All hands on deck”: administrator perspectives on managing COVID-19 outbreaks in U.S. nursing homes

Context: Managing COVID-19 outbreaks at U.S. nursing homes highlight the structural weaknesses of pre-pandemic long-term care emergency preparedness protocols. Objective: To understand how nursing home administrators managed staffing and facility operations during an active COVID-19 outbreak. Methods: This descriptive qualitative study conducted semi-structured interviews with administrators at 40 U.S. nursing homes from July 2020–December 2021. Interview questions focused on the impact of COVID-19 on nursing home operations and staffing, among other topics. Interview transcripts were qualitatively analysed to identify overarching themes using modified grounded theory and thematic analysis. Findings: Four major themes emerged from analysis. (1) Administrators described the rapidity of viral infection of staff and residents as overwhelming and long-lasting; (2) a COVID-19 outbreak had an immediate impact on staffing levels; (3) administrators implemented short-term compensatory strategies to manage staffing shortages during COVID-19 outbreaks; and (4) administrator and staff roles and responsibilities expanded in order to maintain facility operations during, and post-COVID-19 outbreak. Limitations: Findings may not be generalizable to all U.S. nursing homes and may not reflect current COVID-19 mitigation protocols and perspectives as interviews concluded in December 2021. Implications: U.S. nursing home administrators used crisis-management strategies to sustain facility operations during active COVID-19 outbreaks. This approach highlights on-going weaknesses in the long-term care infrastructure at U.S. nursing homes. Learning from administrator experiences during the COVID-19 pandemic is critical for the development of robust emergency preparedness plans and the improvement of state and federal resource coordination efforts to support U.S. nursing homes during future public health emergencies

FEV1 over time in patients with connective tissue disease-related bronchiolitis

SummaryBackgroundFibrosis or inflammation of the bronchioles is a well-known manifestation of connective tissue disease (CTD). However, the natural history of CTD-related bronchiolitis is largely unknown.MethodsWe analyzed consecutive patients evaluated at National Jewish Health (Denver, CO) from 1998 to 2008 with CTD and surgical lung biopsy-confirmed bronchiolitis. Linear mixed effects models were used to estimate the longitudinal postbronchodilator FEV1 %predicted (%pred) course and differences between subjects with or without constrictive bronchiolitis (CB).ResultsOf 28 subjects with a mean age of 53 ± 9 years, fourteen (50%) had CB. The most common CTD diagnosis was rheumatoid arthritis (n = 14; 50%). There were no significant differences in demographics, smoking status, underlying CTD diagnoses, 6-min walk distance, dyspnea score or drug therapy between subjects with CB and those with cellular bronchiolitis. Three subjects with CB (11%) and four with cellular bronchiolitis (14%) died. Compared with subjects with CB, those with cellular bronchiolitis had higher mean FEV1 %pred at all times. There were no significant differences in FEV1 %pred slope within- or between-groups (CB vs. cellular bronchiolitis) preceding surgical lung biopsy or afterward.ConclusionSubjects with CTD-related CB had lower FEV1 %pred values than those with CTD-related cellular bronchiolitis at all time points, but FEV1 %pred remained stable over time in both groups regardless of therapy received

Applying the Higher Education Academy framework for partnership in learning and teaching in higher education to online partnership learning communities: A case study and an extended model

As internet access and use increase exponentially, pedagogical practice becomes increasingly embedded in online platforms. We report on an online initiative of engaged student learning, the peer-led, staff-assisted e-helpdesk for research methods and statistics, which we evaluated and redeveloped using the lens and guiding principles of the framework for partnership in learning and teaching of the Higher Education Academy (HEA). The aim of the redevelopment was to steer the initiative towards a more integrative and sustainable implementation, as manifest in the applied construct of an online partnership learning community. Our evolving experience of the e-helpdesk highlighted the central role of the facilitator in engineering and maintaining social presence in the online community. We propose an extended model for building an online partnership learning community, whereby partnership encapsulates all the essential elements of student and staff partnership as outlined in the HEA framework, but is also critically defined by similar parameters of partnership between users and facilitators. In this model, the facilitator’s role becomes more involved in instructional teaching as disciplinary expertise increases, but descending levels of disciplinary expertise can foster ascending levels of independent learning and shared discovery for both users and facilitators.  &nbsp

Evidence and methods required to evaluate the impact for patients who use social prescribing : a rapid systematic review and qualitative interviews

Background Social prescribing encourages health-care and other professionals to refer patients to a link worker, who will develop a personalised plan to improve the patient’s health and well-being. We explore the feasibility of evaluating the service. Objective The objective was to answer the following research questions. (1) What are the most important evaluation questions that an impact study could investigate? (2) What data are already available at a local or national level and what else would be needed? (3) Are there sites delivering at a large enough scale and in a position to take part in an impact study? (4) How could the known challenges to evaluation (e.g. information governance and identifying a control group) be addressed? Data sources Data sources included MEDLINE ALL (via Ovid), searched from inception to 14 February 2019, and the first 100 hits of a Google (Google Inc., Mountain View, CA, USA) search. Review methods Rapid systematic review – electronic searches up to February 2019. Studies included any study design or outcomes. Screening was conducted by one reviewer; eligibility assessment and data extraction were undertaken by two reviewers. Data were synthesised narratively. Qualitative interviews – data from 25 participants in different regions of England were analysed using a pragmatic framework approach across 12 areas including prior data collection, delivery sites, scale and processes of current service delivery, and known challenges to evaluation. Views of key stakeholders (i.e. patients and academics) were captured. Results Rapid systematic review – 27 out of 124 studies were included. We identified outcomes and highlighted research challenges. Important evaluation questions included identification of the most appropriate (1) outcomes and (2) methods for dealing with heterogeneity. Qualitative interviews – social prescribing programmes are holistic in nature, covering domains such as social isolation and finance. Service provision is heterogeneous. The follow-on services that patients access are often underfunded or short term. Available data – there was significant heterogeneity in data availability, format and follow-up. Data were collected using a range of tools in ad hoc databases across sites. Non-attendance data were frequently not captured. Service users are more deprived and vulnerable than the overall practice population. Feasibility and potential limitations of an evaluation – current data collection is limited in determining the effectiveness of the link worker social prescribing model; therefore, uniform data collection across sites is needed. Standardised outcomes and process measures are required. Cost–utility analysis could provide comparative values for assessment alongside other NHS interventions. Limitations This was a rapid systematic review that did not include a systematic quality assessment of studies. COVID-19 had an impact on the shape of the service. We were not able to examine the potential causal mechanisms in any detail. Conclusions We describe possible future research approaches to determine effectiveness and cost-effectiveness evaluations; all are limited in their application. (1) Evaluation using currently available, routinely collected health-care, costing and outcomes data. (2) Evaluative mixed-methods research to capture the complexity of social prescribing through understanding heterogeneous service delivery across comparative settings. Cost-effectiveness evaluation using routinely available costing and outcomes data to supplement qualitative data. (3) Interventional evaluative research, such as a cluster randomised controlled trial focused on the link worker model. Cost-effectiveness data collected as part of the trial. Future work Mature data are currently not available. There needs to be an agreement across schemes on the key outcomes that need to be measured, harmonisation of data collection, and follow-up referrals (how and when). Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 29. See the NIHR Journals Library website for further project information

What is the best way to evaluate social prescribing? A qualitative feasibility assessment for a national impact evaluation study in England

Objectives Despite significant investment in social prescribing in England over the last decade, we still do not know if it works, or how models of social prescribing fit within wider health and care policy and practice. This study explores current service delivery structures and assesses the feasibility of a national evaluation of the link worker model. Methods Semi-structured interviews were conducted between May and September 2020, with 25 key informants from across social prescribing services in England. Participants included link workers, voluntary, community and social enterprise staff, and those involved in policy and decision-making for social prescribing services. Interview and workshop transcripts were analysed thematically, adopting a framework approach. Results We found differences in how services are provided, including by individual link workers, and between organisations and regions. Standards, referral pathways, reporting, and monitoring structures differ or are lacking in voluntary services as compared to clinical services. People can self-refer to a link worker or be referred by a third party, but the lack of standardised processes generated confusion in both public and professional perceptions of the link worker model. We identified challenges in determining the appropriate outcomes and outcome measures needed to assess the impact of the link worker model. Conclusions The current varied service delivery structures in England poses major challenges for a national impact evaluation. Any future rigorous evaluation needs to be underpinned with national standardised outcomes and process measures which promote uniform data collection

Precision Medicine and the Role of Biomarkers of Radiotherapy Response in Breast Cancer

Radiotherapy remains an important treatment modality in nearly two thirds of all cancers, including the primary curative or palliative treatment of breast cancer. Unfortunately, largely due to tumor heterogeneity, tumor radiotherapy response rates can vary significantly, even between patients diagnosed with the same tumor type. Although in recent years significant technological advances have been made in the way radiation can be precisely delivered to tumors, it is proving more difficult to personalize radiotherapyregimens based on cancer biology. Biomarkers that provide prognostic or predictive information regarding a tumor’s intrinsic radiosensitivity or its response to treatment couldprove valuable in helping to personalize radiation dosing, enabling clinicians to make decisions between different treatment options whilst avoiding radiation-induced toxicity in patients unlikely to gain therapeutic benefit. Studies have investigated numerous waysin which both patient and tumor radiosensitivities can be assessed. Tumor molecular profiling has been used to develop radiosensitivity gene signatures, while the assessment of specific intracellular or secreted proteins, including circulating tumor cells, exosomes and DNA, has been performed to identify prognostic or predictive biomarkers of radiation response. Finally, the investigation of biomarkers related to radiation-induced toxicity could provide another means by which radiotherapy could become personalized. In this review, we discuss studies that have used these methods to identify or develop prognostic/predictive signatures of radiosensitivity, and how such assays could be used in the future as a means of providing personalized radiotherapy

Applying the Higher Education Academy Framework for Partnership in Learning and Teaching in Higher Education to Online Partnership Learning Communities: A Case Study and an Extended Model

As internet access and use increase exponentially, pedagogical practice becomes increasingly embedded in online platforms. We report on an online initiative of engaged student learning, the peer-led, staff-assisted e-helpdesk for research methods and statistics, which we evaluated and redeveloped using the lens and guiding principles of the framework for partnership in learning and teaching of the Higher Education Academy (HEA). The aim of the redevelopment was to steer the initiative towards a more integrative and sustainable implementation, as manifest in the applied construct of an online partnership learning community. Our evolving experience of the e-helpdesk highlighted the central role of the facilitator in engineering and maintaining social presence in the online community. We propose an extended model for building an online partnership learning community, whereby partnership encapsulates all the essential elements of student and staff partnership as outlined in the HEA framework, but is also critically defined by similar parameters of partnership between users and facilitators. In this model, the facilitator’s role becomes more involved in instructional teaching as disciplinary expertise increases, but descending levels of disciplinary expertise can foster ascending levels of independent learning and shared discovery for both users and facilitators

Extension's Dining with Diabetes: Helping People Prevent and Manage Diabetes in Ohio and throughout the Nation

Diabetes is a common, serious and expensive disease in Ohio, the United States and around the world. The complications of untreated or undertreated diabetes are devastating and include heart, kidney, eye and nerve diseases. Studies have shown that when blood glucose is controlled, complications of diabetes are delayed or possibly prevented. Extension's Dining with Diabetes (DWD) program is designed for people with diabetes, their family members and those at risk; and it consists of education, cooking demonstrations, and taste testing. Participants are engaged on the topics of healthy cooking strategies, meal planning, portion control, label reading, physical activity, and goal setting. The program is delivered as a series of four face-to-face sessions with a three-month reunion led by Extension educators partnering with registered nurses, certified diabetes educators or registered dietatians. In addition to Extension offices, local community centers, faith-based organizations, libraries and hospitals are often used as locations in which to offer the program. State and local health departments, clinics, hospitals, pharmacies and community health coalitions are active in marketing the program. DWD has been implemented in Ohio for more than a decade, and is now a national program with more than 38 states participating. Dining with Diabetes has a successful history of being implemented in Ohio and adapted by other states. The national program and evaluation provides the opportunity to demonstrate national impact and how Ohio's efforts compare with other states in terms of improving diabetes outcomes. The national program evaluation includes assessment of knowledge, attitudes and skill gains related to diabetes management. Medium-term outcomes include reported behavior change in the areas of food selection, food preparation, label reading, and physical activity. Participants who reported at three months follow-up demonstrated the ability to maintain or improve dietary change after completing the program.AUTHOR AFFILIATION: Dan Remley, Field Specialist, Food, Nutrition and Wellness, The Ohio State University Extension, [email protected] (Corresponding Author); Shari Gallup, Educator, Family and Consumer Sciences, The Ohio State University Extension; Margaret Jenkins, Educator, Family and Consumer Sciences, The Ohio State University Extension; Tammy Jones, Educator, Family and Consumer Sciences, The Ohio State University Extension; Jenny Lobb, Educator, Family and Consumer Sciences, The Ohio State University Extension; Susan Zies, Educator, Family and Consumer Sciences, The Ohio State University Extension; Marie Economos, Educator, Family and Consumer Sciences, The Ohio State University Extension; Chris Kendle, Educator, Family and Consumer Sciences, The Ohio State University Extension; Chelsea Peckny, Assistant Professor, College of Pharmacy; Joyce Riley, Educator, Family and Consumer Sciences, The Ohio State University Extension; Amy Meehan, Healthy People Program Specialist; Brian Butler, Evaluation Specialist, The Ohio State University Extension; Ingrid Adams, Associate Professor; Lisa Barlage, Educator, Family and Consumer Sciences, The Ohio State University Extension; Candace Heer, Associate Professor; Amanda Bohlen, Educator, Family and Consumer Sciences, The Ohio State University Extension.Diabetes is a common, serious and expensive disease in Ohio, the United States and around the world. The complications of untreated or undertreated diabetes are devastating and include heart, kidney, eye and nerve diseases. Extension's Dining with Diabetes (DWD) program engages participants on the topics of healthy cooking strategies, meal planning, portion control, label reading, physical activity, and goal setting. The program is delivered as a series of four face-to-face sessions with a three-month reunion led by Extension educators partnering with registered nurses, certified diabetes educators or registered dietitians. DWD has a national curricula and evaluation, providing the opportunity to demonstrate national and state-level impact on knowledge, attitudes and skills related to diabetes management

The Eye of the Beholder: Youths and Parents Differ on What Matters in Mental Health Services

The goal of this study was to examine the degree to which youths and caregivers attend to different factors in evaluating their experiences with mental health programs. Youth (n = 251) receiving mental health services at community agencies and their caregivers (n = 275) were asked open-ended questions regarding the positive and negative aspects of the services. Qualitative analyses revealed some agreement but also divergence between youth and caregivers regarding the criteria by which services were evaluated and aspects of services that were valued most highly. Youths’ positive comments primarily focused on treatment outcomes while caregivers focused more on characteristics of the program and provider. Youths’ negative comments reflected dissatisfaction with the program, provider, and types of services offered while caregivers expressed dissatisfaction mainly with program characteristics. Results support the importance of assessing both youth and caregivers in attempts to understand the factors used by consumers to evaluate youth mental health services

Levetiracetam Reverses Synaptic Deficits Produced by Overexpression of SV2A

Levetiracetam is an FDA-approved drug used to treat epilepsy and other disorders of the nervous system. Although it is known that levetiracetam binds the synaptic vesicle protein SV2A, how drug binding affects synaptic functioning remains unknown. Here we report that levetiracetam reverses the effects of excess SV2A in autaptic hippocampal neurons. Expression of an SV2A-EGFP fusion protein produced a ∼1.5-fold increase in synaptic levels of SV2, and resulted in reduced synaptic release probability. The overexpression phenotype parallels that seen in neurons from SV2 knockout mice, which experience severe seizures. Overexpression of SV2A also increased synaptic levels of the calcium-sensor protein synaptotagmin, an SV2-binding protein whose stability and trafficking are regulated by SV2. Treatment with levetiracetam rescued normal neurotransmission and restored normal levels of SV2 and synaptotagmin at the synapse. These results indicate that changes in SV2 expression in either direction impact neurotransmission, and suggest that levetiracetam may modulate SV2 protein interactions