No longer hungry in hospital : improving the hospital mealtime experience for older people through Action Research

‘The definitive version is available at www.blackwell-synergy.com.’ Copyright Blackwell Publishing DOI: 10.1111/j.1365-2702.2007.02063.xAims and objectives.  This study aimed to improve the mealtime experience of older people in a hospital setting through helping staff to make changes to their clinical practice and the ward environment. Background.  Poor nutritional care has been a persistent and seemingly intractable problem for many years. Methods.  We used an action research design for the study, drawing on techniques from practice development to support the action phase of the work, including action learning, role modelling good practice and reflection. The ward context was explored at the beginning and end of the study using focus groups, interviews, observation and benchmarking. Results.  Ward staff made a number of changes to their nursing practice. The most significant was that all staff became engaged with, prioritized and were involved in the mealtime, ensuring that there was sufficient time and expertise available to assist patients with eating. Conclusions.  This study demonstrates that it is possible to change nursing practice at mealtimes and that this change leads to improvements in patients’ experience through ensuring they receive the help they need. Relevance to clinical practice.  Although hospital mealtimes are frequently viewed as problematic, we have shown that nurses can be enabled to make changes to their practice that have a positive impact on both the mealtime experience and wider patient care.Peer reviewe

Physical activity interventions in children and young people with Type 1 diabetes mellitus: a systematic review with meta-analysis

Aims To synthesize evidence from randomized and non‐randomized studies of physical activity interventions in children and young people with Type 1 diabetes so as to explore clinically relevant health outcomes and inform the promotion of physical activity. Method We conducted a search of CINAHL Plus, the Cochrane Library, EMBASE, MEDLINE, PsycINFO, SCOPUS, SportDiscus and Web of Science between October and December 2012. Eligible articles included subjects aged ≤18 years with Type 1 diabetes and a physical activity intervention that was more than a one‐off activity session. Physiological, psychological, behavioural or social outcomes were those of interest. Results A total of 26 articles (10 randomized and 16 non‐randomized studies), published in the period 1964–2012, were reviewed. Although there was heterogeneity in study design, methods and reporting, 23 articles reported at least one significant beneficial health outcome at follow‐up. Meta‐analyses of these studies showed potential benefits of physical activity on HbA1c (11 studies, 345 participants, standardized mean difference ‐0.52, 95% CI ‐0.97 to ‐0.07; P = 0.02), BMI (four studies, 195 participants, standardized mean difference ‐0.41, 95% CI ‐0.70 to ‐0.12; P = 0.006) and triglycerides (five studies, 206 participants, standardized mean difference ‐0.70, 95% CI ‐1.25 to ‐0.14; P = 0.01).The largest effect size was for total cholesterol (five studies, 206 participants, standardized mean difference ‐0.91, 95% CI ‐1.66 to ‐0.17; P = 0.02). Conclusions Physical activity is important for diabetes management and has the potential to delay cardiovascular disease, but there is a lack of studies that are underpinned by psychological behaviour change theory, promoting sustained physical activity and exploring psychological outcomes. There remains a lack of knowledge of how to promote physical activity in people with Type 1 diabetes

Global survey of the frequency of atrial fibrillation-associated stroke: embolic stroke of undetermined source global registry

Background and Purpose—Atrial fibrillation (AF) is increasingly recognized as the single most important cause of disabling ischemic stroke in the elderly. We undertook an international survey to characterize the frequency of AF-associated stroke, methods of AF detection, and patient features. Methods—Consecutive patients hospitalized for ischemic stroke in 2013 to 2014 were surveyed from 19 stroke research centers in 19 different countries. Data were analyzed by global regions and World Bank income levels. Results—Of 2144 patients with ischemic stroke, 590 (28%; 95% confidence interval, 25.6–29.5) had AF-associated stroke, with highest frequencies in North America (35%) and Europe (33%) and lowest in Latin America (17%). Most had a history of AF before stroke (15%) or newly detected AF on electrocardiography (10%); only 2% of patients with ischemic stroke had unsuspected AF detected by poststroke cardiac rhythm monitoring. The mean age and 30-day mortality rate of patients with AF-associated stroke (75 years; SD, 11.5 years; 10%; 95% confidence interval, 7.6–12.6, respectively) were substantially higher than those of patients without AF (64 years; SD, 15.58 years; 4%; 95% confidence interval, 3.3–5.4; P<0.001 for both comparisons). There was a strong positive correlation between the mean age and the frequency of AF (r=0.76; P=0.0002). Conclusions—This cross-sectional global sample of patients with recent ischemic stroke shows a substantial frequency of AF-associated stroke throughout the world in proportion to the mean age of the stroke population. Most AF is identified by history or electrocardiography; the yield of conventional short-duration cardiac rhythm monitoring is relatively low. Patients with AF-associated stroke were typically elderly (>75 years old) and more often women

Season, weather, and suicide:Further evidence for ecological complexity

Background: easonality in suicide is reported worldwide, and peaks in late spring. Despite the potential connection to the weather, associations between meteorological variables and suicide does not explain seasonality. Studies testing for seasonality while controlling for the weather show patterns that are more complex than a straightforward link between spring-like weather and suicide. Methods: We tested whether seasonality in suicide was due to meteorological variation (hours of sunshine, rainfall, or temperature) in a novel population (Scotland; 2003–2013). We also sought to further explore the ecological complexity demonstrated in previous work by testing associations at a single location (Tay Road Bridge; 1968–2017). RESULTS: We found peaks in suicidal behavior in June at the bridge, but no seasonality for Scotland as a whole. Seasonality was reduced when we controlled for maximum temperature and hours of sunshine. We found patterns to be dependent upon sex, with stronger seasonal and meteorological effects amongst men. Limitations: Our study was exploratory and relies on population-level data. Conclusions: Seasonal and meteorological effects on suicide are dependent upon local and individual context, with significant effects apparent at the Tay Road Bridge and not across Scotland as a whole. Men may be more sensitive to season and weather. In order to determine whether seasonality in suicide is due to meteorological variation, future research should test patterns in small geographical units, in men and women, and for different suicide methods, and seek to identify the social and physical factors which predict variation in patterns

The developmental state, speculative urbanisation and the politics of displacement in gentrifying Seoul

What does gentrification mean under speculative urbanisation led by a strong developmental state? This paper analyses the contemporary history of Seoul’s urban redevelopment, arguing that new-build gentrification is an endogenous process embedded in Korea’s highly speculative urban development processes from the 1980s. Property owners, construction firms and local/central governments coalesce, facilitating the extraction of exchange value by closing the rent gap. Displacement of poorer owner-occupiers and tenants was requisite for the success of speculative accumulation. Furthermore, the paper also contends that Korea’s speculative urbanisation under the strong developmental (and later (neo-)liberalising) state has rendered popular resistance to displacement ineffective despite its initial success in securing state concessions. Examining the experience of Seoul in times of condensed industrialisation and speculative urbanisation helps inform the existing literature on gentrification by resorting to non-Western empirics

Occurrence and characterization of oseltamivir-resistant influenza virus in children between 2007-2008 and 2008-2009 seasons

PurposeThere was a global increase in the prevalence of oseltamivir-resistant influenza viruses during the 2007-2008 influenza season. This study was conducted to investigate the occurrence and characteristics of oseltamivir-resistant influenza viruses during the 2007-2008 and 2008-2009 influenza seasons among patients who were treated with oseltamivir (group A) and those that did not receive oseltamivir (group B).MethodsA prospective study was conducted on 321 pediatric patients who were hospitalized because of influenza during the 2007-2008 and 2008-2009 influenza seasons. Drug resistance tests were conducted on influenza viruses isolated from 91 patients.ResultsThere was no significant difference between the clinical characteristics of groups A and B during both seasons. Influenza A/H1N1, isolated from both groups A and B during the 2007-2008 and 2008-2009 periods, was not resistant to zanamivir. However, phenotypic analysis of the virus revealed a high oseltamivir IC50 range and that H275Y substitution of the neuraminidase (NA) gene and partial variation of the hemagglutinin (HA) gene did not affect its antigenicity to the HA vaccine even though group A had a shorter hospitalization duration and fewer lower respiratory tract complications than group B. In addition, there was no significant difference in the clinical manifestations between oseltamivir-susceptible and oseltamivir-resistant strains of influenza A/H1N1.ConclusionEstablishment of guidelines to efficiently treat influenza with oseltamivir, a commonly used drug for treating influenza in Korean pediatric patients, and a treatment strategy with a new therapeutic agent is required

Genetic architecture distinguishes systemic juvenile idiopathic arthritis from other forms of juvenile idiopathic arthritis: clinical and therapeutic implications

OBJECTIVES: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of conditions unified by the presence of chronic childhood arthritis without an identifiable cause. Systemic JIA (sJIA) is a rare form of JIA characterised by systemic inflammation. sJIA is distinguished from other forms of JIA by unique clinical features and treatment responses that are similar to autoinflammatory diseases. However, approximately half of children with sJIA develop destructive, long-standing arthritis that appears similar to other forms of JIA. Using genomic approaches, we sought to gain novel insights into the pathophysiology of sJIA and its relationship with other forms of JIA. METHODS: We performed a genome-wide association study of 770 children with sJIA collected in nine countries by the International Childhood Arthritis Genetics Consortium. Single nucleotide polymorphisms were tested for association with sJIA. Weighted genetic risk scores were used to compare the genetic architecture of sJIA with other JIA subtypes. RESULTS: The major histocompatibility complex locus and a locus on chromosome 1 each showed association with sJIA exceeding the threshold for genome-wide significance, while 23 other novel loci were suggestive of association with sJIA. Using a combination of genetic and statistical approaches, we found no evidence of shared genetic architecture between sJIA and other common JIA subtypes. CONCLUSIONS: The lack of shared genetic risk factors between sJIA and other JIA subtypes supports the hypothesis that sJIA is a unique disease process and argues for a different classification framework. Research to improve sJIA therapy should target its unique genetics and specific pathophysiological pathways