Assessment of an audit-feedback instrument for oral health care facilities in South Africa

Published ArticleThe assessment of an audit-feedback instrument (AFI) for infection prevention and control was conducted on a population of South African oral health care facilities, mainly to test its workability in the varied facility configurations. A purposive selection strategy was followed, selecting 50 South African oral health care facilities. Results from 49 completed AFIs revealed demographic details and information on infection prevention and control practices for the 11 AFI focus areas: Administrative controls; personnel protection controls; environmental- and work controls; surface contamination management; equipment maintenance; air- and waterline management; personal protective equipment usage; personal- and hand hygiene practices; sterilisation practices; sharps handling and waste management. None of the participating facilities demonstrated 100% compliance. Notably, administrative controls and air- and waterline management scored the lowest mean values; 31% and 36% respectively, while personal- and hand hygiene practices and waste management performed the best, at respectively 75% and 63%. The general lack of compliance with infection prevention and control precautions in the participating oral health care facilities clearly poses a safety hazard to patients and oral health care workers. These findings demonstrate the urgent need for a monitoring system, such as the AFI, to be instituted in South African oral health care facilities

3D digital geometry designs for Poland’s syndrome using Magics and Geomagic® Freeform®

Published ArticlePurpose – Poland’s syndrome patients often seek medical interventions to improve their aesthetic appearances. Design and manufacturing technologies make it possible to produce custom-made implants for such medical conditions. The purpose of this study was to compare the 3D digital geometries that were designed using Magics and Geomagic® Freeform® for two anonymous case studies of Poland’s syndrome patients. Design/methodology/approach – Computed tomography data were acquired and processed in Mimics® to isolate the pectoralis muscles in STL file format. STL files were imported into Magics and Geomagic® Freeform® to design 3D digital geometries. Thereafter, comparative analyses were performed of the respective 3D digital geometries. Findings – The angle between the vertical and oblique planes for both sides of the thorax was 6.5° for the female and 14° for the male. The surface areas and volumes of the geometries for the female were smaller than the male. Deviation analyses between the healthy side and reconstructed side of a thorax showed that 73 per cent of the test points for Magics and 78 per cent for Geomagic® Freeform® fell in the nominated tolerance region of > 5 and <15 mm for the female. For the male, it was 83 per cent for Magics and 88 per cent for Geomagic® Freeform®. Practical implications – Geomagic® Freeform® provides a more versatile design environment; however, the STL editor Magics may be an option to design 3D geometries for less intricate and less contoured implants. Originality/value – This was a first attempt to compare the 3D geometries for Poland’s syndrome designed with an STL editor to those designed with a computer-aided design program

Helping staff to implement psychosocial interventions in care homes: Augmenting existing practices and meeting needs for support

This is the author accepted manuscript. The final version is available from Wiley via the DOI in this recordObjective To contribute to an optimised training programme for care staff that supports the implementation of evidence-based psychosocial interventions in long-term care. Methods Qualitative study that involved focus group discussions with 119 care home staff within 16 care homes in the UK. Part of wider clinical trial aimed at developing and evaluating an effective and practical psychosocial intervention and implementation approach for people with dementia in long-term care. Inductive thematic analysis was used to identify themes and interpret the data. Results The findings highlighted that successful training and support interventions must acknowledge and respond to 'whole home' issues. Three overarching themes emerged as influential: the importance of contextual factors such as staff morale, interpersonal relationships within the home, and experience and perceived value of the proposed intervention. Conclusions Priority must be given to obtain the commitment of all staff, management and relatives to the training programme and ensure that expectations regarding interaction with residents, participation in activities and the reduction of medication are shared across the care home.National Institute for Health Research (NIHR

Improving quality of life for people with dementia in care homes: Making psychosocial interventions work

This is the author accepted manuscript. The final version is available from Cambridge University Press via the DOI in this recordPsychosocial interventions can improve behaviour and mood in people with dementia, but it is unclear how to maximise their effectiveness or acceptability in residential settings. Aims To understand what underlies the successful implementation of psychosocial interventions in care homes. Method Systematic review and meta-synthesis of qualitative research. Results The synthesis of 39 qualitative papers revealed that beneficial psychosocial interventions met the needs of people with dementia to connect with others, make a meaningful contribution and reminisce. Successful implementation rested on the active engagement of staff and family and the continuing provision of tailored interventions and support. This necessitated staff time, and raised issues around priorities and risk, but ultimately helped redefine staff attitudes towards residents and the caregiving role. Conclusions The findings from the meta-synthesis can help to inform the development and evaluation of psychosocial interventions in care homes and support their widespread implementation in clinical settings.National Institute for Health Research (NIHR

The disconnect between evidence and practice: A systematic review of person-centred interventions and training manuals for care home staff working with people with dementia

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this recordObjective The overall objective is to determine the availability of person-centred intervention and training manuals for dementia care staff with clinical trial evidence of efficacy. Design Interventions were identified using a search of electronic databases, augmented by mainstream search engines, reference lists, hand searching for resources and consultation with an expert panel. The specific search for published manuals was complemented by a search for randomised control trials focussing on training and activity-based interventions for people with dementia in care homes. Manuals were screened for eligibility and rated to assess their quality, relevance and feasibility. Results A meta-analysis of randomised control trials indicated that person-centred training interventions conferred significant benefit in improving agitation and reducing the use of antipsychotics. Each of the efficacious packages included a sustained period of joint working and supervision with a trained mental health professional in addition to an educational element. However, of the 170 manuals that were identified, 30 met the quality criteria and only four had been evaluated in clinical trials. Conclusions Despite the availability of a small number of evidence-based training manuals, there is a widespread use of person-centred intervention and training manuals that are not evidence-based. Clearer guidance is needed to ensure that commissioned training and interventions are based on robust evidence. Copyright © 2014 John Wiley & Sons, Ltd.National Institute for Health Research (NIHR

Practitioners’ understanding of barriers to accessing specialist support by family carers of people with dementia in distress

Distressing symptoms in dementia are hard to manage for many family carers. This article explores practitioners' perceptions of the barriers to accessing skilled behaviour management support encountered by carers. A survey of cases referred to the English National Health Service (n = 5,360) was followed by in-depth group discussions and practitioner interviews. Data revealed that practitioners focused on care home residents or older people with mental health problems other than dementia, rather than community-dwelling people with dementia and families. Barriers to access included misperceptions about the nature of distressing behaviour affecting carers and structural limitations in the capacity of specialist services to respond to carers

The value of personalized psychosocial interventions to address behavioral and psychological symptoms in people with dementia living in care home settings: A systematic review

This is the author accepted manuscript. the final version is available from Cambridge University Press via the DOI in this recordBackground: Several important systematic reviews and meta-Analyses focusing on psychosocial interventions have been undertaken in the last decade. However, they have not focused specifically on the treatment of individual behavioral and psychological symptoms of dementia (BPSD) with personalized interventions. This updated systematic review will focus on studies reporting the effect of personalized psychosocial interventions on key BPSD in care homes. Methods: Systematic review of the evidence for psychosocial interventions for BPSD, focusing on papers published between 2000 and 2012. All care home and nursing home studies including individual and cluster randomized controlled trials (RCTs) and pre-/post-Test studies with control conditions were included. Results: 641 studies were identified, of which 40 fulfilled inclusion and exclusion criteria. There was good evidence to support the value of personalized pleasant activities with and without social interaction for the treatment of agitation, and reminiscence therapy to improve mood. The evidence for other therapies was more limited. Conclusions: There is a growing body of evidence indicating specific effects of different personalized psychosocial interventions on individual BPSD and mood outcomes. Copyright © International Psychogeriatric Association 2014

Detection of a transit by the planetary companion of HD 80606

We report the detection of a transit egress by the ~ 3.9-Jupiter-mass planet HD 80606b, an object in a highly-eccentric orbit (e ~ 0.93) about its parent star of approximately solar type. The astrophysical reality of the signal of variability in HD 80606 is confirmed by observation with two independent telescope systems, and checks against several reference stars in the field. Differential photometry with respect to the nearby comparison star HD 80607 provides a precise light curve. Modelling of the light curve with a full eccentric-orbit model indicates a planet/star-radius ratio of 0.1057 +/- 0.0018, corresponding to a planet radius of 1.029 R_J for a solar-radius parent star; and a precise orbital inclination of 89.285 +/- 0.023 degrees, giving a total transit duration of 12.1 +/- 0.4 hours. The planet hence joins HD 17156b in a class of highly eccentric transiting planets, in which HD 80606b has both the longest period and most eccentric orbit. The recently reported discovery of a secondary eclipse of HD 80606b by the Spitzer Space Observatory permits a combined analysis with the mid-time of primary transit in which the orbital parameters of the system can be tightly constrained. We derive a transit ephemeris of T_tr = HJD (2454876.344 +/- 0.011) + (111.4277 +/- 0.0032) E.Comment: Accepted for publication in MNRAS Letter