Collaborative medication management for older adults after hospital discharge: a qualitative descriptive study

Background : Safe medication management for older adults after hospital discharge requires a well-coordinated,interprofessional, patient-centered approach. This study aimed to describe the perceived needs for collaborative medication management for older adults taking several different medications at home after hospital discharge. Methods : A qualitative descriptive study was conducted using semi-structured interviews with older adults (n = 28), informal (n = 17), and professional caregivers (n = 13). Results : Findings revealed four main needs: older adults and informal caregivers’ perceived needs for greater involvement in discharge planning; older adults’ perceived needs to be informed, listened to, and to be actively involved in decision-making; informal caregivers’ perceived needs for help in supporting and coordinating medication management; and older adults’ and informal and professional caregivers’ perceived needs for better communication and coordination between professional caregivers. Conclusion: This study revealed two underutilized pathways towards improving collaborative medication management: medication follow-up involving a community healthcare professional taking an overarching responsibility and empowering older adults and their informal caregivers in medication management after hospital discharge

Beliefs about Polypharmacy among Home-Dwelling Older Adults Living with Multiple Chronic Conditions, Informal Caregivers and Healthcare Professionals: A Qualitative Study

Although home-dwelling older adults are frequently assisted with polypharmacy management by their informal caregivers, they can still face medication-related problems. Identifying older adults’ and their informal caregivers’ beliefs about medication is a gateway to understanding and improving medication adherence. This study aimed to analyse beliefs about polypharmacy among home-dwelling older adults with multiple chronic conditions and their informal caregivers, focusing on their daily medication practices. Semi-structured interviews were conducted with 28 older adults, 17 informal caregivers, but also 13 healthcare professionals. Based on an inductive methodological approach, data were analysed using thematic content analysis. Interviews revealed the different attitudes adopted by older adults and their informal caregivers in relation to the treatment information provided by healthcare professionals. A variety of beliefs were identified and linked to medication adherence by examining daily medication practices. Polypharmacy was experienced as a habit but also an obligation, highlighting some of the strategies and negotiations underlying medication use at home. Collecting viewpoints from multiple stakeholders is an innovative way of accessing and analysing beliefs about polypharmacy. Daily medication practices provided information about medication beliefs and may contribute to developing targeted professional interventions that improve medication adherence

Simultaneous multiple breath washout and oxygen-enhanced magnetic resonance imaging in healthy adults.

Lung function testing and lung imaging are commonly used techniques to monitor respiratory diseases, such as cystic fibrosis (CF). The nitrogen (N2) multiple-breath washout technique (MBW) has been shown to detect ventilation inhomogeneity in CF, but the underlying pathophysiological processes that are altered are often unclear. Dynamic oxygen-enhanced magnetic resonance imaging (OE-MRI) could potentially be performed simultaneously with MBW because both techniques require breathing of 100% oxygen (O2) and may allow for visualisation of alterations underlying impaired MBW outcomes. However, simultaneous MBW and OE-MRI has never been assessed, potentially as it requires a magnetic resonance (MR) compatible MBW equipment. In this pilot study, we assessed whether MBW and OE-MRI can be performed simultaneously using a commercial MBW device that has been modified to be MR-compatible. We performed simultaneous measurements in five healthy volunteers aged 25-35 years. We obtained O2 and N2 concentrations from both techniques, and generated O2 wash-in time constant and N2 washout maps from OE-MRI data. We obtained good quality simultaneous measurements in two healthy volunteers due to technical challenges related to the MBW equipment and poor tolerance. Oxygen and N2 concentrations from both techniques, as well as O2 wash-in time constant maps and N2 washout maps could be obtained, suggesting that simultaneous measurements may have the potential to allow for comparison and visualization of regional differences in ventilation underlying impaired MBW outcomes. Simultaneous MBW and OE-MRI measurements can be performed with a modified MBW device and may help to understand MBW outcomes, but the measurements are challenging and have poor feasibility

Long-term pulmonary outcome of children with congenital diaphragmatic hernia: functional lung MRI using matrix-pencil decomposition enables side-specific assessment of lung function.

OBJECTIVES In patients with congenital diaphragmatic hernia (CDH) the exact functional outcome of the affected lung side is still unknown, mainly due to the lack of spatially resolved diagnostic tools. Functional matrix-pencil decomposition (MP-) lung MRI fills this gap as it measures side-specific ventilation and perfusion. We aimed to assess the overall and side-specific pulmonary long-term outcomes of patients with CDH using lung function tests and MP-MRI. METHODS Thirteen school-aged children with CDH (seven with small and six with large defect-sized CDH, defined as > 50% of the chest wall circumference being devoid of diaphragm tissue) and thirteen healthy matched controls underwent spirometry, multiple-breath washout, and MP-MRI. The main outcomes were forced expiratory volume in 1 second (FEV1), lung clearance index (LCI2.5), ventilation defect percentage (VDP), and perfusion defect percentage (QDP). RESULTS Patients with a large CDH showed significantly reduced overall lung function compared to healthy controls (mean difference [95%-CIadjusted]: FEV1 (z-score) -4.26 [-5.61, -2.92], FVC (z-score) -3.97 [-5.68, -2.26], LCI2.5 (TO) 1.12 [0.47, 1.76], VDP (%) 8.59 [3.58, 13.60], QDP (%) 17.22 [13.16, 21.27]) and to patients with a small CDH. Side-specific examination by MP-MRI revealed particularly reduced ipsilateral ventilation and perfusion in patients with a large CDH (mean difference to contralateral side [95%-CIadjusted]: VDP (%) 14.80 [10.50, 19.00], QDP (%) 23.50 [1.75, 45.20]). CONCLUSIONS Data indicate impaired overall lung function with particular limitation of the ipsilateral side in patients with a large CDH. MP-MRI is a promising tool to provide valuable side-specific functional information in the follow-up of patients with CDH. CLINICAL RELEVANCE STATEMENT In patients with congenital diaphragmatic hernia, easily applicable MP-MRI allows specific examination of the lung side affected by the hernia and provides valuable information on ventilation and perfusion with implications for clinical practice, making it a promising tool for routine follow-up. KEY POINTS • Functional matrix pencil decomposition (MP) MRI data from a small sample indicate reduced ipsilateral pulmonary ventilation and perfusion in children with large congenital diaphragmatic hernia (CDH). • Easily applicable pencil decomposition MRI provides valuable side-specific diagnostic information on lung ventilation and perfusion. This is a clear advantage over conventional lung function tests, helping to comprehensively follow up patients with congenital diaphragmatic hernia and monitor therapy effects

Mycolactone subverts immunity by selectively blocking the Sec61 translocon

Mycolactone, an immunosuppressive macrolide released by the human pathogen Mycobacterium ulcerans, was previously shown to impair Sec61-dependent protein translocation, but the underlying molecular mechanism was not identified. In this study, we show that mycolactone directly targets the alpha subunit of the Sec61 translocon to block the production of secreted and integral membrane proteins with high potency. We identify a single-amino acid mutation conferring resistance to mycolactone, which localizes its interaction site near the lumenal plug of Sec61 alpha. Quantitative proteomics reveals that during T cell activation, mycolactone-mediated Sec61 blockade affects a selective subset of secretory proteins including key signal-transmitting receptors and adhesion molecules. Expression of mutant Sec61 alpha in mycolactone-treated T cells rescued their homing potential and effector functions. Furthermore, when expressed in macrophages, the mycolactone-resistant mutant restored IFN-gamma receptor-mediated antimicrobial responses. Thus, our data provide definitive genetic evidence that Sec61 is the host receptor mediating the diverse immunomodulatory effects of mycolactone and identify Sec61 as a novel regulator of immune cell functions.Peer reviewe

Do older adults benefit from post-acute care following hospitalisation? A prospective cohort study at three Swiss nursing homes

BACKGROUND Post-acute care (PAC) programmes appear favourable for older adult inpatients too fragile to be discharged home without extensive support, but otherwise not qualifying for specific rehabilitation. Consequently, many Swiss nursing homes have opened PAC wards after a new federal law refined reimbursement in 2012. However, PAC outcomes in this setting have not been well studied. OBJECTIVE To investigate the functional outcomes of a nursing home-based PAC programme for older adult patients and to evaluate the influences of age, gender and frailty status on these outcomes. METHODS This was a prospective cohort study in 135 consecutive patients aged 60 and older admitted to PAC at three nursing homes in Zurich, Switzerland, over a two-month period. Geriatric assessment at admission included mobility, physical performance, cognition, nutrition, frailty, activities of daily living (ADL) and social support. The primary outcomes of the study, Short Physical Performance Battery (SPPB), handgrip strength (HGS) and Barthel Index (BI), were repeated before discharge from PAC. Multivariable linear models were used to analyse differences between these primary outcomes at admission and discharge, adjusting for baseline age, gender, BMI, length of stay (LOS), polypharmacy, cognition, and prior living status. RESULTS We identified statistically significant improvements between admission and discharge (mean [95% confidence interval]; % change) in BI (69.0 [65.0–72.9] vs 79.6 [75.6–83.6]; +15.4%), gait speed (0.55 [0.48–0.62] vs 0.65 [0.58–0.71] m/s; +18.2%) and SPPB scores (5.5 [5.0–6.1] vs 6.9 [6.3–7.4]; +24%), p-values for all comparisons <0.001. CONCLUSIONS In this real-word sample, PAC resulted in a significant and clinically relevant improvement in physical performance and ADL. However, our study should be replicated with a larger sample. Furthermore, long-term outcomes of PAC warrant additional investigation

Consequences of nurse presenteeism in Switzerland and Portugal and strategies to minimize it ::a qualitative study

Nurses exhibit higher rates of presenteeism than other professionals, with consequences for the quality of care and patient safety. However, nurses’ perceptions of these issues have been poorly explored. This study investigated the perceptions and experiences of frontline nurses and nurse managers in Switzerland and Portugal about the consequences of presenteeism and strategies to minimize it in different healthcare settings. Our qualitative study design used video focus groups involving 55 participants from both countries. Thematic analysis of their transcribed discussions revealed six themes surrounding the consequences of presenteeism: the personal impact on nurses’ health and wellbeing, on their family relationships, and on professional frustration and dissatisfaction; the professional impact on work dynamics; the social impact on the quality of care and patient safety and on society’s impressions of the profession. At the individual, collective, and institutional levels, six strategies were evoked to minimize presenteeism: encouraging professionals’ self-knowledge; creating a positive work atmosphere; facilitating communication channels; developing a positive organizational culture; implementing preventive/curative institutional interventions; identifying and documenting situations linked to presenteeism. Nurses’ perceptions and experiences provided a deeper understanding of their presenteeism and revealed underusedCette étude qualitative visait explorer les perceptions et les expériences des infirmières en Suisse et au Portugal sur les conséquences du présentéisme et les stratégies pour le minimiser dans différents contextes cliniques. Des groupes de discussion vidéo ont été utilisés impliquant 55 participants des deux pays. L'analyse thématique de leurs discussions transcrites a révélé six thèmes entourant les conséquences du présentéisme : l'impact personnel sur la santé et le bien-être des infirmières, sur leurs relations familiales, ainsi que sur la frustration et l'insatisfaction professionnelles ; l'impact sur leur santé et bien-être; l'impact sur leur qualité de vie; l'impact professionnel sur la dynamique de travail ; l'impact social sur la qualité des soins et la sécurité des patients et sur les représentations de la profession par la société. Aux niveaux individuel, collectif et institutionnel, six stratégies ont été évoquées pour minimiser le présentéisme : encourager la connaissance de soi ; créer un climat de travail positif ; faciliter les canaux de communication ; développer une culture organisationnelle positive ; mettre en place des interventions institutionnelles préventives/curatives ; identifier et documenter les situations liées au présentéisme. Ces résultats révèlent des voies sous-utilisées pour prévenir et minimiser le présentéisme infirmier en différents contextes cliniques