25 research outputs found

    A Cluster-Randomised Trial of Staff Education to Improve the Quality of Life of People with Dementia Living in Residential Care: The DIRECT Study

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    BACKGROUND: The Dementia In Residential care: EduCation intervention Trial (DIRECT) was conducted to determine if delivery of education designed to meet the perceived need of GPs and care staff improves the quality of life of participants with dementia living in residential care. METHODOLOGY/PRINCIPAL FINDINGS: This cluster-randomised controlled trial was conducted in 39 residential aged care facilities in the metropolitan area of Perth, Western Australia. 351 care facility residents aged 65 years and older with Mini-Mental State Examination ≤ 24, their GPs and facility staff participated. Flexible education designed to meet the perceived needs of learners was delivered to GPs and care facility staff in intervention groups. The primary outcome of the study was self-rated quality of life of participants with dementia, measured using the QOL-Alzheimer's Disease Scale (QOL-AD) at 4 weeks and 6 months after the conclusion of the intervention. Analysis accounted for the effect of clustering by using multi-level regression analysis. Education of GPs or care facility staff did not affect the primary outcome at either 4 weeks or 6 months. In a post hoc analysis excluding facilities in which fewer than 50% of staff attended an education session, self-rated QOL-AD scores were 6.14 points (adjusted 95%CI 1.14, 11.15) higher at four-week follow-up among residents in facilities randomly assigned to the education intervention. CONCLUSION: The education intervention directed at care facilities or GPs did not improve the quality of life ratings of participants with dementia as a group. This may be explained by the poor adherence to the intervention programme, as participants with dementia living in facilities where staff participated at least minimally seemed to benefit. TRIAL REGISTRATION: ANZCTR.org.au ACTRN12607000417482

    Phenotypic Analysis of Human Lymph Nodes in Subjects With New-Onset Type 1 Diabetes and Healthy Individuals by Flow Cytometry.

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    Background: Ultrasound guided sampling of human lymph node (LN) combined with advanced flow cytometry allows phenotypic analysis of multiple immune cell subsets. These may provide insights into immune processes and responses to immunotherapies not apparent from analysis of the blood. Methods: Ultrasound guided inguinal LN samples were obtained by both fine needle aspiration (FNA) and core needle biopsy in 10 adults within 8 weeks of diagnosis of type 1 diabetes (T1D) and 12 age-matched healthy controls at two study centers. Peripheral blood mononuclear cells (PBMC) were obtained on the same occasion. Samples were transported same day to the central laboratory and analyzed by multicolour flow cytometry. Results: LN sampling was well-tolerated and yielded sufficient cells for analysis in 95% of cases. We confirmed the segregation of CD69+ cells into LN and the predominance of CD8+ Temra cells in blood previously reported. In addition, we demonstrated clear enrichment of CD8+ naïve, FOXP3+ Treg, class-switched B cells, CD56bright NK cells and plasmacytoid dendritic cells (DC) in LNs as well as CD4+ T cells of the Th2 phenotype and those expressing Helios and Ki67. Conventional NK cells were virtually absent from LNs as were Th22 and Th1Th17 cells. Paired correlation analysis of blood and LN in the same individuals indicated that for many cell subsets, especially those associated with activation: such as CD25+ and proliferating (Ki67+) T cells, activated follicular helper T cells and class-switched B cells, levels in the LN compartment could not be predicted by analysis of blood. We also observed an increase in Th1-like Treg and less proliferating (Ki67+) CD4+ T cells in LN from T1D compared to control LNs, changes which were not reflected in the blood. Conclusions: LN sampling in humans is well-tolerated. We provide the first detailed "roadmap" comparing immune subsets in LN vs. blood emphasizing a role for differentiated effector T cells in the blood and T cell regulation, B cell activation and memory in the LN. For many subsets, frequencies in blood, did not correlate with LN, suggesting that LN sampling would be valuable for monitoring immuno-therapies where these subsets may be impacted

    The stress process in occupational settings: the role of psychosocial factors

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    This thesis is concerned with the direct and indirect mechanisms through which psychosocial stressors affect well-being, within the framework of the Michigan Model (House, 1981). An additional aim is to examine the stress process during workplace transitions. Empirical studies were conducted in three occupational settings: a cross-sectional pilot study with a sample of white-collar employees of several companies (N=144), and two longitudinal studies with samples drawn from a single retail chain, the "manager study" (N=261) and the "relocation study" (N=175). Although statistical control for individual differences (including response style) attenuated associations between work characteristics and strain outcomes, in all three samples work characteristics jointly contributed to the explanation of job satisfaction and psychological distress. More specifically, perceptions of control and social support were associated with job satisfaction, while work demands played a significant role in explaining symptom report. Furthermore, symptom levels predicted work absence in a combined sample of retail employees (N=221). In addition to direct effects, mediation and moderation patterns were examined. Results suggested that work perceptions partially mediated relations between personality (specifically locus of control beliefs and neuroticism) and strain. A similar pattern of mediation was apparent for social support. However, evidence for moderation of the stress process by individual and work characteristics was equivocal. Cross-sectional analyses using the manager sample data revealed significant interactions of control and Type A behaviour with work characteristics, but these interactions were not consistent in form with theory and past research. In contrast, in the longitudinal relocation study interactions were consistent with expectations: the negative impact of change was buffered by social support from senior colleagues and perceptions of control. Longitudinal analyses also demonstrated negative effects of workplace change; decreasing job satisfaction was observed during organisational restructuring, and transfer to a new branch was associated with increased psychological distress. Furthermore latent variable models revealed that changes in support, role ambiguity, and control over time were predictive of changes in job satisfaction. Overall, the present studies emphasise the need to examine simultaneously the joint influences of individual and work characteristics in occupational stress research. In this way the direct and indirect mechanisms through which psychosocial factors influence strain may be more fully understood, and strain-reducing interventions devised

    The stress process in occupational settings

    No full text
    This thesis is concerned with the direct and indirect mechanisms through which psychosocial stressors affect well-being, within the framework of the Michigan Model (House, 1981). An additional aim is to examine the stress process during workplace transitions. Empirical studies were conducted in three occupational settings: a cross-sectional pilot study with a sample of white-collar employees of several companies (N=144), and two longitudinal studies with samples drawn from a single retail chain, the "manager study" (N=261) and the "relocation study" (N=175). Although statistical control for individual differences (including response style) attenuated associations between work characteristics and strain outcomes, in all three samples work characteristics jointly contributed to the explanation of job satisfaction and psychological distress. More specifically, perceptions of control and social support were associated with job satisfaction, while work demands played a significant role in explaining symptom report. Furthermore, symptom levels predicted work absence in a combined sample of retail employees (N=221). In addition to direct effects, mediation and moderation patterns were examined. Results suggested that work perceptions partially mediated relations between personality (specifically locus of control beliefs and neuroticism) and strain. A similar pattern of mediation was apparent for social support. However, evidence for moderation of the stress process by individual and work characteristics was equivocal. Cross-sectional analyses using the manager sample data revealed significant interactions of control and Type A behaviour with work characteristics, but these interactions were not consistent in form with theory and past research. In contrast, in the longitudinal relocation study interactions were consistent with expectations: the negative impact of change was buffered by social support from senior colleagues and perceptions of control. Longitudinal analyses also demonstrated negative effects of workplace change; decreasing job satisfaction was observed during organisational restructuring, and transfer to a new branch was associated with increased psychological distress. Furthermore latent variable models revealed that changes in support, role ambiguity, and control over time were predictive of changes in job satisfaction. Overall, the present studies emphasise the need to examine simultaneously the joint influences of individual and work characteristics in occupational stress research. In this way the direct and indirect mechanisms through which psychosocial factors influence strain may be more fully understood, and strain-reducing interventions devised.</p

    The stress process in occupational settings

    No full text
    This thesis is concerned with the direct and indirect mechanisms through which psychosocial stressors affect well-being, within the framework of the Michigan Model (House, 1981). An additional aim is to examine the stress process during workplace transitions. Empirical studies were conducted in three occupational settings: a cross-sectional pilot study with a sample of white-collar employees of several companies (N=144), and two longitudinal studies with samples drawn from a single retail chain, the "manager study" (N=261) and the "relocation study" (N=175). Although statistical control for individual differences (including response style) attenuated associations between work characteristics and strain outcomes, in all three samples work characteristics jointly contributed to the explanation of job satisfaction and psychological distress. More specifically, perceptions of control and social support were associated with job satisfaction, while work demands played a significant role in explaining symptom report. Furthermore, symptom levels predicted work absence in a combined sample of retail employees (N=221). In addition to direct effects, mediation and moderation patterns were examined. Results suggested that work perceptions partially mediated relations between personality (specifically locus of control beliefs and neuroticism) and strain. A similar pattern of mediation was apparent for social support. However, evidence for moderation of the stress process by individual and work characteristics was equivocal. Cross-sectional analyses using the manager sample data revealed significant interactions of control and Type A behaviour with work characteristics, but these interactions were not consistent in form with theory and past research. In contrast, in the longitudinal relocation study interactions were consistent with expectations: the negative impact of change was buffered by social support from senior colleagues and perceptions of control. Longitudinal analyses also demonstrated negative effects of workplace change; decreasing job satisfaction was observed during organisational restructuring, and transfer to a new branch was associated with increased psychological distress. Furthermore latent variable models revealed that changes in support, role ambiguity, and control over time were predictive of changes in job satisfaction. Overall, the present studies emphasise the need to examine simultaneously the joint influences of individual and work characteristics in occupational stress research. In this way the direct and indirect mechanisms through which psychosocial factors influence strain may be more fully understood, and strain-reducing interventions devised.</p

    Diagnosis and management of breast implant capsule recurrence following mastectomy and subpectoral implant - innovative use of ADM for reconstruction.

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    It is well reported that patients who have undergone breast augmentation and subsequently develop breast cancer can successfully undergo breast-conserving therapy with preservation of their implants. However, there is a paucity of literature on the radiological investigations and surgical techniques in postmastectomy implant-reconstructed patients who develop recurrences to enable preservation of their implant-based reconstruction whilst effectively treating the local recurrence. The wide adoption of acellular dermal matrix use in prosthetic breast reconstruction in recent years has made radiological evaluation of such patients challenging. Herein presented is a case of a 37-year-old woman where wide local excision of a local recurrence abutting a peri-implant capsule following previous mastectomy and implant-acellular dermal matrix (ADM) reconstruction was performed with successful preservation of reconstruction volume (and shape) using an ADM patch to repair the capsular defect whilst retaining the implant in situ. Radiological investigation facilitated and guided the surgical planning and oncological clearance

    Validating “Image box”-a new approach to multicentre radiology reviews using a web-based image review system: study protocol

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    ObjectivesTo validate the use of “Imagebox”- a web-based image review system for large scale multicentre trials.Patients and MethodsAs part of the multicentre trial ‘Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH) study’ mammograms were collected and digitised. Software was created allowing digitised mammograms to be viewed from any location with internet access. Two validation studies were performed. Firstly phantom studies using line-pairs (1–20 lpmm-1) to assess spatial resolution and the CDMAM 3.4 phantom were used to assess the visibility of gold discs for contrast detail .Secondly a comparison was made between the scoring of 77 patients’ original diagnostic analogue mammograms from 29 hospitals and the corresponding web images. Films and web images were scored by one experienced breast radiologist according to the BIRADS classification. At least 8 weeks elapsed between scoring images from the same patient.ResultsThe original analogue spatial resolution was 20 lpmm-1 and web resolution of the same image reduced at 8.9 lpmm-1. Contrast detail assessment demonstrated analogue and web images with near concordance and the image quality factor, IQFinv for the web was reduced but within the 95% confidence interval of the original mammograms. BIRADS final assessment showed good agreement between the analogue and the identical web images (Kappa 0.82).ConclusionThe overall reduction in spatial resolution did not adversely affect the quality of the diagnostic image on “Imagebox”. This may be due to its functionality, specifically the high magnification zoom which enhances diagnostic interpretation. Imagebox is a promising solution to address the logistical challenges for large breast imaging reviews and has further potential for education and self assessment
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