Training Staff in Long-Term Care Facilities-Effects on Residents' Symptoms, Psychological Well-Being, and Proxy Satisfaction

Context. Long-term care facility (LTCF) residents have unmet needs in end-of-life and symptom care. Objectives. This study examines the effects of an end-of-life care staff training intervention on LTCF residents' pain, symptoms, and psychological well-being and their proxies' satisfaction with care. Methods. We report findings from a single-blind, cluster randomized controlled trial featuring 324 residents with end-of-life care needs in 20 LTCF wards in Helsinki. The training intervention included four 4-hour educational workshops on palliative care principles (advance care planning, adverse effects of hospitalizations, symptom management, communication, supporting proxies, challenging situations). Training was provided to all members of staff in small groups. Education was based on constructive learning methods and included participants' own resident cases, role-plays, and small-group discussions. During a 12-month follow-up we assessed residents' symptoms with the Edmonton Symptom Assessment Scale (ESAS), pain with the PAINAD instrument and psychological well-being using a PWB questionnaire. Proxies' satisfaction with care was assessed using the SWC-EOLD. Results. The change in ESAS symptom scores from baseline to 6 months favored the intervention group compared with the control group. However, the finding was diluted at 12 months. PAINAD, PWB, and SWC-EOLD scores remained unaffected by the intervention. All follow-up analyses were adjusted for age, gender, do-not-resuscitate order, need for help, and clustering. Conclusion. Our rigorous randomized controlled trial on palliative care training intervention demonstrated mild effects on residents' symptoms and no robust effects on psychological well-being or on proxies' satisfaction with care. (C) 2021 The Authors. Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.Peer reviewe

Effects of Staff Training on Nursing Home Residents’ End-Of-Life Care : A Randomized Controlled Trial

Publisher Copyright: © 2021 AMDA – The Society for Post-Acute and Long-Term Care MedicinePeer reviewe

Does environmental adaptation or dispersal history explain the geographical distribution of Ixodes ricinus and Ixodes persulcatus ticks in Finland?

In Finland, the distribution area of the taiga tick, Ixodes persulcatus (Schulze, 1930), is nested within a broader area of distribution of a congeneric species, the sheep tick, Ixodes ricinus (Linnaeus, 1758) (Acari: Ixodidae). We assess whether distinct environmental adaptations or dispersal history provides a more parsimonious explanation for the differences in the distributions of the two common and medically important ixodids in Finland. We used an innovative spatially constrained randomization procedure to analyze whether crowdsourced occurrence data points of the two tick species had statistically different associations with any of the 28 environmental variables. Using points of presence in a region of species co-occurrence, we built Maxent models to examine whether environmental factors or dispersal history could explain the absence of I. persulcatus in a part of the range of I. ricinus in Finland. Five environmental variables-number of inhabitants, road length, elevation above sea level, proportion of barren bedrock and boulders, and proportion of unsorted glacial deposits-were significant at p 80%) for I. persulcatus south of its current, sharply bounded distribution range, suggesting that the species has not fulfilled its distribution potential in Finland. The two most common and medically relevant ixodids in Finland may colonize habitats with different environmental conditions. On the contrary, the recent establishment and ongoing dispersion of I. persulcatus in Fennoscandia rather than environmental conditions cause the southernmost distribution limit of the species in Finland

Training nursing home staff to improve residents' end-of-life care : design and baseline findings from a randomized controlled trial

Key summary pointsAimWe present the design, intervention, baseline findings and feasibility of a randomized, controlled trial examining the effectiveness of staff training in palliative care on nursing home residents' hospitalizations and health-related quality-of-life.FindingsMost staff members participated in the training sessions and they gave good feedback. Our patient groups are fairly well balanced in their characteristics.MessageIf our further trial shows patient-related benefits, we will have a well-defined model for improving palliative care in nursing homes. AbstractPurposeWe aim to describe the design, educational intervention, baseline findings and feasibility of our training intervention. Our trial will aim to improve the residents' health-related quality of life (HRQOL) and to reduce unnecessary hospitalizations.MethodsWe recruited 340 residents from 20 nursing home wards in Helsinki, and they were randomized into intervention and control groups. At baseline, all the participants were assessed for demographics, medical history, medication, HRQOL, symptoms, hospitalizations, advance care plans, and proxies' satisfaction with care. The staff in the intervention wards were offered four 4-h educational sessions on the principles of palliative care (advance care planning, the adverse effects of hospitalizations, symptom management, communication, giving support to proxies and challenging situations). The sessions were based on constructive learning methods and patient cases.ResultsThe mean age of residents was 84years and 76% were women. The intervention and control groups did not differ with respect to demographics, terminal diseases, comorbidities, nutritional status, cognition or the use of palliative medication. However, the control residents were more likely to be bed-bound and to have a do-not-resuscitate order on their medical chart. Of about 180 staff members, 132 completed the educational intervention. The discussions in the training sessions were lively and the participants gave an overall rating of 4.6/5 for the education.ConclusionsWe have successfully randomized nursing home wards in this trial and completed staff training with very positive feedback. If our trial shows resident-related benefits, we will have a well-defined model for improving palliative care in nursing homes. The study was registered in the Australian New Zealand Clinical Trials Registry under the intervention code: ACTRN12617001040358.Peer reviewe

Staff Training Interventions to Improve End-of-Life Care of Nursing Home Residents: A Systematic Review

Objectives: The aim was to review evidence from all randomized controlled trials (RCTs) using palliative care education or staff training as an intervention to improve nursing home residents' quality of life (QOL) or quality of dying (QOD) or to reduce burdensome hospitalizations. Design: A systematic review with a narrative summary. Setting and Participants: Residents in nursing homes and other long-term care facilities. Methods: We searched MEDLINE, CINAHL, PsycINFO, the Cochrane Library, Scopus, and Google Scholar, references of known articles, previous reviews, and recent volumes of key journals. RCTs were included in the review. Methodologic quality was assessed. Results: The search yielded 932 articles after removing the duplicates. Of them, 16 cluster RCTs fulfilled inclusion criteria for analysis. There was a great variety in the interventions with respect to learning methods, intensity, complexity, and length of staff training. Most interventions featured other elements besides staff training. In the 6 high-quality trials, only 1 showed a reduction in hospitalizations, whereas among 6 moderate-quality trials 2 suggested a reduction in hospitalizations. None of the high-quality trials showed effects on residents' QOL or QOD. Staff reported an improved QOD in 1 moderatequality trial. Conclusions and Implications: Irrespective of the means of staff training, there were surprisingly few effects of education on residents' QOL, QOD, or burdensome hospitalizations. Further studies are needed to explore the reasons behind these findings. (C) 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.Peer reviewe

Scots pine needle longevity and other shoot characteristics along pollution gradients

Abstract Branches of adult Scots pine (Pinus sylvestris L.) trees were sampled from boreal dry pine forests to study needle longevity, its variation and its relation to other shoot characteristics. The stands studied were located along transects from two smelters and one city, e.g. along gradients of pollution impact. Constant needle age structures were assumed and static life-tables generated. Mean needle longevity was calculated as the sum of the proportions of living needle fascicles on the successive annual shoots. It fully incorporated the information of the static life-tables and was preferred to median or maximum ages because of its significantly lower variation. The first half of the shedding span, the duration of the period when the needle survival gradually dropped from 90 to 50 %, proved to validly reflect the changes in the needle age structure. Needle longevity decreased 15-40 % towards the pollution sources along the transects studied. Near the smelters, needle longevity decreased with the increasing needle Fe, or Fe, Ni and Cu concentration that represented the main constituents of the airborne particle emissions. Near the city, needle longevity decreased with the increasing needle N and P concentrations, annual needle mass and needle mass packing and decreasing needle area packing. In the urban forests, needle Mg, P and K concentrations decreased linearly with the decreasing needle survival from the second to the fourth needle age class. Concentrations in the living needles of the fourth age class stayed over 80 % of the average for all the age classes, though needle survival dropped below 50 %. A decreasing needle Mn concentration was detected towards all the emission sources. Leaching, especially from the soil, as a possible cause was discussed. Needle longevity had the lowest variation among the shoot characteristics, which increases its value as a tool in ecological monitoring. Low plasticity in needle longevity could be an acclimation to the ambient environmental conditions and length of the growing season and to maximise the carbon gain per time. Needle longevity decreased and annual needle mass and leaf mass per area increased upwards in the crowns of mature Scots pines, reflecting the acclimation to irradiance

Needle surface micromorphology of Pinus Sylvestris near an oil refinery in Lithuania

Konferencija: Development of environmentally friendly plant protection in the Baltic region location: proceedings of the international conference, Tartu, Estonia, September 28-29, 2000. ISBN 9985882776Gamtos mokslų fakultetasVytauto Didžiojo universitetasŽemės ūkio akademij

Does environmental adaptation or dispersal history explain the geographical distribution of Ixodes ricinus and Ixodes persulcatus ticks in Finland?

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