Protocol for a randomised controlled trial of an outreach support program for family carers of older people discharged from hospital

Background: Presentations to hospital of older people receiving family care at home incur substantial costs for patients, families, and the health care system, yet there can be positive carer outcomes when systematically assessing/addressing their support needs, and reductions in older people's returns to hospital attributed to appropriate discharge planning. This study will trial the Further Enabling Care at Home program, a 2-week telephone outreach initiative for family carers of older people returning home from hospital. Hypotheses are that the program will (a) better prepare families to sustain their caregiving role and (b) reduce patients' re-presentations/readmissions to hospital, and/or their length of stay; also that reduced health system costs attributable to the program will outweigh costs of its implementation. Methods/Design: In this randomised controlled trial, family carers of older patients aged 70+ discharged from a Medical Assessment Unit in a Western Australian tertiary hospital, plus the patients themselves, will be recruited at discharge (N = 180 dyads). Carers will be randomly assigned (block allocation, assessors blinded) to receive usual care (control) or the new program (intervention). The primary outcome is the carer's self-reported preparedness for caregiving (Preparedness for Caregiving Scale administered within 4 days of discharge, 2-3 weeks post-discharge, 6 weeks post-discharge). To detect a clinically meaningful change of two points with 80 % power, 126 carers need to complete the study. Patients' returns to hospital and subsequent length of stay will be ascertained for a minimum of 3 months after the index admission. Regression analyses will be used to determine differences in carer and patient outcomes over time associated with the group (intervention or control). Data will be analysed using an Intention to Treat approach. A qualitative exploration will examine patients' and their family carers' experiences of the new program (interviews) and explore the hospital staff's perceptions (focus groups). Process evaluation will identify barriers to, and facilitators of, program implementation. A comprehensive economic evaluation will determine cost consequences. Discussion: This study investigates a novel approach to identifying and addressing family carers' needs following discharge from hospital of the older person receiving care. If successful, the program has potential to be incorporated into routine post-discharge support. Trial registration: Australian and New Zealand Clinical Trial Registry: ACTRN12614001174673

On the Gibbs states of the noncritical Potts model on Z^2

We prove that all Gibbs states of the q-state nearest neighbor Potts model on Z^2 below the critical temperature are convex combinations of the q pure phases; in particular, they are all translation invariant. To achieve this goal, we consider such models in large finite boxes with arbitrary boundary condition, and prove that the center of the box lies deeply inside a pure phase with high probability. Our estimate of the finite-volume error term is of essentially optimal order, which stems from the Brownian scaling of fluctuating interfaces. The results hold at any supercritical value of the inverse temperature.Comment: Minor typos corrected after proofreading. Final version, to appear in Probab. Theory Relat. Field

MRI of the kidney—state of the art

Ultrasound and computed tomography (CT) are modalities of first choice in renal imaging. Until now, magnetic resonance imaging (MRI) has mainly been used as a problem-solving technique. MRI has the advantage of superior soft-tissue contrast, which provides a powerful tool in the detection and characterization of renal lesions. The MRI features of common and less common renal lesions are discussed as well as the evaluation of the spread of malignant lesions and preoperative assessment. MR urography technique and applications are discussed as well as the role of MRI in the evaluation of potential kidney donors. Furthermore the advances in functional MRI of the kidney are highlighted

Kontrastmittelfreie quantitative Messung der Perfusion der Unterschenkelmuskulatur mittels MR-Spektroskopie-basierter Arterial Spin Labeling (ASL) Technik: FAIR-PRESS

Ziele: Aufgrund der niedrigen Perfusion der Muskulatur am Unterschenkel vor allem in Ruhe ist eine akkurate Messung mittels herkömmlicher MRT-Methoden schwierig. Es wurde nun eine auf der volumenselektiven 1H-Spektroskopie basierte ASL-Sequenz zur Messung der Unterschenkelperfusion getestet. Methode: Die Sequenz kombiniert die lokalisierte Spektroskopie-Technik (PRESS) mit einer „pulsed ASL“ Methode, der Flow-sensitive Alternating Inversion Recovery (FAIR). Zur Bestimmung des in das Untersuchungsvolumen einströmenden Blutes wurden sowohl Spektren nach globalem Inversionspuls als auch nach lokalem Inversionspuls aufgenommen und subtrahiert. Die Differenz im Wasserpeak der beiden nacheinander aufgenommenen Spektren ist proportional zur Gewebeperfusion des aquirierten Voxels. Die Messung erfolgte an 6 gesunden Probanden mittels eines 3 T MRT. Die Messungen im M. Tibialis anterior und im M. Soleus wurden in Ruhe sowie nach Manschetten-induzierter Hyperämie durchgeführt. Die Voxelgröße betrug 20×20×10mm. Andere wichtige Sequenzparameter waren: TR=1800ms, TE=39ms, TI=1200ms. Absolute Perfusionswerte wurden unter Annahme zusätzlicher Parameter (lambda=0.9ml/g, T1blut=1600ms, T1muskel=1400ms, Transitdelay=100ms) berechnet. Ergebnis: Die absoluten Perfusionswerte des M. Soleus betrugen in Ruhe 18±5ml/(100g * min) (n=6). Im Musculus Tibialis anterior wurden 15±8ml/(100g * min) gemessen. Nach induzierter Ischämie wurden in der Phase der Hyperämie deutlich erhöhte Perfusionswerte von bis zu 120ml/(100g * min) ermittelt. Schlussfolgerung: Die FAIR-PRESS Methode ist für die Messung der muskulären Perfusion sowohl in Ruhe als auch bei post-ischämischer Hyperämie geeignet

Time-Of-Flight Angiography in Humans at 9.4T

At ultra-high magnetic field strengths ToF benefits from long tissue T1 times that leads to a suppressed background. On the other hand, SAR restrictions impose an upper limit on the actual flip angle that can be used. By increasing the pulse duration the SAR is reduced, enabling the use of optimal flip angles. The venous signal can be removed without need for additional suppression pulses, with only minor loss in image contrast, by prolonging TE. In conclusion, ToF can be performed at 9.4T using state-of-the-art methodology