The Heart of Living and Dying: Upstreaming Advance Care Planning into Community Conversations in the Public Domain in Northern Ireland.

This paper provides an evaluation of the Heart of Living and Dying (HLD) Initiative. This initiative is a group process that attempts to bring Advance Care Planning (ACP) into the public domain. It encourages participants to consider what matters to them in their living along with their hopes, preferences, and wishes for their final years and end-of-life care. An inductive, interpretive, and naturalistic approach allowed the researcher to study these phenomena in their natural setting i.e., the community. This qualitative study used 5 focus groups with 17 people and employed thematic data analysis to identify key themes. All participants in the HLD speak from a personal perspective irrespective of any professional background. It transpired that 16 respondents worked in health and social care, which subsequently became noteworthy in the findings. Three key themes were identified: (a) feeling emotionally safe enough to have such sensitive conversations is vital; (b) participating in the HLD process increases the confidence of those participants who worked in health and social care, to undertake ACP conversations and (c) planning ahead is a complex, staged process rather than a single record-making event. The Covid-19 pandemic crisis reinforced the need to upstream ACP initiatives such as the HLD, as the norm for everyone, since all of us will one day die. It is recommended that the HLD be incorporated within ACP training given that the experiential nature of it and the use of groups was reported to build confidence in facilitating ACP conversations. A virtual HLD process needs to be developed to adapt to restrictions on gatherings due to Covid 19

The Role of Education and Verbal Abilities in Altering the Effect of Age-Related Gray Matter Differences on Cognition

Evidence suggests that individual variability in lifetime exposures influences how cognitive performance changes with advancing age. Brain maintenance and cognitive reserve are theories meant to account for preserved performance despite advancing age. These theories differ in their causal mechanisms. Brain maintenance predicts more advantageous lifetime exposures will reduce age-related neural differences. Cognitive reserve predicts that lifetime exposures will not directly reduce these differences but minimize their impact on cognitive performance. The present work used moderated-mediation modeling to investigate the contributions of these mechanisms at explaining variability in cognitive performance among a group of 39 healthy younger (mean age (standard deviation) 25.9 (2.92) and 45 healthy older adults (65.2 (2.79)). Cognitive scores were computed using composite measures from three separate domains (speed of processing, fluid reasoning, and memory), while their lifetime exposures were estimated using education and verbal IQ measures. T1-weighted MR images were used to measure cortical thickness and subcortical volumes. Results suggest a stronger role for cognitive reserve mechanisms in explaining age-related cognitive variability: even with age-related reduced gray matter, individuals with greater lifetime exposures could perform better given their quantity of brain measures

Educational Attainment Moderates the Association Between Hippocampal Volumes and Memory Performances in Healthy Older Adults

Objective: To examine whether educational attainment, as a proxy of cognitive reserve, moderated the association between hippocampal volumes and episodic verbal memory performances in healthy older adults.Methods: Data from 76 community dwelling older adults were included in the present study. Measures of hippocampal volumes (total, left, and right) were obtained using FreeSurfer software. Immediate and delayed verbal recall scores were derived from performances on the California Verbal Learning Test-Second Edition and the Wechsler Memory Scale- Third Edition. Educational attainment was defined by years of education. Linear regression analyses were performed using immediate and delayed recall as dependent variables and hippocampal volumes, years of education, and their interaction terms as independent variables. All analyses were controlled for age, sex, depression, and health status.Results: Total and left Hippocampal volumes had a positive main effect on delayed recall only. Additionally, the interaction between total, left, and right hippocampal volumes and education was a significant predictor for delayed recall performance but not for immediate recall performance. The positive association between hippocampal volumes and delayed recall was greatest in those with more years of education.Conclusion: Larger hippocampal volumes were associated with better delayed verbal recall and the effect on delayed recall was greatest in those with more years of education. Having higher levels of education, or cognitive reserve, may enable individuals to capitalize on greater structural integrity in the hippocampus to support delayed recall in old age. However, longitudinal research is needed to investigate the directionality of these associations

The development and validation of a scoring tool to predict the operative duration of elective laparoscopic cholecystectomy

Background: The ability to accurately predict operative duration has the potential to optimise theatre efficiency and utilisation, thus reducing costs and increasing staff and patient satisfaction. With laparoscopic cholecystectomy being one of the most commonly performed procedures worldwide, a tool to predict operative duration could be extremely beneficial to healthcare organisations. Methods: Data collected from the CholeS study on patients undergoing cholecystectomy in UK and Irish hospitals between 04/2014 and 05/2014 were used to study operative duration. A multivariable binary logistic regression model was produced in order to identify significant independent predictors of long (> 90 min) operations. The resulting model was converted to a risk score, which was subsequently validated on second cohort of patients using ROC curves. Results: After exclusions, data were available for 7227 patients in the derivation (CholeS) cohort. The median operative duration was 60 min (interquartile range 45–85), with 17.7% of operations lasting longer than 90 min. Ten factors were found to be significant independent predictors of operative durations > 90 min, including ASA, age, previous surgical admissions, BMI, gallbladder wall thickness and CBD diameter. A risk score was then produced from these factors, and applied to a cohort of 2405 patients from a tertiary centre for external validation. This returned an area under the ROC curve of 0.708 (SE = 0.013, p  90 min increasing more than eightfold from 5.1 to 41.8% in the extremes of the score. Conclusion: The scoring tool produced in this study was found to be significantly predictive of long operative durations on validation in an external cohort. As such, the tool may have the potential to enable organisations to better organise theatre lists and deliver greater efficiencies in care

Heterozygous Variants in KMT2E Cause a Spectrum of Neurodevelopmental Disorders and Epilepsy.

We delineate a KMT2E-related neurodevelopmental disorder on the basis of 38 individuals in 36 families. This study includes 31 distinct heterozygous variants in KMT2E (28 ascertained from Matchmaker Exchange and three previously reported), and four individuals with chromosome 7q22.2-22.23 microdeletions encompassing KMT2E (one previously reported). Almost all variants occurred de novo, and most were truncating. Most affected individuals with protein-truncating variants presented with mild intellectual disability. One-quarter of individuals met criteria for autism. Additional common features include macrocephaly, hypotonia, functional gastrointestinal abnormalities, and a subtle facial gestalt. Epilepsy was present in about one-fifth of individuals with truncating variants and was responsive to treatment with anti-epileptic medications in almost all. More than 70% of the individuals were male, and expressivity was variable by sex; epilepsy was more common in females and autism more common in males. The four individuals with microdeletions encompassing KMT2E generally presented similarly to those with truncating variants, but the degree of developmental delay was greater. The group of four individuals with missense variants in KMT2E presented with the most severe developmental delays. Epilepsy was present in all individuals with missense variants, often manifesting as treatment-resistant infantile epileptic encephalopathy. Microcephaly was also common in this group. Haploinsufficiency versus gain-of-function or dominant-negative effects specific to these missense variants in KMT2E might explain this divergence in phenotype, but requires independent validation. Disruptive variants in KMT2E are an under-recognized cause of neurodevelopmental abnormalities

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Carico di lavoro e conflitto lavoro-vita privata nei controllori del traffico aereo: la moderazione della resilienza

Introduzione. Il conflitto tra lavoro e vita privata ha ricevuto una crescente attenzione da parte dei ricercatori a causa dei suoi numerosi e documentati effetti negativi sia sugli esiti di salute sia lavorativi. Tuttavia, pochi studi sono stati svolti con l’obiettivo di comprendere quali variabili potessero essere associate a tale fenomeno all’interno di un gruppo di lavoratori particolare come quello dei controllori del traffico aereo. Obiettivi. L’obiettivo del presente studio è quello di indagare in che modo il carico di lavoro possa esercitare un impatto sulla soddisfazione lavorativa attraverso il conflitto lavoro-famiglia e se tale relazione possa essere influenzata dai livelli di resilienza posseduti. Metodo. 168 controllori del traffico aereo operanti sul territorio nazionale hanno compilato un questionario self-report online volto a misurare: resilienza (Connor-Davidson Resilience Scale CD-RISC), carico di lavoro (Workload Scale), conflitto lavoro-vita privata (Work-Family Conflict Scale), soddisfazione lavorativa (un item) e alcuni aspetti legati all’esposizione diretta e vicaria al COVID-19 (check-list ad hoc). I dati sono stati analizzati tramite modelli di mediazione e mediazione moderata. Risultati. Il carico di lavoro è positivamente associato al conflitto lavoro-vita privata (β=.74, p<.001). Ciò, a sua volta, si associa negativamente alla soddisfazione lavorativa (β= -.42, p<.01). La resilienza mitiga gli effetti del carico di lavoro sul conflitto lavoro-vita privata (β=-.14, p<.05) suggerendo come l’effetto negativo del carico di lavoro sulla soddisfazione lavorativa attraverso il conflitto lavoro-vita privata sia minore per le persone maggiormente resilienti. Limiti. Questo studio trasversale si basa su dati raccolti attraverso misure esclusivamente self-report. Aspetti innovativi. Si tratta del primo studio in letteratura volto ad indagare la relazione tra il carico di lavoro, il conflitto lavoro-vita privata e la soddisfazione lavorativa in un campione di controllori del traffico aereo operanti in Italia. Inoltre, identificando la resilienza come risorsa protettiva, questo studio può fornire utili implicazioni per la pratica

Be mindful=be able to handle critical incidents: A mixed-method study among Italian air traffic controllers

Research goals. Air traffic controllers (ATCOs) are among the most high-risk groups for critical incidents (CIs). Facing such incidents may hinder professional activity, undermine affected individuals’ well-being and cause company financial losses. Shedding light on how and when ATCOs feel capable of managing CIs is crucial to formulate preventive measures that help companies reduce future incidents. This study aims to examine the mediating processes – i.e., problem-focused coping tendencies – and boundary conditions – i.e., previous experience with CIs and training on CI management – associated with the impact of mindfulness on self-efficacy in managing CIs. Theoretical background. Mindfulness – the intentional and non-judgmental attention to present events (Brown et al., 2007) – is a personal resource for ATCOs (Kearney et al., 2016) as it enables them to make timely decisions (Li et al., 2018), be aware of and attentive to ICs (Li et al., 2014) to find solutions to address them (Liang et al., 2022). Although the link between mindfulness practices and self-efficacy has been proven (Charoensukmongkol, 2013), little is known about the factors enhancing self-efficacy in managing CIs among ATCOs. Based on the social cognitive theory (Bandura, 1989), prior experience with ICs and training in CI management are mastery experiences that can foster self-efficacy. Design. A total of 168 Italian ATCOs completed questionnaires that measured mindfulness, self-efficacy in assessing and deciding about critical incidents, problem-focused coping tendencies, prior experience with CIs, training on CI management, and COVID-19-related experience variables. Descriptive statistics and moderated mediation analyses were performed. To deepen the quantitative results, ten semi-structured interviews were conducted and analysed using thematic analysis. Results. High-mindful ATCOs were more problem-oriented and then self-confident about their ability to manage CIs, especially when they had prior experience with CIs and received training on CI management. Three core themes were identified from the interviews: decision-making as a core job aspect; environmental facilitators (training, social support); personal resources (prior experience, coping strategies, situational awareness). Limitations. This cross-sectional study merely relied on self-report measurements. Research/practical implications. This study moves a step forward in both the air traffic management and mindfulness literature, as it is the first to clarify how and when mindfulness can promote self-efficacy in managing CIs in the understudied population of ATCOs during the pandemic. ATCOs could benefit from on-the-spot mindfulness interventions, CI management, and problem-focused coping strategies training. Mentoring and sharing sessions could also help less experienced aviation personnel build skills

Personal resources and environmental facilitators of air traffic controllers’ self-efficacy in handling critical events: a mixed-method study

Given to COVID-19 travel restrictions, air traffic controllers (ATCOs) have witnessed changes in their work modes, besides facing often critical events and decision-making under pressure. However, little is known about ATCOs during the pandemic. It is also still unclear how and when mindfulness may spur ATCOs self-efficacy in handling critical events. This study fills this gap by integrating data survey from a sample of 168 Italian ATCOs with qualitative data from 10 semi-structured interviews. Moderated mediation models and thematic analysis were performed. The results showed that the positive link between ATCOs’ mindfulness and self-efficacy in handling critical events was mediated by problem-focused coping tendencies, but only when ATCOs had prior experience with critical events. The direct effect of mindfulness on self-efficacy was significant only for ATCOs who were trained in critical incident management. The themes that emerged from the interviews deepened these results. Despite its cross-sectional design and self-report nature, this is the first mixed-method study to identify mindfulness as a catalyst for ATCOs’ self-efficacy during a pandemic. ATCOs could benefit from mindfulness interventions, mentoring, training in critical event management, and problem-focused coping