years 1, 6, and 12. Mean age was 46 years, with diabetes duration of 24.5 years at EDIC year 12. Differences in IMT progression between DCCT intensive and conventional treatment groups were examined, controlling for clinical characteristics, IMT reader, and imaging device. RESULTS Common carotid IMT progression from EDIC years 1 to 6 was 0.019 mm less in intensive than in conventional (P < 0.0001), and from years 1 to 12 was 0.014 mm less (P = 0.048); but change from years 6 to 12 was similar (intensive − conventional = 0.005 mm, P = 0.379). Mean A1C levels during DCCT and DCCT/EDIC were strongly associated with progression of IMT, explaining most of the differences in IMT progression between DCCT treatment groups. Albuminuria, older age, male sex, smoking, and higher systolic blood pressure were significant predictors of IMT progression. CONCLUSIONS Intensive treatment slowed IMT progression for 6 years after the end of DCCT but did not affect IMT progression thereafter (6–12 years). A beneficial effect of prior intensive treatment was still evident 13 years after DCCT ended. These differences were attenuated but not negated after adjusting for blood pressure. These results support the early initiation and continued maintenance of intensive diabetes management in type 1 diabetes to retard atherosclerosis

A study of the norcaradiene-cycloheptatriene equilibrium in a series of azulenones by NMR spectroscopy; the impact of substitution on the position of equilibrium

A systematic investigation of the influence of substitution at positions C-2 and C-3 on the azulenone skeleton, based on NMR characterisation, is discussed with particular focus on the impact of the steric and electronic characteristics of substituents on the position of the norcaradiene-cycloheptatriene (NCD-CHT) equilibrium. Variable temperature (VT) NMR studies, undertaken to enable the resolution of signals for the equilibrating valence tautomers revealed, in addition, interesting shifts in the equilibrium

Multicultural workforce development model and resources in aged care

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. Full-text embargoed for 24 months until 31 Dec 2019

Developing the multicultural workforce to improve the quality of care for residents: Final report

This publication is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) license. This report is made available following 24 month embargo from date of publication (November 2017).Cultural and linguistic diversity between residents and staff is significant in residential aged care homes in Australia. The diversity generates many opportunities for aged care organisations to address equitable and culturally appropriate care for residents. However, diversity can also be a challenge to achieving high-quality care for residents and to staff cohesion. This final report describes the project: ‘Developing the multicultural workforce to improve the quality of care for residents’. This project was funded by the Australian Government Department of Health under the ‘Service Improvement and Healthy Ageing Grants’ in 2015. Flinders University, AnglicareSA Inc. and Resthaven Inc. formed the consortium to undertake the project led by Flinders University. Participating sites from these organisations included four residential aged care homes (RACHs). The aim of the project was to work with stakeholders to develop, implement and evaluate a multicultural workforce development model (MCWD), an education program and resources to support the implementation of the model. A Critical Action Research approach was applied to achieve the aims and objectives described above. The project was completed in two phases over a 2-year period. In phase one (12 months), the project team undertook a study of residents and staff experiences in cross-cultural care services in the four participating sites. Findings from the literature review and the study informed the development of the MCWD model and resources to support the implementation of the model. In phase two (12 months), a site champion in each participating site was appointed by their organisation to implement the MCWD model, cross-cultural care toolkit, cross-cultural care self-reflection toolkit and cross-cultural care program for aged care staff. The implementation of the Multicultural Workforce Development (MCWD) Model and resources using the site champion model was associated with improved resident satisfaction with cross-cultural care services, staff perceptions of cultural competence, and experiences in cross-cultural interactions with residents and co-workers. There is a need to embed and sustain the MCWD model in residential aged care homes using the site champion model

Frequency and Clinical Implications of Discordant Creatine Kinase-MB and Troponin Measurements in Acute Coronary Syndromes

OBJECTIVES We sought to evaluate the association between discordant cardiac marker results and in-hospital mortality and treatment patterns in patients with non-ST-segment elevation acute coronary syndromes (NSTE ACS). BACKGROUND Creatine kinase-MB (CK-MB) and cardiac troponins (cTn) are often measured concurrently in patients with NSTE ACS. The significance of discordant CK-MB and cTn results is unknown. METHODS Among 29,357 ACS patients in the CRUSADE initiative who had both CK-MB and cTn measured during the first 36 hours, we examined relationships of four marker combinations (CK-MB-/cTn-, CK-MB+ /cTn-, CK-MB-/cTn+ , and CK-MB+ /cTn+) with mortality and American College of Cardiology/American Heart Association guidelines-recommended acute care. RESULTS The CK-MB and cTn results were discordant in 28% of patients (CK-MB+ /cTn-, 10%; CK-MB-/cTn+ , 18%). In-hospital mortality was 2.7% among CK-MB-/cTn- patients; 3.0%, CK-MB+ /cTn-; 4.5%, CK-MB-/cTn+ ; and 5.9%, CK-MB+ /cTn+ . After adjustment for other presenting risk factors, patients with CK-MB+ /cTn- had a mortality odds ratio (OR) of 1.02 (95% confidence interval [CI] 0.75 to 1.38), those with CK-MB-/ cTn+ had an OR of 1.15 (95% CI 0.86 to 1.54), and those with CK-MB+ /cTn+ had an OR of 1.53 (95% CI 1.18 to 1.98). Despite variable risk, patients with CK-MB+ /cTn- and CK-MB-/cTn+ were treated similarly with early antithrombotic agents and catheter-based interventions. CONCLUSIONS Among patients with NSTE ACS, an elevated troponin level identifies patients at increased acute risk regardless of CK-MB status, but an isolated CK-MB+ status has limited prognostic value. Recognition of these risk differences may contribute to more appropriate early use of antithrombotic therapy and invasive management for all cTn+ patients

A population-based study of anxiety as a precursor for depression in childhood and adolescence

BACKGROUND: Anxiety and depression co-occur in children and adolescents with anxiety commonly preceding depression. Although there is some evidence to suggest that the association between early anxiety and later depression is explained by a shared genetic aetiology, the contribution of environmental factors is less well examined and it is unknown whether anxiety itself is a phenotypic risk factor for later depression. These explanations of the association between early anxiety and later depression were evaluated. METHODS: Anxiety and depressive symptoms were assessed longitudinally in a U.K. population-based sample of 676 twins aged 5–17 at baseline. At baseline, anxiety and depression were assessed by parental questionnaire. Depression was assessed three years later by parental and adolescent questionnaire. RESULTS: Shared genetic effects between early anxiety and later depression were found. A model of a phenotypic risk effect from early anxiety on later depression provided a poor fit to the data. However, there were significant genetic effects specific to later depression, showing that early anxiety and later depression do not index entirely the same genetic risk. CONCLUSIONS: Anxiety and depression are associated over time because they share a partly common genetic aetiology rather than because the anxiety phenotype leads to later depression

Effects of antiplatelet therapy on stroke risk by brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases: subgroup analyses of the RESTART randomised, open-label trial

Background Findings from the RESTART trial suggest that starting antiplatelet therapy might reduce the risk of recurrent symptomatic intracerebral haemorrhage compared with avoiding antiplatelet therapy. Brain imaging features of intracerebral haemorrhage and cerebral small vessel diseases (such as cerebral microbleeds) are associated with greater risks of recurrent intracerebral haemorrhage. We did subgroup analyses of the RESTART trial to explore whether these brain imaging features modify the effects of antiplatelet therapy