Older adults as simulated participants: a scoping review

AbstractIntroductionSimulated participants (SPs) can support development of competencies associated with person-centred care of older adults. There is limited information and understanding about working with older adult SPs and those who support them to create authentic, safe and effective simulations. This review aimed to review simulation literature focused on the care of older adults to explore and summarize what is known about working with older adults as SPs in healthcare providers’ education.MethodsThis scoping review followed Arksey and O’Malley’s five-stage approach, involving identification, selection, charting, collating, summarizing and reporting on results. Databases searched included MEDLINE, PsychINFO and EBSCO. To capture additional articles, we hand-searched the reference lists of articles selected for inclusion, MedEdPORTAL and Google Scholar.ResultsFrom the initial 816 citations identified, 12 articles were in scope. Articles were either research or educational guides. Findings related to general characteristics of articles, description of SPs, conceptualization of SP role/scenario, SP preparation and scenario implementation.DiscussionOlder adult SPs contribute to healthcare provider training in authentic, engaging, safe and effective ways. This scoping review provides a foundation on which to further develop older adult SP practices by highlighting their well-being and safety (both physical and psychological), promoting ways to increase diversity and inclusion, and emphasizing that the words we use matter. Improved reporting details of articles involving older adult SPs will facilitate the identification of effective practices

Introducing Interprofessional Education and Care Concepts in a Geriatric Multilevel Centre: Development and Introduction of a Toolkit for Staff and Students

Background: Although interprofessional education (IPE) is not new, there has been limited research in IPE focused on the care of older adults. The objective of this study was to develop and implement an interprofessional education and care (IPE/C) toolkit, to help staff and students understand and apply the concepts of IPE/C.Methods and Findings: Focus groups identified staff and students’ understanding of IPE/C and informed development of an IPE/C toolkit comprised of IPE/C tools and resources. Five clinical teams (N = 51) attended workshops that introduced the toolkit and educated teams about IPE/C. Focus group participants had heard of but had limited exposure to IPE/C. Responses to the Attitudes Toward Health Care Teams (ATHT) questionnaire indicated a positive trend on all questions; 2 questions in subscale 1 were statistically significant (p = .01 & p = .005), indicating a positive attitude toward teams and teamwork. Several limitations were identified, including inconsistent attendance at workshops, scheduling challenges, and limited physician participation.Conclusions: This pilot project provided baseline data on staff and students’ understanding of and attitudes toward IPE/C in a multilevel geriatric centre and demonstrated that an IPE/C toolkit delivered via team workshops can enhance healthcare team attitudes. Next steps include expanding the rollout to other teams and introducing the toolkit to all staff and students

Delayed administration of dopaminergic drugs is not associated with prolonged length of stay of hospitalized patients with Parkinson's disease

Background: Punctual delivery of dopaminergic medication to Parkinson's disease (PD) patients may be important in optimizing disease control. We tested the hypothesis that prompt delivery of l-dopa medications to emergency hospital inpatients was associated with a decreased length of stay in hospital. Methods: The study population consisted of all urgent hospitalizations for patients with a diagnosis of PD to the Royal Derby Hospital over a two-year period. Data were extracted on timing of delivery of drugs, number of co-morbidities and length of stay. Statistical analysis used linear regression adjusting for within admission clustering. Results: 431 individuals provided data from a total of 737 admissions. 39% of scheduled l-dopa doses were either not given or administered over 30 min later than the scheduled time. There was no association between the omission or timing of a dose of PD medication and length of stay in hospital. The number of coded diagnoses was strongly associated with length of stay with a dose-response association (pTREND<0.001). Those with 10 concurrent diagnoses had a 11 day longer stay (95% confidence intervals: +2 to +21) than those with no comorbidities. Conclusions Delayed administration of dopaminergic drugs is not associated with prolonged length of stay of in patients with PD who were admitted to hospital as an emergency. However, the number of co-existing medical diagnoses was associated with length of stay, and early attention to these has the potential to improve patient care and decrease length of stay in hospital

miRNA contributions to pediatric-onset multiple sclerosis inferred from GWAS.

ObjectiveOnset of multiple sclerosis (MS) occurs in childhood for approximately 5% of cases (pediatric MS, or ped-MS). Epigenetic influences are strongly implicated in MS pathogenesis in adults, including the contribution from microRNAs (miRNAs), small noncoding RNAs that affect gene expression by binding target gene mRNAs. Few studies have specifically examined miRNAs in ped-MS, but individuals developing MS at an early age may carry a relatively high burden of genetic risk factors, and miRNA dysregulation may therefore play a larger role in the development of ped-MS than in adult-onset MS. This study aimed to look for evidence of miRNA involvement in ped-MS pathogenesis.MethodsGWAS results from 486 ped-MS cases and 1362 controls from the U.S. Pediatric MS Network and Kaiser Permanente Northern California membership were investigated for miRNA-specific signals. First, enrichment of miRNA-target gene network signals was evaluated using MIGWAS software. Second, SNPs in miRNA genes and in target gene binding sites (miR-SNPs) were tested for association with ped-MS, and pathway analysis was performed on associated target genes.ResultsMIGWAS analysis showed that miRNA-target gene signals were enriched in GWAS (P = 0.038) and identified 39 candidate biomarker miRNA-target gene pairs, including immune and neuronal signaling genes. The miR-SNP analysis implicated dysregulation of miRNA binding to target genes in five pathways, mainly involved in immune signaling.InterpretationEvidence from GWAS suggests that miRNAs play a role in ped-MS pathogenesis by affecting immune signaling and other pathways. Candidate biomarker miRNA-target gene pairs should be further studied for diagnostic, prognostic, and/or therapeutic utility

Implementation of a Mental Health Guideline in a Long-Term Care Home: A Participatory Action Approach

AbstractBackground: The goal of this pilot study was to implement a Canadian mental health guideline in a long-term care residence in order to improve interprofessional care of clients with mood and behavioural issues.Methods: Using a participatory action approach, this pilot study engaged staff/physicians, residents, and families in identifying key priorities for action related to the goal of improving interprofessional care. This resulted in the implementation of educational interventions, a mandate for non-registered nursing staff to attend interprofessional rounds, and enhanced interprofessional collaboration through unit-based huddles. A staff satisfaction survey and focus groups were conducted to assess perceptions of change.Findings: The staff satisfaction survey revealed statistically significant improvements in perceived job satisfaction, leadership, and workplace resources. Focus group findings indicated improved interprofessional collaboration, teamwork, support, and communication. Staff noted a stronger perception of being valued and increased confidence in their own contributions.Conclusions: Both qualitative and quantitative improvements were noted in staffjob satisfaction. Despite some limitations, these findings suggest that further dissemination of this initiative with rigorous evaluation is warranted

Mycobiome Sequencing and Analysis Applied to Fungal Community Profiling of the Lower Respiratory Tract During Fungal Pathogenesis

Invasive fungal infections are an increasingly important cause of human morbidity and mortality. We generated a next-generation sequencing (NGS)-based method designed to detect a wide range of fungi and applied it to analysis of the fungal microbiome (mycobiome) of the lung during fungal infection. Internal transcribed spacer 1 (ITS1) amplicon sequencing and a custom analysis pipeline detected 96% of species from three mock communities comprised of potential fungal lung pathogens with good recapitulation of the expected species distributions (Pearson correlation coefficients r = 0.63, p = 0.004; r = 0.71, p < 0.001; r = 0.62, p = 0.002). We used this pipeline to analyze mycobiomes of bronchoalveolar lavage (BAL) specimens classified as culture-negative (n = 50) or culture-positive (n = 39) for Blastomyces dermatitidis/gilchristii, the causative agent of North America blastomycosis. Detected in 91.4% of the culture-positive samples, Blastomyces dominated (>50% relative abundance) the mycobiome in 68.6% of these culture-positive samples but was absent in culture-negative samples. To overcome any bias in relative abundance due to between-sample variation in fungal biomass, an abundance-weighting calculation was used to normalize the data by accounting for sample-specific PCR cycle number and PCR product concentration data utilized during sample preparation. After normalization, there was a statistically significant greater overall abundance of ITS1 amplicon in the Blastomyces-culture-positive samples versus culture-negative samples. Moreover, the normalization revealed a greater biomass of yeast and environmental fungi in several Blastomyces-culture-positive samples than in the culture-negative samples. Successful detection of Coccidioides, Scedosporium, Phaeoacremonium, and Aspergillus in 6 additional culture-positive BALs by ITS1 amplicon sequencing demonstrates the ability of this method to detect a broad range of fungi from clinical specimens, suggesting that it may be a potentially useful adjunct to traditional fungal microbiological testing for the diagnosis of respiratory mycoses

A core outcome set for neonatal abstinence syndrome: Study protocol for a systematic review, parent interviews and a Delphi survey

Background: The prevalence of neonatal abstinence syndrome (NAS) is increasing globally resulting in an increased incidence of adverse neonatal outcomes and health system costs. Evidence regarding the effectiveness of NAS prevention and management strategies is very weak and further research initiatives are critically needed to support meta-analysis and clinical practice guidelines. In NAS research, the choice of outcomes and the use of valid, responsive and feasible measurement instruments are crucial. There is currently no consensus and evidence-based core outcome set (COS) for NAS. Methods/design: The development of the NAS-COS will include five stages led by an international Multidisciplinary Steering Committee: (1) qualitative interviews with parents/families and a systematic review (SR) to identify items for inclusion in a COS. The SR will also identify participants for the Delphi survey, (2) a three-round Delphi survey to gain expert opinion on the importance of health outcomes influencing NAS management decisions, (3), a consensus meeting to finalize the items and definitions with experts and COS users, (4) feasibility and pilot testing, development of the COS and explanatory document and (5) implementation planning. Discussion: Since standardized outcome measurement and reporting will improve NAS clinical research consistency, efficacy and impact, this COS will reflect the minimum set of health outcomes which should be measured in trials evaluating interventions for preventing or treating NAS

From St. Petersburg to Krushchev\u27s Boot

Program for the first annual RISD Cabaret held in Memorial Hall. Design and layout by Justin Kerr.https://digitalcommons.risd.edu/liberalarts_cabaret_programs/1000/thumbnail.jp