Exploring the provision and support of care for long-term conditions in dementia: A qualitative study combining interviews and document analysis

Background: The challenge of managing multiple long-term conditions is a prevalent issue for people with dementia and those who support their care. The presence of dementia complicates healthcare delivery and the development of personalised care plans, as health systems and clinical guidelines are often designed around single condition services. Objective: This study aimed to explore how care for long-term conditions is provided and supported for people with dementia in the community. Methods: In a qualitative, case study design, consecutive telephone or video-call interviews were conducted with people with dementia, their family carers and healthcare providers over a four-month period. Participant accounts were triangulated with documentary analysis of primary care medical records and event-based diaries kept by participants with dementia. Thematic analysis was used to develop across-group themes. Findings: Six main themes were identified from eight case studies: 1) Balancing support and independence, 2) Implementing and adapting advice for dementia contexts, 3) Prioritising physical, cognitive and mental health needs, 4) Competing and entwined needs and priorities, 5) Curating supportive professional networks, 6) Family carer support and coping. Discussion: These findings reflect the dynamic nature of dementia care which requires the adaptation of support in response to changing need. We witnessed the daily realities for families of implementing care recommendations in the community, which were often adapted for the contexts of family carers’ priorities for care of the person living with dementia and what they were able to provide. Realistic self-management plans which are deliverable in practice must consider the intersection of physical, cognitive and mental health needs and priorities, and family carers needs and resources

Supporting self-care of long-term conditions in people with dementia: A systematic review

BACKGROUND: Long-term conditions are common in people living with dementia; their self-management is an important determinant of wellbeing. Family carers often support or substitute self-care activities, and act as proxies for self-management, as dementia progresses. OBJECTIVES: To conduct the first systematic review of how management of long-term conditions in people with dementia is best enabled and supported, including factors that facilitate or inhibit self-management and management by a proxy. DESIGN: Systematic review. DATA SOURCES: We systematically searched MEDLINE, PsychINFO, Embase and Allied and Complementary Medicine databases up to November 2018. REVIEW METHODS: We identified the long-term conditions most prevalent in people with dementia that require an element of self-management. We then developed our inclusion criteria to identify qualitative and quantitative studies describing the self-management (or self-management assisted by family carers) of long-term conditions in people with dementia. Two authors independently rated study validity using a standardised checklist. We synthesised qualitative and quantitative findings using a data driven convergent synthesis approach. RESULTS: We included 12 articles meeting predetermined inclusion criteria: seven qualitative, two case studies, two quantitative and one mixed methods study. We identified four main themes across these studies: (1) dementia symptoms impeding treatment regimens (forgetfulness, decreased understanding, ability to communicate symptoms and behavioural and psychological symptoms); (2) adapting routines to be simpler, (using memory aids and accommodating physical limitations); (3) negotiating self-management support (carer availability and knowledge; balancing needs for safety and empowerment); and (4) interface with professionals, (Routine simplification, condition specific education, and acknowledging carer role). CONCLUSIONS: People living with dementia can be supported to manage their own health for as long as possible, through simplifying routines and reminding, but where this can no longer be negotiated, carers take over responsibility for self-management, often due to safety concerns. Empowerment of people with dementia to remain involved in their care reduces the loss experienced by this transition. Communication and partnership between clinicians and carers is critical when supporting people living with a long-term condition and dementia. Care planning for people living with dementia and a long-term condition should include explicit discussion of how these partnerships will work and guidance on strategies carers can use to support people to self-manage long-term conditions

An exploration of how specialist dementia nurses perceive and maintain the skills and competencies that frame their specialism: A qualitative survey.

BACKGROUND: UK policy for complex and long-term health conditions including dementia has recommended that specialist nursing intervention is offered across the trajectory of the condition, but there is a lack of agreement regarding the skills and competencies that specialist nurses are expected to possess. Admiral Nurses are the largest UK group of specialist dementia nurses. OBJECTIVE: To explore how Admiral Nurses met and were supported to meet competencies as defined in the Admiral Nurse Competency Framework, and to develop and maintain skills as dementia specialists. DESIGN: Cross-sectional, semi-structured survey. SETTING: Online national survey. PARTICIPANTS: Admiral (specialist dementia) Nurses. METHODS: We co-designed our survey with Admiral Nurses; then invited Admiral Nurses to complete it in 2022-23 Data were analysed thematically. RESULTS: 68 (20% of all Admiral Nurses) completed the survey; most were female (85.2%), from a white ethnic group (88.2%); they reported on average 24 years of nursing experience. We identified three themes in responses: 1.Having time and skills for meaningful support, explored how participants were resourced with time and skills to understand and address family carer client needs by active listening, tailoring person-centred support, and "walking alongside" families. 2.Partnering family carers, concerned how they co-designed interventions with family carers, learning from these collaborative partnerships where expertise was shared. 3.Practice and peer-based learning, explored how participants took responsibility for using available training, peer learning and self-reflection to develop their practice. CONCLUSIONS: Admiral Nurse roles enabled respondents to develop as autonomous practitioners and to access resources that supported them to build and sustain their dementia specialist practice. Learning was practice based, through partnerships with family carer clients, peer support and self-directed learning. Specialist nursing models may help address the global health workforce emergency, through enabling creative practice development and valued roles that support retention of experienced nurses

Seeing Speech: Ultrasound-based Multimedia Resources for Pronunciation Learning in Indigenous Languages

Pronunciation is an important aspect of Indigenous language learning, and one which requires creative community-oriented solutions. Towards this end, we have developed a pronunciation learning tool that incorporates ultrasound technology to give learners a visual aid to help them articulate unfamiliar and/or challenging sounds. Ultrasound is used to create videos of a model speaker’s tongue movements during speech, which are then overlaid on videos of an external profile view of the model’s head to create ultrasound-enhanced pronunciation videos for individual words or sounds. A key advantage of these videos is that learners are able see how speech is produced rather than just hear and try to mimic it. Although ultrasound-enhanced videos were originally developed for commonly taught languages such as Japanese and French, there has been widespread interest from Indigenous communities in Western Canada to develop their own customized videos. This paper reports on three collaborations between linguists and communities in British Columbia to develop ultrasound-enhanced videos for the SENĆOŦEN, Secwepemc, and Halq’emeylem languages. These videos can give learners a new way to learn pronunciation that focuses on seeing speech, and can create new documentation of understudied sound systems for future generations.National Foreign Language Resource Cente

The antibacterial activity of honey

Honey is an old remedy recently rediscovered as a possible alternative to modern antibiotics in wound management but its mode of action is not fully understood. The antibacterial activity of honey can be divided into hydrogen peroxide and non-hydrogen peroxide-derived activity. This later type of activity is characteristic of honeys from Australasia (e.g. manuka honey) and preferred for wound management, although historically local honeys have been used. The main aim of this study was to investigate the mechanisms of antibacterial action of manuka honey. The stability of antibacterial action of manuka honey under different conditions was determined, it was observed that manuka honey lost its antibacterial activity when pH was increased and that it remained the same with heating. Storage seemed to increase the potency of manuka honey. The effects of honey on Staph. aureus and Pseud. aeruginosa, were investigated using MIC/MBC detenninations, time-kill studies, commitment to death, resistance training, electron microscopy, effects on respiration rates, leakage of intracellular material, and for Staph. aureus the proteome of treated and non-treated cells were compared. It was observed that the effect of manuka honey on Gram-positive and Gram-negative cells is different. Gram-positive bacteria had a lower MIC than Gram-negative bacteria, but the time-kill experiments and the commitment-to-deaths howed that Gram negative were inhibited more rapidly. Clinical strains of both bacteria showed different time-kill profiles to type strains. The methodology used for MIC determination was found to affect to the results obtained. No honey-resistant ram-positive bacteria were recovered, but Gramnegative bacteria were found to be able to become phenotypically resistant to manuka honey. Electron microscopy showed that honey inflicted physical damages in both types of cells, and in Gram-positive bacteria led to an increase in the proportion of population of cells with a complete septum. Gram-positive cells incubated in honey increased their endogenousre spiration rate whilst this was decreased in Gram-negative, major leakage was observed in Gram-negative bacteria whilst only minor leakage was observed in Gram-positive bacteria, which is consistent with the amount of damage observed with electron microscopy. The proteome analysis of Staph aureus, revealed a general down regulation of protein synthesis. Thirty Portuguese honeys were assayed for their antibacteriaal ativity and honeys derived from Lavandulas toechas(lavender) were found to possess non-peroxide activity. A selection of manuka honeys was screened for antimicrobial producing bacteria. In total 106 bacteria were recovered (85% were identified as Bacillus sp. ) and of those, 76 were capable of inhibiting the growth of at least one strain of bacteria tested, meaning that some of the antibacterial activity in manuka honey could be due to the presence of antimicrobial agents of bacterial origin. The antibacterial activity of manuka honey has previously been claimed to be due to hydrogen peroxide production and not to a non-peroxide source of activity. A study of free radical production and antioxidant potential demonstrated that manuka honey did not produce any hydroxyl radicals via the Fenton reaction. Thus hydrogen peroxide could not be present. It was also observed that even free radical-producing honeys were able to quench radical production in vitro. In conclusion this study has demonstrated that the non-peroxide activity of manuka honey is not exclusive to Australasia honeys, that it is not derived from hydrogen peroxide generation and may have a microbial origin. Furthermore the action of manuka honey on Gram-negative bacteria seems to be more physical than in Gram positive where it appears to interfere with the cell physiology, perhaps by stopping the cell cycle before cytokinesis.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Annexin A1 attenuates cardiac diastolic dysfunction in mice with inflammatory arthritis.

Rheumatoid arthritis (RA) carries a twofold increased incidence of heart failure with preserved ejection fraction, accompanied by diastolic dysfunction, which can lead to death. The causes of diastolic dysfunction are unknown, and there are currently no well-characterized animal models for studying these mechanisms. Current medications for RA do not have marked beneficial cardio-protective effects. K/BxN F1 progeny and KRN control mice were analyzed over time for arthritis development, monitoring left ventricular diastolic and systolic function using echocardiography. Excised hearts were analyzed by flow cytometry, qPCR, and histology. In pharmacological experiments, K/BxN F1 mice were treated with human recombinant AnxA1 (hrAnxA1, 1 μg/mouse) or vehicle daily. K/BxN F1 mice exhibited fully developed arthritis with normal cardiac function at 4 wk; however, by week 8, all mice displayed left ventricular diastolic dysfunction with preserved ejection fraction. This dysfunction was associated with cardiac hypertrophy, myocardial inflammation and fibrosis, and inflammatory markers. Daily treatment of K/BxN F1 mice with hrAnxA1 from weeks 4 to 8 halted progression of the diastolic dysfunction. The treatment reduced cardiac transcripts of proinflammatory cytokines and profibrotic markers. At the cellular level, hrAnxA1 decreased activated T cells and increased MHC IIlow macrophage infiltration in K/BxN F1 hearts. Similar effects were obtained when hrAnxA1 was administered from week 8 to week 15. We describe an animal model of inflammatory arthritis that recapitulates the cardiomyopathy of RA. Treatment with hrAnxA1 after disease onset corrected the diastolic dysfunction through modulation of both fibroblast and inflammatory cell phenotype within the heart

Characterisation of the Mopra Radio Telescope at 16--50 GHz

We present the results of a programme of scanning and mapping observations of astronomical masers and Jupiter designed to characterise the performance of the Mopra Radio Telescope at frequencies between 16-50 GHz using the 12-mm and 7-mm receivers. We use these observations to determine the telescope beam size, beam shape and overall telescope beam efficiency as a function of frequency. We find that the beam size is well fit by $\lambda$/$D$ over the frequency range with a correlation coefficient of ~90%. We determine the telescope main beam efficiencies are between ~48-64% for the 12-mm receiver and reasonably flat at ~50% for the 7-mm receiver. Beam maps of strong H$_2$O (22 GHz) and SiO masers (43 GHz) provide a means to examine the radial beam pattern of the telescope. At both frequencies the radial beam pattern reveals the presence of three components, a central `core', which is well fit by a Gaussian and constitutes the telescopes main beam, and inner and outer error beams. At both frequencies the inner and outer error beams extend out to approximately 2 and 3.4 times the full-width half maximum of the main beam respectively. Sources with angular sizes a factor of two or more larger than the telescope main beam will couple to the main and error beams, and therefore the power contributed by the error beams needs to be considered. From measurements of the radial beam power pattern we estimate the amount of power contained in the inner and outer error beams is of order one-fifth at 22 GHz rising slightly to one-third at 43 GHz.Comment: Accepted for publication in PAS

Nature as a 'Lifeline': The Power of Photography when Exploring the Experiences of Older Adults living with Memory Loss and Memory Concerns

The visual is an underutilised modality through which to investigate experiences of memory loss in older people. We describe a visual ethnography with older adults experiencing subjective or objective memory loss, receiving a cognitive wellbeing group intervention designed to prevent cognitive decline and dementia (APPLE-Tree programme). We aimed to explore lived experiences of people with memory concerns, how participants engaged with this photography and co-design project, and how collaboration with an artist/photographer enhanced this process. Nineteen participants shared photographs reflecting what they valued in their daily lives, their experiences of memory concerns, and the intervention. Fourteen participated in qualitative photo-elicitation interviews, and thirteen collaborated with a professional artist/photographer to co-create an exhibition, in individual meetings and workshops, during which a researcher took ethnographic field notes. Eight participants were re-interviewed after the exhibition launch. We contextualise images produced by participants in relation to discourses around the visual and ageing and highlight their relationship with themes developed through thematic analysis that interconnects photographic, observational and interview data. We present themes around the use of photographs to: (1) celebrate connections to nature as a lifeline; (2) anchor lives within the context of relationships with family; (3) reflect on self and identity, enduring through ageing, memory concerns, pandemic, and ageing stereotypes. We explore visual research as a powerful tool for eliciting meaningful accounts from older adults experiencing cognitive change and to connect the arts and social sciences within ageing studies