Care for dying patients in a skilled nursing facility: A train-the-trainer program

Session presented on Tuesday, November 10, 2015: A growing number of patients are dying in skilled nursing (SN) facilities. It is estimated that by the year 2020 up to 40% of United States\u27 deaths will occur in nursing homes. Many of the facilities are under prepared to care for patients at the end of life. In order to meet the needs of these patients, CHI Franciscan Hospice developed a train-the-trainer program in partnership with representatives from the SN facilities. Seed grant money for this project was provided by the Robert Wood Johnson Executive Nurse Alumni Association. This presentation will discuss both collaborative development of the curriculum and the results of the five session training program. The curriculum was divided into five sessions occurring one month apart. After each session, SN staff were asked to go back to their facility and do a training session based on the information and tools from that session. One of the unique aspects of this project was the opportunity to debrief at the beginning of each session. Session content included: An overview of hospice services in skilled nursing facilities including discussion of what is a good death, how to collaborate with hospice to provide care and what is the regulatory environment. Communication and relationships including discussion of advance directives, how to have difficult conversations about dying with patients and families and how to collaborate with hospice on developing a plan of care. Pain and symptom management. Regulatory and Compliance including discussion about what the regulatory environment is for both hospice and for skilled nursing facilities. Bereavement. Discussion of bereavement for families and for staff who have long-term relationships with patients. The ELNEC Geriatric Curriculum provided the evidence based framework for the sessions

Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial

Background: Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population. Methods: In a multicentre, multinational, parallel randomised controlled trial, participants aged 6–18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0–10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299. Findings: Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference −3·5 mmol/mol (95% CI −6·5 to −0·5 [–0·32 percentage points, −0·59 to −0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26–53]), but consistently high with CamAPS FX (93% [88–96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis. Interpretation: The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX

If you buy, I buy : Shopping Groups on Facebook and its impact on Fashion Consumption.

Vårt syfte med denna studie har varit att undersöka och analysera hur kommunikationen inom shoppinggrupper på Facebook påverkar kvinnliga medlemmarnas köpbeteende när det gäller modevaror samt i vilken del av köpbeslutsprocessen som kommunikationen i en shoppinggrupp verkar mest effektivt. Detta har vi sökt svar på genom enkätundersökningar samt intervjuer. Uppsatsen belyser även vilka kommunikativa faktorer inom en shoppinggrupp som stimulerar till köp av modeplagg. För att kunna analysera och diskutera och därefter komma fram till en slutsats har vi använt oss av tidigare forskning och köpbeslutsprocessen. Studien visar att shoppinggrupper har ett stort inflytande på konsumenter när det kommer till att genomföra köp av modeplagg. Konsumenter influeras av andra medlemmar genom bilder, kommentarer och rekommendationer i sin strävan efter att känna gemenskap och delaktighet i det sociala samspelet. Genom kommentarer, diskussion och kommunikation skapas samhörighet och gemenskap, vilket utgör kärnan i dessa grupper. När det kommer till konsumenternas köpbeteende framgår det utifrån resultatet att det är kommunikationen inom shoppinggrupperna som är den styrande faktorn i alla steg av köpbeslutsprocessen.Our purpose of this study has been to investigate and analyze how communication within shopping groups on Facebook affects women's buying behavior in fashionable goods and in what part of the purchasing decision-making process that the communication in a shopping group seems most effective. We have sought this through questionnaires and interviews. The essay also highlights the communicative factors within a shopping group that stimulates the purchase of fashionable items. In order to analyze and discuss and then arrive at a conclusion, we have used the previous research and purchasing decision process. The study shows that shopping groups have a major influence on consumers when it comes to buying behavior in fashionable goods. Consumers are influenced by other members through pictures, comments and recommendations. In his quest to feel community and participation in social interaction. Through comments, discussion and communication, togetherness and community are created, which forms the core of these groups. When it comes to consumer purchasing behavior, it is apparent from the result that it is the communication within the shopping groups that is the guiding factor in all stages of the purchase decision process