Perceptive responses and familiar staff facilitate meaningful engagement of older adults and family/care partners in long-term care home implementation science research during COVID-19

A novel registered practical nurse-led video conferencing approach using PIECESTM for team-based care planning was developed to engage family/care partners in the care of older adults. The objectives were to: (a) explore the experiences of older adults and family/care partners in collaborating in implementation science research in long-term care (LTC); (b) identify facilitators and barriers to engaging older adults and family/care partners in implementation science research; and (c) share recommendations to support the engagement of older adults and family/care partners in research. A qualitative descriptive design was used. Two older adults and two family/care partners from two Canadian LTC homes were involved in the research. Data, comprised of interviews with older adults and family/care partners, and notes from research team meetings, were analyzed using thematic analysis. Older adults and family/care partners perceived they made valuable contributions to the research project. They expressed beliefs that care delivery required improvements for older adults with responsive behaviours in LTC, which served as motivation to participate in the research project. Facilitating factors included the support of familiar LTC staff for older adults to engage in research activities and understanding the value of PIECES. A barrier to engagement for older adults was research terminology and processes described during team meetings. This research highlighted taken-for-granted factors in a collaborative research endeavour with older adults and family/care partners. One-on-one interaction, follow-up \u27reporting\u27 and presence of familiar LTC staff are needed to support meaningful engagement of older adults and family/care partners in research. Experience Framework This article is associated with the Innovation & Technology lens of The Beryl Institute Experience Framework (https://theberylinstitute.org/experience-framework/). Access other PXJ articles related to this lens. Access other resources related to this lens

Using a realist approach to evaluate smoking cessation interventions targeting pregnant women and young people

Background This paper describes a study protocol designed to evaluate a programme of smoking cessation interventions targeting pregnant women and young people living in urban and rural locations in Northeast Scotland. The study design was developed on so-called 'realist' evaluation principles, which are concerned with the implementation of interventions as well as their outcomes. Methods/design A two-phased study was designed based on the Theory of Change (TOC) using mixed methods to assess both process and outcome factors. The study was designed with input from the relevant stakeholders. The mixed-methods approach consists of semi-structured interviews with planners, service providers, service users and non-users. These qualitative interviews will be analysed using a thematic framework approach. The quantitative element of the study will include the analysis of routinely collected data and specific project monitoring data, such as data on service engagement, service use, quit rates and changes in smoking status. Discussion The process of involving key stakeholders was conducted using logic modelling and TOC tools. Engaging stakeholders, including those responsible for funding, developing and delivering, and those intended to benefit from interventions aimed at them, in their evaluation design, are considered by many to increase the validity and rigour of the subsequent evidence generated. This study is intended to determine not only the components and processes, but also the possible effectiveness of this set of health interventions, and contribute to the evidence base about smoking cessation interventions aimed at priority groups in Scotland. It is also anticipated that this study will contribute to the ongoing debate about the role and challenges of 'realist' evaluation approaches in general, and the utility of logic modelling and TOC approaches in particular, for evaluation of complex health interventions

Human T cell recognition of the blood stage antigen Plasmodium hypoxanthine guanine xanthine phosphoribosyl transferase (HGXPRT) in acute malaria

<p>Abstract</p> <p>Background</p> <p>The <it>Plasmodium </it>purine salvage enzyme, hypoxanthine guanine xanthine phosphoribosyl transferase (HGXPRT) can protect mice against <it>Plasmodium yoelii </it>pRBC challenge in a T cell-dependent manner and has, therefore, been proposed as a novel vaccine candidate. It is not known whether natural exposure to <it>Plasmodium falciparum </it>stimulates HGXPRT T cell reactivity in humans.</p> <p>Methods</p> <p>PBMC and plasma collected from malaria-exposed Indonesians during infection and 7–28 days after anti-malarial therapy, were assessed for HGXPRT recognition using CFSE proliferation, IFNγ ELISPOT assay and ELISA.</p> <p>Results</p> <p>HGXPRT-specific T cell proliferation was found in 44% of patients during acute infection; in 80% of responders both CD4⁺and CD8⁺T cell subsets proliferated. Antigen-specific T cell proliferation was largely lost within 28 days of parasite clearance. HGXPRT-specific IFN-γ production was more frequent 28 days after treatment than during acute infection. HGXPRT-specific plasma IgG was undetectable even in individuals exposed to malaria for at least two years.</p> <p>Conclusion</p> <p>The prevalence of acute proliferative and convalescent IFNγ responses to HGXPRT demonstrates cellular immunogenicity in humans. Further studies to determine minimal HGXPRT epitopes, the specificity of responses for Plasmodia and associations with protection are required. Frequent and robust T cell proliferation, high sequence conservation among <it>Plasmodium </it>species and absent IgG responses distinguish HGXPRT from other malaria antigens.</p

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P &lt; 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

Does improved physical function following a NuStep® seated all extremity exercise intervention reduce the fear of falling and improve quality of life in older adults with fear of falling living in community care homes?

Background: Decreased physical activity associated with fear of falling invokes a dangerous cycle of more fear, reduced activity and falls. NuStep is a seated all-extremity recumbent cross trainer which provides safe and efficient exercise training. Hypotheses/Objectives: The objectives of this study are to: i. improve physical function and mobility of older adults living with a fear of falling with a NuStep; ii. assess change in self-reported fear of falling and quality of life before and after the exercise intervention; and iii. determine whether there is a relationship between exercise-related improved physical function/mobility with change in fear of falling and/or quality of life of older adults living with a fear of falling. Proposed Methods: A longitudinal cohort intervention study design. Subjects (n=15) will be older adults living in community care homes. Baseline and post-intervention measures will include physical function, mobility, fear of falling and quality of life. NuStep will be used to provide an exercise training intervention to induce a clinically meaningful change in performance on measures of function and mobility. Functional data will be analyzed using repeated measures ANOVA and appropriate statistics to determine any relationship between improved function/mobility and fear/quality of life. Discussion/Future Applications Physical activity that improves function and/or mobility may be an important influence on managing the adverse effects of fear of falling. The NuStep offers a safe, effective method of exercise training which may provide additional benefits than just improved physical function including reduced isolation, improved self-confidence and enjoyment

Current Experiences and Future Expectations for Physical Activity Participation: Perspectives of Young People with Physical Disabilities and Their Rehabilitation Clinicians

© 2020 Taylor & Francis Group, LLC. Purpose: Researchers investigated current physical activity experiences of youth with physical disabilities and expectations for continued participation as they transition to adult services. Method: Youth (n = 6) and clinicians (n = 7) from a rehabilitation center participated in two separate focus groups. Researchers used inductive thematic analysis. Results: Four themes emerged among youth: “good for your health”; “motivation is key”; “social opportunities in safe environments”; “wanting to stay active.” Among clinicians, five themes arose: “added therapeutic benefits with participation”; “development as individuals through physical activity”; “inclusive and supportive environments”; “parents as advocates”; “transitioning to adult services is important.” Conclusions: Themes across focus groups were comparable. Participants expressed positive experiences for youth attending a dedicated adapted fitness center. To facilitate current and future physical activity in adulthood for youth with physical disabilities in integrated settings, the following are warranted: accessible buildings, trained staff, adapted equipment, and positive attitudes toward disability