Learning to deliver LGBT+ aged care: exploring and documenting best practices in professional and vocational education through the World Café method

Substantial evidence on the adverse impact of ageing on lesbian, gay, bisexual and transgender (LGBT+) populations through the lack of inclusive care services has highlighted the need for education and training of the health and social care workforce to enhance their skills, knowledge and capabilities in this area. We describe a cross-national collaboration across four European Union countries called BEING ME. This collaboration examined the current pedagogic environment within professional, vocational and community-based education to identify what is most valuable for addressing these needs. The World Café method enabled a process of structured learning and knowledge exchange between stakeholders resulting in: (a) identification of best practices in pedagogies, (b) generation of tailored co-produced educational resources, and (c) recommendations on how to improve the knowledge and capabilities of future care professionals in the area of LGBT+ affirmative practices. Combined with themes from the post-Café evaluation, our findings suggest that underpinning professional and vocational education with a person-in-environment perspective facilitates going some way to acknowledging the historical context of older LGBT+ people's lives. Addressing the unique needs of sub-populations within LGBT+ communities and setting these in the context of holistic and person-centred care may better enable the meeting of their unique diverse needs for ageing. Recommendations are made for learning and teaching strategies to support improved LGBT+ aged care

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Pedagogical principles and methods underpinning education of health and social care practitioners on experiences and needs of older LGBT+ people: findings from a systematic review

There is a growing awareness of the need for LGBT + competency training to ensure that the health and social care services offered to older LGBT + people is affirmative and gender sensitive. To conduct a synthesis of the literature that describes the pedagogical principles, curriculum content and methods (teaching and assessment) used to educate health and social care practitioners on the experiences and needs of older LGBT + people. Systematic thematic review of literature. MEDLINE, CINAHL, PsycINFO, EMBASE, Web of Science, Social Sciences Index, ERIC. In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement, this review examined peer-reviewed papers published in English, prior to April 2018 that addressed pedagogical and curriculum issues on the inclusion of needs and experiences of older LGBT + people. The combined searches yielded 2214 papers of which 17 papers were eligible for inclusion, 10 discussion papers and 7 evaluation studies. Analysis identified the following themes: i) Acknowledging the wider historical context of older LGBT + people's lives; ii) Recognising that older LGBT + people are not a homogenous group; iii) Incorporating a multitude of theories and models from different perspectives; iv) Alerting practitioners to the health issues and disparities facing older LGBT + people; v) Including content that supports inclusive care for older LGBT + people; vi) Addressing barriers to older LGBT + people accessing health care; vii) Interactive activities are the preferred pedagogical strategy; viii) Involving older LGBT + people in curriculum development is a core principle; and ix) Mandatory education is not always the solution. As the field matures there is a need for more exploration of curriculum principles, assessment strategies and strategies to overcome barriers to the inclusion of issues experienced by older LGBT + people within curricula. [Abstract copyright: Copyright © 2019 Elsevier Ltd. All rights reserved.

Learning to deliver LGBT+ aged care : exploring and documenting best practices in professional and vocational education through the World Café method - corrigendum

This article was originally published with incorrect affiliations for authors Agnes Higgins and Brian Keogh, who are in fact affiliated with the School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin, Ireland. The article has now been updated with the correct information

Genetic mapping of Cacopsylla pyri resistance in an interspecific pear (Pyrus spp.) population

Cacopsylla pyri (pear psylla) is one of the most serious pests of pear (Pyrus spp.) in Europe. It can cause high yield losses, and its control has become difficult since it has developed resistance to a wide range of pesticides. Pear breeders are developing new cultivars resistant to pear psyllids, and Asian species, such as Pyrus ussuriensis and Pyrus × bretschneideri, are good sources of resistance. Antixenosis and antibiosis resistance to psylla were both identified in pear; they may differ in the biological mechanism and probably have different genetic backgrounds. We crossed interspecific P. × bretschneideri × Pyrus communis hybrid PEAR3, resistant to pear psylla, with the susceptible European pear cultivar ‘Moonglow’ to obtain an F1 population for the genetic mapping of the resistance. Quantitative trait locus (QTL) analysis was carried out for antibiosis by measuring the number of surviving nymphs and the nymphal development, using a novel phenotyping protocol and a saturated genetic map made of single-nucleotide polymorphism (SNP) and microsatellite (simple sequence repeats (SSR)) markers. A stable QTL was detected on linkage group (LG) 8 of PEAR3 (R 2 = 17.2–39.1 %). In addition, QTLs were detected on LG5 (R 2 = 10.8 %) of PEAR3 and on LG15 of ‘Moonglow’ (R 2 = 13.7 %