Access to primary care for socio-economically disadvantaged older people in rural areas: a qualitative study

Objective: We aim to explore the barriers to accessing primary care for socio-economically disadvantaged older people in rural areas. Methods: Using a community recruitment strategy, fifteen people over 65 years, living in a rural area, and receiving financial support were recruited for semi-structured interviews. Four focus groups were held with rural health professionals. Interviews and focus groups were audio-recorded and transcribed. Thematic analysis was used to identify barriers to primary care access. Findings: Older people’s experience can be understood within the context of a patient perceived set of unwritten rules or social contract – an individual is careful not to bother the doctor in return for additional goodwill when they become unwell. However, most found it difficult to access primary care due to engaged telephone lines, availability of appointments, interactions with receptionists; breaching their perceived social contract. This left some feeling unwelcome, worthless or marginalised, especially those with high expectations of the social contract or limited resources, skills and/or desire to adapt to service changes Health professionals’ described how rising demands and expectations coupled with service constraints had necessitated service development, such as fewer home visits, more telephone consultations, triaging calls and modifying the appointment system. Conclusion: Multiple barriers to accessing primary care exist for this group. As primary care is re-organised to reduce costs, commissioners and practitioners must not lose sight of the perceived social contract and models of care that form the basis of how many older people interact with the service

Nursing-Relevant Patient Outcomes and Clinical Processes in Data Science Literature: 2019 Year in Review

Data science continues to be recognized and used within healthcare due to the increased availability of large data sets and advanced analytics. It can be challenging for nurse leaders to remain apprised of this rapidly changing landscape. In this paper, we describe our findings from a scoping literature review of papers published in 2019 that use data science to explore, explain, and/or predict 15 phenomena of interest to nurses. Fourteen of the 15 phenomena were associated with at least one paper published in 2019. We identified the use of many contemporary data science methods (e.g., natural language processing, neural networks) for many of the outcomes. We found many studies exploring Readmissions and Pressure Injuries. The topics of Artificial Intelligence/Machine Learning Acceptance, Burnout, Patient Safety, and Unit Culture were poorly represented. We hope the studies described in this paper help readers: (a) understand the breadth and depth of data science’s ability to improve clinical processes and patient outcomes that are relevant to nurses and (b) identify gaps in the literature that are in need of exploration

Antibiofilm Activity of an Exopolysaccharide from Marine Bacterium Vibrio sp. QY101

Bacterial exopolysaccharides have always been suggested to play crucial roles in the bacterial initial adhesion and the development of complex architecture in the later stages of bacterial biofilm formation. However, Escherichia coli group II capsular polysaccharide was characterized to exert broad-spectrum biofilm inhibition activity. In this study, we firstly reported that a bacterial exopolysaccharide (A101) not only inhibits biofilm formation of many bacteria but also disrupts established biofilm of some strains. A101 with an average molecular weight of up to 546 KDa, was isolated and purified from the culture supernatant of the marine bacterium Vibrio sp. QY101 by ethanol precipitation, iron-exchange chromatography and gel filtration chromatography. High performance liquid chromatography traces of the hydrolyzed polysaccharides showed that A101 is primarily consisted of galacturonic acid, glucuronic acid, rhamnose and glucosamine. A101 was demonstrated to inhibit biofilm formation by a wide range of Gram-negative and Gram-positive bacteria without antibacterial activity. Furthermore, A101 displayed a significant disruption on the established biofilm produced by Pseudomonas aeruginosa, but not by Staphylococcus aureus. Importantly, A101 increased the aminoglycosides antibiotics' capability of killing P. aeruginosa biofilm. Cell primary attachment to surfaces and intercellular aggregates assays suggested that A101 inhibited cell aggregates of both P. aeruginosa and S. aureus, while the cell-surface interactions inhibition only occurred in S. aureus, and the pre-formed cell aggregates dispersion induced by A101 only occurred in P. aeruginosa. Taken together, these data identify the antibiofilm activity of A101, which may make it potential in the design of new therapeutic strategies for bacterial biofilm-associated infections and limiting biofilm formation on medical indwelling devices. The found of A101 antibiofilm activity may also promote a new recognition about the functions of bacterial exopolysaccharides

Study Abroad and Developing Reflective Research Practice Through Blogs A Preliminary Study from the United Kingdom

Blogs are seen as an important strand of social networking and a significant way of disseminating research ideas and sharing knowledge and perceptions with new audiences via digital platforms. The use of blogs within off-campus activities, such as study abroad field visits, have the potential to enhance students’ social media skills and confidence about becoming active researchers in public through communicating field research experiences and reflections on what they see, learn, hear and do. Via a semi-structured questionnaire administered to UK based university students participating in a recent Criminology program field visit to Slovenia in Europe, we assess the extent to which blogging facilitates student reflective practice on their lived experiences of undertaking research in culturally unfamiliar environments. We show that blogging combined with the whole experience of international fieldwork has a ‘learning gain’ for students exemplified through a willingness to engage in reflective practice, self-awareness and transferable skills

A Closer Look at the “Right” Format for Clinical Decision Support: Methods for Evaluating a Storyboard BestPractice Advisory

(1) Background: The five rights of clinical decision support (CDS) are a well-known framework for planning the nuances of CDS, but recent advancements have given us more options to modify the format of the alert. One-size-fits-all assessments fail to capture the nuance of different BestPractice Advisory (BPA) formats. To demonstrate a tailored evaluation methodology, we assessed a BPA after implementation of Storyboard for changes in alert fatigue, behavior influence, and task completion; (2) Methods: Data from 19 weeks before and after implementation were used to evaluate differences in each domain. Individual clinics were evaluated for task completion and compared for changes pre- and post-redesign; (3) Results: The change in format was correlated with an increase in alert fatigue, a decrease in erroneous free text answers, and worsened task completion at a system level. At a local level, however, 14% of clinics had improved task completion; (4) Conclusions: While the change in BPA format was correlated with decreased performance, the changes may have been driven primarily by the COVID-19 pandemic. The framework and metrics proposed can be used in future studies to assess the impact of new CDS formats. Although the changes in this study seemed undesirable in aggregate, some positive changes were observed at the level of individual clinics. Personalized implementations of CDS tools based on local need should be considered

Life course disadvantage and systemic inflammation : the role of psychosocial functioning

Thesis (Ph. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, 2015.Experiences of disadvantage over the life course, including childhood adversity and low socioeconomic status (SES), have been linked to low-grade systemic inflammation, a potential risk factor for cardiovascular and other chronic diseases, late-life disability, and earlier mortality. Using data from the Midlife in the United States (MIDUS) survey, this study investigated the extent to which psychosocial functioning mediates or moderates associations of childhood adversity and low SES with systemic inflammation among middle-aged and older adults in the United States. Analytic aims were informed by developmental, reserve capacity, and stress process models, which outline ways in which the preceding exposures might adversely affect psychosocial functioning, thereby increasing susceptibility to the emotional, behavioral, and biological concomitants of stress. Structural equation modeling with latent variables revealed adverse effects of childhood adversity and low SES on both psychosocial resources and psychological distress, although neither psychosocial construct was significantly associated with inflammation. Despite minimal evidence of mediation in full-sample analyses, multiple groups analyses indicated that in women, there were small but statistically significant indirect effects of both exposures on inflammation transmitted through psychological distress and bio-behavioral risk. In Blacks/African-Americans, childhood adversity exerted an indirect effect through the same pathway. Furthermore, resources and distress interacted with SES to predict inflammation in men. Contrary to hypotheses, inflammation was positively associated with resources and negatively associated with distress at higher levels of SES, effects that were not attenuated by bio-behavioral risk. However, in supplemental analyses, effects of resources and distress on IL-6 were in the expected directions at lower levels of SES. Results highlight the psychological cost of disadvantage over the life course, as well as the potential role of associated distress in pathways from social exposures to physiological dysregulation and disease risk. Results also underscore the need for further investigation of how socioeconomic and psychosocial factors interact in giving rise to systemic inflammation

Perceived control, chronic stress, and geriatric frailty: explicating frailty’s psychosocial etiology

Thesis (Ph. D.)--University of Rochester. Margaret Warner Graduate School of Education and Human Development, Department of Teaching & Curriculum, 2015.Frailty in older adults is a highly prevalent syndrome that is characterized by increased vulnerability to stressors and is more generally thought to result from dysregulation across multiple physiologic systems. Although research has long recognized that psychosocial factors including chronic stress and perceived control influence geriatric health outcomes, relatively little research has explored their etiologic role in the development of frailty. Thus, the primary purpose of this study was to close key knowledge and methodological gaps that exist within the extant literature and to develop empirically based insights into the psychosocial etiology of geriatric or phenotypic frailty, using the allostatic load model of stress and a model of perceived control as guiding theoretical frameworks. Using a population-based sample of older adults from the Health and Retirement Study, the present study found a frailty prevalence of 7-8% in study subsamples. In structural equations modeling, the present study found that perceived control fully mediated the chronic stress and baseline phenotypic frailty and change in phenotypic frailty relationship, as well partially mediated the relationship linking socioeconomic status and baseline phenotypic frailty and change in phenotypic frailty. Multiple group analyses supported hypotheses that the mediating role of control was equivalent across gender and racial subgroups. Contrary to hypotheses, the present study found no evidence to support a stress-buffering or moderating effect of perceived control on baseline or change in phenotypic frailty status. Findings from the study advance the understanding of frailty’s psychosocial etiology and underscore the importance of psychosocial factors in senescence and older adult health more generally