How to assess and manage frailty in patients with HIV

As a result of the successful treatment of HIV over the last four decades, people living with HIV (PLWH) can now expect a near normal life expectancy1. This change in demographic alongside later life acquisition of HIV2, has resulted in clinical services now seeing an older HIV cohort, with patients experiencing many of the problems of an older HIV-negative cohort such as multiple medical diagnoses, polypharmacy and frailty

The impact of person-centred care on patient safety: An umbrella review of systematic reviews.

BACKGROUND:Nursing literature frequently emphasises the benefits of person-centred approaches for healthcare quality and safety. OBJECTIVE:This umbrella review aimed to synthesise the combined evidence from systematic reviews assessing the impact of person-centred care interventions on patient safety. DESIGN:A three-step review process included a preliminary review of literature, a comprehensive search, and manual searching of reference lists and forward citations of selected reviews. The review protocol was registered with Prospero (CRD42018090048). DATA SOURCES:Reviewers searched 10 databases for systematic reviews published in English-language peer-reviewed journals between 2000 and 2019: Academic Search Complete, CINAHL, Cochrane Library, EMBASE, JBI Database, Medline, ProQuest Health & Medicine, PROSPERO Register, PubMed and Scopus. REVIEW METHODS:Covidence software was used to manage screening and eligibility. Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using the JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses. RESULTS:From an initial total of 3412 potential titles, 16 reviews met the inclusion criteria. The selected reviews examined the impact of person-centred care for diverse groups of patients (children, adults and older people) in varied settings. Most systematic reviews assessed experimental studies, generally comparing person-centred interventions with 'usual care', often demonstrating limited evidence of impact on safety. Reviews addressed several patient safety outcomes relevant to nursing, including falls, infections, medication use and misuse, and mortality rates. The systematic reviews were generally well conducted, although several included studies of poor or fair quality. Given the heterogeneity of the interventions, outcomes and research designs of studies included in the selected reviews, we were unable to draw unequivocal conclusions about the implications of person-centred care for patient safety in this umbrella review. However, there was some encouraging evidence that person-centred care initiatives may result in reduced rates of falls (in acute care and residential aged care settings). The review also highlighted reductions in agitation for people with dementia and some improvement in anti-psychotic medication use in older people with dementia. CONCLUSIONS:Although abundant evidence exists demonstrating the positive effects of person-centred care on healthcare quality and on patient (and provider) wellbeing, there is little research focussing specifically on the impact of person-centred care on patient safety. Thus, there is scope for further high-quality nursing research into how person-centred interventions improve specific patient safety outcomes in order to inform more widespread adoption of person-centred practice

Neutron inelastic scattering investigation of the magnetic excitations in Cu_2Te_2O_5X_2 (X=Br, Cl)

Neutron inelastic scattering investigations have been performed on the spin tetrahedral system Cu_2Te_2O_5X_2 (X = Cl, Br). We report the observation of magnetic excitations with a dispersive component in both compounds, associated with the 3D incommensurate magnetic order that develops below $T^{Cl}_{N}$=18.2 K and $T^{Br}_{N}$=11.4 K. The excitation in Cu_2Te_2O_5Cl_2 softens as the temperature approaches $T^{Cl}_{N}$, leaving diffuse quasi-elastic scattering above the transition temperature. In the bromide, the excitations are present well above $T^{Br}_{N}$, which might be attributed to the presence of a degree of low dimensional correlations above $T^{Br}_{N}$ in this compound

Psycholinguistic profiling of a deaf child with additional literacy difficulties: A single case study

A study by Susan Ebbels (2000) showed that it was possible to use the Stackhouse & Wells (1997) psycholinguistic framework to plan and interpret an investigation of a hearing-impaired child's speech processing skills in order to determine points of breakdown and so inform therapy. The first aim of this study was to examine the speech processing abilities of a ten year old hearing-impaired boy with speech difficulties using the Stackhouse & Wells (1997) psycholinguistic framework. The subject chosen had literacy difficulties that did not seem to be wholly accounted for by his hearing loss. This led to the study's second aim of using a psycholinguistic hypothesis-led approach to investigate and determine the reasons for the additional literacy difficulties of a hearing-impaired child. Thus the study used a psycholinguistic approach to identify the root of speech processing and literacy difficulties experienced by a hearing-impaired child. It was found that, despite his hearing impairment and output difficulties for certain consonant clusters, the subject's speech production was not affected by poor auditory discrimination or phonological representations, but that he had faulty motor programmes for some words, in line with the phenomenon of 'frozen phonology'. An exploration of the reasons for his literacy difficulties uncovered phonological awareness difficulties, particularly with blending and segmenting of words and found that his knowledge of the letter-to-sound relationship for vowels was extremely poor. A set of picture/word/sound colour cards was used to teach the sounds associated with a set of vowels, as suggested by Broomfield and Combley (2003). One teaching session was found to improve the subject's ability to correctly read the vowels taught, thus demonstrating his potential to acquire this skill

'Grey nomad' travellers' use of remote health services in Australia: a qualitative enquiry of hospital managers' perspectives.

BACKGROUND: For more than the last two decades, older Australians travelling domestically in self-sufficient accommodation and recreational vehicles for extended periods of time have been referred to as 'Grey Nomads'. By 2021 more than 750,000 such recreational vehicles were registered in Australia. Tourism data for the year to September 2017 show 11.8 million domestic camping and caravanning trips in Australia, 29% of which were people aged 55 and over. As the 'baby boomer' generation increasingly comes to retirement, the size of this travelling population is growing. This term applies to the spike in birth rates after World War II from 1946-1964. This growing group of domestic travellers are potential healthcare consumers in remote areas but relatively little is known about their travel, healthcare needs or care seeking practices. Grey nomads have been described as reflective of the age-comparable sector of the Australian population in that many live with chronic illness. Early concerns were raised that they may "burden" already stretched rural and remote healthcare services but relatively little is known about the impact of these travellers. METHODS: The aim of this study was to explore the utilisation of healthcare services in remote locations in Australia by grey nomads including women travellers, from the perspective of healthcare professionals working in these settings. The study objective was to interview healthcare professionals to seek their experience and details of service delivery to grey nomads. In March 2020 [prior to state border closures due to the COVID-19 pandemic] a field study was conducted to identify the impact of grey nomads on healthcare services in remote New South Wales and Queensland. A qualitative approach was taken to explore the perspectives of nursing healthcare managers working in remote towns along a popular travel route. With appropriate Research Ethics Committee approval, managers were purposively sampled and sample size was determined by data saturation. Thirteen managers were contacted and twelve interviews were scheduled to take place face to face in the healthcare facilities (small hospitals with acute care and aged care services) at mutually convenient times. A semi-structured interview schedule was developed in line with the research aim. The interviews were audio-recorded, transcribed and thematic analysis was undertaken concurrently with data collection for ongoing refinement of questions and to address emerging issues. RESULTS: These nursing managers described a strong service and community ethos. They regarded travellers' healthcare needs no differently to those of local people and described their strong commitment to the provision of healthcare services for their local communities, applying an inclusive definition of community. Traveller presentations were described as predominantly exacerbations of chronic illness such as chest pain, medication-related attendances, and accidents and injuries. No hospital activity data for traveller presentations were available as no reports were routinely generated. Travellers were reported as not always having realistic expectations about what healthcare is available in remote areas and arriving with mixed levels of preparedness. Most travellers were said to be well-prepared for their travel and self-management of their health. However, the healthcare services that can be provided in rural and remote areas needed to be better understood by travellers from metropolitan areas and their urban healthcare providers. CONCLUSION: Participants did not perceive travellers as a burden on health services but recommendations were made regarding their expectations and preparedness. Australia's national transition to electronic health records including a patient-held record was identified as a future support for continuity of care for travellers and to facilitate treatment planning. With no current information to characterise traveller presentations, routinely collected hospital data could be extracted to characterise this patient population, their presentations and the resources required to meet their care needs

The Postoperative Morbidity Survey was validated and used to describe morbidity after major surgery.

OBJECTIVES: To describe the reliability and validity of the Postoperative Morbidity Survey (POMS). To describe the level and pattern of short-term postoperative morbidity after major elective surgery using the POMS. STUDY DESIGN AND SETTING: This was a prospective cohort study of 439 adults undergoing major elective surgery in a UK teaching hospital. The POMS, an 18-item survey that address nine domains of postoperative morbidity, was recorded on postoperative days 3, 5, 8, and 15. RESULTS: Inter-rater reliability was perfect for 11/18 items (Kappa=1.0), with Kappa=0.94 for 6/18 items. A priori hypotheses that the POMS would discriminate between patients with known measures of morbidity risk, and predict length of stay were generally supported through observation of data trends, and there was statistically significant evidence of construct validity for all but the wound and neurological domains. POMS-defined morbidity was present in 325 of 433 patients (75.1%) remaining in hospital on postoperative day 3 after surgery, 231 of 407 patients (56.8%) on day 5, 138 of 299 patients (46.2%) on day 8, and 70 of 111 patients (63.1%) on day 15. Gastrointestinal (47.4%), infectious (46.5%), pain-related (40.3%), pulmonary (39.4%), and renal problems (33.3%) were the most common forms of morbidity. CONCLUSION: The POMS is a reliable and valid survey of short-term postoperative morbidity in major elective surgery. Many patients remain in hospital without any morbidity as recorded by the POMS

Truncation in the tcdC region of the Clostridium difficile PathLoc of clinical isolates does not predict increased biological activity of Toxin B or Toxin A

<p>Abstract</p> <p>Background</p> <p>The increased severity of disease associated with the NAP1 strain of <it>Clostridium difficile </it>has been attributed to mutations to the <it>tcdC </it>gene which codes for a negative regulator of toxin production. To assess the role of hyper-production of Toxins A and B in clinical isolates of <it>Clostridium difficile</it>, two NAP1-related and five NAP1 non-related strains were compared.</p> <p>Methods</p> <p>Sequencing was performed on <it>tcdC</it>, <it>tcdR</it>, and <it>tcdE</it> to determine if there were differences that might account for hyper-production of Toxin A and Toxin B in NAP1-related strains. Biological activity of Toxin B was evaluated using the HFF cell CPE assay and Toxin A biological activity was assessed using the Caco-2 Trans-membrane resistance assay.</p> <p>Results</p> <p>Our results confirm that Toxin A and Toxin B production in NAP1-related strains and ATCC 43255 occurs earlier in the exponential growth phase compared to most NAP1-nonrelated clinical isolates. Despite the hyper-production observed in ATCC 43255 it had no mutations in <it>tcdC</it>, <it>tcdR </it>or <it>tcdE</it>. Analysis of the other clinical isolates indicated that the kinetics and ultimate final concentration of Toxin A and B did not correlate with the presence or lack of alterations in <it>tcdC</it>, <it>tcdR </it>or <it>tcdE</it>.</p> <p>Conclusion</p> <p>Our data do not support a direct role for alterations in the <it>tcdC </it>gene as a predictor of hyperproduction of Toxin A and B in NAP1-related strains.</p

Staff perceptions on the role and value of chaplains in first responder and military settings: A scoping review

Background&#x0D; Chaplains in first responder and military services support staff prior to, during and after critical incidents. Some studies have explored the role of chaplains in these settings predominantly in the military and from chaplains’ perspectives. However, few studies have explored the perspective of staff. This scoping review aims to map the literature on staff perceptions of the role and value of chaplains in first responder and military settings.&#x0D;  &#x0D; Method&#x0D; A scoping review using the Arksey &amp; O’Malley (2003) and Joanna Briggs Institute Scoping Review Methodology was conducted. English language peer-reviewed and grey literature in CINAHL, PubMed, PsychINFO, ProQuest and Google Scholar from 2004-2019 was reviewed for inclusion. Records were included if they provided staff perspectives on the role and value of chaplains in first responder and military settings. The initial search identified 491 records after removal of duplicates. All titles and abstracts were then screened for relevance to the research question and 84 were selected for full-text review. Seven records were included in final review; five dissertations and two peer-reviewed articles. Five of these were from the military and two from the police. Data were extracted and thematically analysed to identify staff perceptions of the role, skills and attributes, and value of chaplains in first responder and military settings.&#x0D;  &#x0D; Results &#x0D; Staff understood the role of chaplain to include the provision of spiritual and pastoral care and guidance and, in the case of police, providing scene support. Staff from all of the services identified requisite skills and attributes for chaplains such as being available, approachable and engaged; counselling; maintaining confidentiality and trust; being organisationally aware; and possessing distinct personality traits and knowledge of specialty content areas. The value chaplains brought to their services emerged from chaplains being trusted as a result of being proactively available for staff, families and bystanders for formal and informal conversation; organisational belonging and awareness resulting in enhanced staff satisfaction and retention; and promoting staff physical, mental, social and spiritual wellbeing.&#x0D;  &#x0D; Conclusions&#x0D; Although military and police staff identified spiritual, psychological and social benefits to chaplains maintaining an active and visible role in their services, the small number of papers identified make generalisation of these findings to other first responder services problematic. Further research is therefore required to understand the impact of the chaplain’s role as part of the care team in first responder services.</jats:p

A Cross‐Sectional Assessment of Frailty, Falls and Perceptions of Ageing in People Living with HIV Using an mHealth Platform

Objective: To evaluate frailty, falls and perceptions of ageing among clinically stable individuals with HIV, engaged with remote healthcare delivered via a novel smartphone application. Methods: This was a multi-centre European cross-sectional, questionnaire-based sub-study of EmERGE participants. Frailty was assessed using the five-item FRAIL scale. Present criteria were summed and categorized as follows: 0, robust; 1-2, pre-frail; 3-5, frail. Falls history and EQ-5D-5L quality of life measure were completed. Participants were asked their felt age and personal satisfaction with ageing. Results: A total of 1373 participated, with a mean age of 45 (± 9.8) years. Frailty was uncommon at 2%; 12.4% fell in the previous year, 58.8% of these recurrently. Mood symptoms and pain were prevalent, at 43.3% and 31.8%, respectively. Ageing satisfaction was high at 76.4%, with 74.6% feeling younger than their chronological age; the mean felt age was 39.3 years. In multivariable analysis, mood symptoms and pain were positively associated with frailty, falls and ageing dissatisfaction. An increase in pain severity and mood symptoms were respectively associated with 34% and 63% increased odds of pre-frailty/frailty. An increment in pain symptoms was associated with a 71% increase in odds of falling. Pain was associated with ageing poorly, as were mood symptoms, with odds of dissatisfaction increasing by 34% per increment in severity. Conclusions: Although uncommon, frailty, falls and ageing dissatisfaction were seen in a younger cohort with medically stable HIV infection using a remote care model, promoting screening as advocated by European guidelines. These were more common in those with pain or mood symptoms, which should be proactively managed in clinical care and explored further in future research.info:eu-repo/semantics/publishedVersio