Is it my job? The role of RNs in the assessment and identification of delirium in hospitalized older adults: an exploratory qualitative study

Delirium is characterized by acute and fluctuating cognitive decline, which is often missed in older adults who are assumed to be experiencing age-related changes or dementia. Delirium affects up to 50% of hospitalized older adults. The aim of the current study was to (a) explore current practices of RNs in assessing and identifying delirium in hospitalized older adults and (b) inform new educational initiatives. Qualitative methods were adopted using eight semi-structured group interviews with 24 RNs. Thematic analysis revealed a dichotomy in practice where RNs described delirium assessment and identification as (a) It\u27s Not My Job, (b) It is My Job, and (c) It\u27s Complex. The imperative to improve delirium assessment and identification to create safer and more caring health care environments means the current findings provide important evidence to build into practice and education strategies. The current authors have developed engaging educational interventions and begun implementation at the study site to develop delirium assessment and identification capacity, which moves clinicians beyond awareness and aims at practice adherence or the consistent application of evidence-based delirium assessment

The impact of self-efficacy on asthma management amongst older Australian adults

Rationale: Australian asthma rates are high by international standards causing greatest mortality amongst older adults. This paper looks at the relationships between perceived self-efficacy (belief in oneself) to manage the physical discomfort or pain caused by asthma and also the emotional distress caused by asthma and: reported health status; asthma quality of life for both mood and breathlessness; asthma management practices; and emergency health care use for asthma in adults aged 55 years and over. Methods: A 20 page survey exploring the health beliefs, behaviours and attitudes of older Australians, was mailed to 9,000 people, (response rate = 46.8%). Participants were recruited through a random sample obtained from the Australian Electoral Roll Office. Results: Correlations show that people who reported high physical or emotional self-efficacy were more likely to report better health and quality of life. They were less likely to report that asthma had interfered with their day-to-day activities or that they had utilised emergency health care for asthma. Regular asthma reviews with their general practitioner, owning an asthma action plan, having received asthma education and regularly monitoring asthma control did not appear to be related to self-efficacy. Summary: These results indicate that neither physical nor emotional self-efficacy are significantly correlated with popular asthma self-management strategies. However, both physical and emotional self-efficacy were significantly correlated with health rating, quality of life for breathlessness and mood and the impact of asthma on their day-to-day activities. Factors that increase older adults\u27 asthma self-efficacy need to be further investigated

Systematic review of comprehensive primary health care models

Many countries are investing in primary health care (PHC) reform, with particular attention being paid to establishing local or regional organisational structures; implementing new funding arrangements and changing the PHC workforce skills mix. This review examines what is known about the implementation and effectiveness of the different system-wide models being developed in Australia, United Kingdom and New Zealand to achieveThe research reported in this paper is a project of the Australian Primary Health Care Research Institute, which is supported by a grant from the Australian Government Department of Health and Ageing under the Primary Health Care Research, Evaluation and Development Strategy

Medication Management for People Living with Dementia: Development and Evaluation of a Multilingual Information Resource for Family Caregivers of People Living with Dementia

The aim of this chapter is to describe the development and evaluation of an online multilingual information resource focused on medication management, targeting people living with dementia and their family caregivers. Maintaining effective medication management is important to allow ongoing quality of life within the community setting and avoiding medication-related preventable hospitalisations for the person living with dementia. Family caregivers are likely to assume the role of medication management on behalf of the person in their care as dementia progresses. Little training or information is available to family caregivers to assist them with this role. A pilot online information resource was developed and evaluated. Responding to the evaluation, this resource was improved, and a more extensive evaluation process was undertaken. The development and evaluation process are outlined with a view to guiding the development of similar resources, especially those targeting linguistically diverse family caregivers and those with dementia. This is especially important given that many older adults will migrate during their lifetime, often to a country where they are not familiar with the language or health services. Extra support is needed to assist older immigrants who are themselves at risk or are caring for someone with dementia

Developing Innovative Practices Through Third-Space Partnerships: Reflections on Project DARE (Dementia Knowledge, Art, Research and Education)

Partnerships between schools, universities, and community organizations have mutual benefits for all involved. These partnerships value the contributions of all participants and capitalize on the expertise and knowledge that each brings. This reflective paper details a collaborative third-space partnership between a university, a primary school, and a community organization. The partnership facilitated the design, development, and implementation of a unique program called Project DARE (Dementia knowledge, Art, Research, and Education). A research-based evaluation of the Project DARE feasibility study can be found elsewhere (Burns et al., 2020). The aim of this paper is to reflect upon the formation of the partnership and the roles that each party played. It also discusses implications for the future development of third-space partnerships

The design and development of a community based multisensory room

This case study describes the design and development of a multisensory environment for use by a local community, in response to local needs. Multisensory environments allow users to control the sensory inputs they experience from the environment. This autonomy may be especially impactful for those living with autism or dementia. The evidence base supporting the design, development and implementation of multisensory environments has been limited to date. This case study explores the evolution of the interdisciplinary team from a request for collaboration to the creation of a functioning multisensory room. It describes the experiences of the group of researchers finding shared understandings and evolving to a transdisciplinary approach

Has the gender gap in voter turnout really disappeared?

According to conventional wisdom, the traditional gender gap in voting has disappeared or even reversed in most established democracies. Drawing on the existing literature on sex differences in political engagement and on pioneering voter turnout theories, this article questions the conventional assumption and hypothesises that women still participate at lower rates in less important elections. It systematically tests this hypothesis by exploring the impact of sex on voter turnout in different electoral arenas. The empirical analyses of two cross-national datasets (Making Electoral Democracy Work and the European Election Study) demonstrate that although there is generally no gender gap in first-order elections, women tend to vote less than men in second-order contests. This reflects women’s weaker interest in politics and their lower levels of knowledge about politics in second-order electoral arenas

Multiple novel prostate cancer susceptibility signals identified by fine-mapping of known risk loci among Europeans

Genome-wide association studies (GWAS) have identified numerous common prostate cancer (PrCa) susceptibility loci. We have fine-mapped 64 GWAS regions known at the conclusion of the iCOGS study using large-scale genotyping and imputation in 25 723 PrCa cases and 26 274 controls of European ancestry. We detected evidence for multiple independent signals at 16 regions, 12 of which contained additional newly identified significant associations. A single signal comprising a spectrum of correlated variation was observed at 39 regions; 35 of which are now described by a novel more significantly associated lead SNP, while the originally reported variant remained as the lead SNP only in 4 regions. We also confirmed two association signals in Europeans that had been previously reported only in East-Asian GWAS. Based on statistical evidence and linkage disequilibrium (LD) structure, we have curated and narrowed down the list of the most likely candidate causal variants for each region. Functional annotation using data from ENCODE filtered for PrCa cell lines and eQTL analysis demonstrated significant enrichment for overlap with bio-features within this set. By incorporating the novel risk variants identified here alongside the refined data for existing association signals, we estimate that these loci now explain ∼38.9% of the familial relative risk of PrCa, an 8.9% improvement over the previously reported GWAS tag SNPs. This suggests that a significant fraction of the heritability of PrCa may have been hidden during the discovery phase of GWAS, in particular due to the presence of multiple independent signals within the same regio

Effects of a balanced translocation between chromosomes 1 and 11 disrupting the DISC1 locus on white matter integrity

Objective Individuals carrying rare, but biologically informative genetic variants provide a unique opportunity to model major mental illness and inform understanding of disease mechanisms. The rarity of such variations means that their study involves small group numbers, however they are amongst the strongest known genetic risk factors for major mental illness and are likely to have large neural effects. DISC1 (Disrupted in Schizophrenia 1) is a gene containing one such risk variant, identified in a single Scottish family through its disruption by a balanced translocation of chromosomes 1 and 11; t(1;11) (q42.1;q14.3). Method Within the original pedigree, we examined the effects of the t(1;11) translocation on white matter integrity, measured by fractional anisotropy (FA). This included family members with (n = 7) and without (n = 13) the translocation, along with a clinical control sample of patients with psychosis (n = 34), and a group of healthy controls (n = 33). Results We report decreased white matter integrity in five clusters in the genu of the corpus callosum, the right inferior fronto-occipital fasciculus, acoustic radiation and fornix. Analysis of the mixed psychosis group also demonstrated decreased white matter integrity in the above regions. FA values within the corpus callosum correlated significantly with positive psychotic symptom severity. Conclusions We demonstrate that the t(1;11) translocation is associated with reduced white matter integrity in frontal commissural and association fibre tracts. These findings overlap with those shown in affected patients with psychosis and in DISC1 animal models and highlight the value of rare but biologically informative mutations in modeling psychosis