Factors associated with successful rehabilitation in older adults: A systematic review and best evidence synthesis

Purpose; Returning to community living is an indicator for successful rehabilitation in older adults admittedto geriatric rehabilitation. Predicting successful rehabilitation could contribute to the deployment of earlydischarge planning, and leads to a more custom-made rehabilitation trajectory. This review aims to presentan overview of factors associated with successful rehabilitation following inpatient geriatric rehabilitation.Method; A systematic literature review was conducted in PubMed, CINAHL and Embase. Extracted factorswere analysed via Bakker’s five levels of evidence.Results; Nine studies with methodological quality of good to moderate were included. For 13 of the 18 extractedfactors, limited (n=3),moderate (n=5) and conflicting (n=5) evidence found a significant association.Conclusions; Caregiver, comorbidities, motor-function, nutritional status, time from onset are significantlyrelated to successful rehabilitation. These factors could support healthcare professionals to indicate successfulrehabilitation at admission and contributes to deployment of early discharge planning and developmentof more custom-made rehabilitation trajectories.Public Health and primary careGeriatrics in primary car

Moral distress among nurses involved in life-prolonging treatments in patients with a short life expectancy: a qualitative interview study.

Objective To explore whether nurses in hospital settings experience moral distress when involved in potentially life-prolonging treatments in adults with a short life expectancy. Methods A qualitative study using semi-structured interviews. Results 23 Registered nurses working in inpatient or outpatient hospital settings participated. The nurses stated they were often not involved in decisions regarding life-prolonging treatments. They reported signs of moral distress such as feeling powerless when they when they were not being listened to in the decision-making process and when confronted with negative treatment outcomes. Nurses felt frustrated when their own values were not reflected in the decision-making or when physicians created unrealistic expectations. Conclusions Hospital nurses experience moral distress when they are involved in life-prolonging treatment because of the patient’s advanced condition and their own lack of involvement in the decision-making process about the treatment. In these situations, moral distress is characterised by feelings of powerlessness and frustration. Practice implications Nurses need to be empowered by training programmes that focus on an active role in the decision-making process. Further research is needed to evaluate effective tools and training programmes that help nurses in shared decision-making processes

High treatment uptake in human immunodeficiency virus/ hepatitis C virus-coinfected patients after unrestricted access to direct-acting antivirals in the Netherlands

Background The Netherlands has provided unrestricted access to direct-acting antivirals (DAAs) since November 2015. We analyzed the nationwide hepatitis C virus (HCV) treatment uptake among patients coinfected with human immunodeficiency virus (HIV) and HCV. Methods Data were obtained from the ATHENA HIV observational cohort in which >98% of HIV-infected patients ever registered since 1998 are included. Patients were included if they ever had 1 positive HCV RNA result, did not have spontaneous clearance, and were known to still be in care. Treatment uptake and outcome were assessed. When patients were treated more than once, data were included from only the most recent treatment episode. Data were updated until February 2017. In addition, each treatment center was queried in April 2017 for a data update on DAA treatment and achieved sustained virological response. Results Of 23574 HIV-infected patients ever linked to care, 1471 HCV-coinfected patients (69% men who have sex with men, 15% persons who [formerly] injected drugs, and 15% with another HIV transmission route) fulfilled the inclusion criteria. Of these, 87% (1284 of 1471) had ever initiated HCV treatment between 2000 and 2017, 76% (1124 of 1471) had their HCV infection cured; DAA treatment results were pending in 6% (92 of 1471). Among men who have sex with men, 83% (844 of 1022) had their HCV infection cured, and DAA treatment results were pending in 6% (66 of 1022). Overall, 187 patients had never initiated treatment, DAAs had failed in 14, and a pegylated interferon-alfa–based regimen had failed in 54. Conclusions Fifteen months after unrestricted DAA availability the majority of HIV/HCV-coinfected patients in the Netherlands have their HCV infection cured (76%) or are awaiting DAA treatment results (6%). This rapid treatment scale-up may contribute to future HCV elimination among these patients