Predicting the severity of radiation skin reactions in women with breast cancer

Skin reactions are unavoidable side effects of radiotherapy for breast cancer that may limit the amount of treatment a patient is able to receive. As well, the discomfort associated with the treatment may negatively affect the patient\u27s quality of life and their willingness to complete a course of treatment that typically extends over seven weeks. Prior literature suggests that variations in patients\u27 tissue reactions to radiation may be related to Individual patient characteristics. Before health care providers can intervene to prevent or minimise skin reactions, a clinical model that helps predict which patients will experience more skin reactions is needed. The purpose of the study was twofold: firstly, to test the theoretical relationships between factors that impair healing and the severity of radiation skin reactions; and secondly, to develop a model to predict the severity of radiation skin reactions in women being treated for breast cancer. The theoretical framework for the study was based on two bodies of knowledge, radiobiology and wound healing. This framework specified three sets of potential predictors of radiation induced skin reactions. These were radiation factors (e.g. dose, fractionation), genetic factors (e.g. personal and family history or cancer, radiosensitive conditions) and personal factors (e.g. age, smoking history, nutritional status). It was hypothesised that the severity of the skin reaction was a function of the relationship between these constructs. A sample of 126 women was recruited to the study over a 14-month data collection period. All the women had undergone lumpectomy and were commencing a standard radiation protocol of 45 Gray to the whole breast delivered in daily fractions of 1.8 Gray over five weeks, and a 20 Gray electron boost to the lumpectomy site delivered in daily fractions of 2 Gray over two weeks. After obtaining written informed consent, data on potential factors were collected by interview at the commencement of treatment and from the medical records. Weekly observations of the skin using the Radiation Therapy Oncology Group scoring system were recorded throughout the seven weeks of treatment. The breast was divided into eight anatomical sites to increase specificity in the final analysis. The mean inter-rater reliability of RTOG scoring between the three observers was 0.85. Chi square analysis revealed that several factors were associated with a more severe reaction. Significant factors from the personal construct included smoking, chemotherapy, history of skin cancer, reaction of the skin to UV radiation, lymphocele aspiration, condition of the lumpectomy scar at the commencement of treatment, weight, and the size of the breast. Stepwise logistic regression analysis revealed the relative risk and predictive value of the factors. A predictive model was developed for each of the eight anatomical Sites of the breast for weeks three to seven of radiation treatment. The principal predictors were a large breast size, smoking during the treatment period, and having had a lymphocele aspirated on at least one occasion prior to radiotherapy. The results show that it is possible to predict the severity of skin reactions in individual patients. The research contributes to theory development in radiation skin reactions and to the practice of radiation oncology nursing. Practice implications centre on individualising the preparation, education and management of women undergoing radiation therapy for breast cancer. Further research with larger samples and using different anatomical sites will contribute to the development of a skin reaction risk assessment tool for general use in radiation oncology nursing

Emergency department transfers from residential aged care: What can we learn from secondary qualitative analysis of Australian Royal Commission data?

Objectives: To use publicly available submissions and evidence from the Australian Royal Commission into Aged Care Quality and Safety as data for secondary qualitative analysis. By investigating the topic of emergency department transfer from the perspective of residents, family members and healthcare professionals, we aimed to identify modifiable factors to reduce transfer rates and improve quality of care. Design: The Australian Royal Commission into Aged Care Quality and Safety has made over 7000 documents publicly available. We used the documents as a large data corpus from which we extracted a data set specific to our topic using keywords. The analysis focused on submissions and hearing transcripts (including exhibits). Qualitative thematic analysis was used to interrogate the text to determine what could be learnt about transfer events from a scholarly perspective. Results: Three overarching themes were identified: shortfalls and failings, reluctance and misunderstanding, and discovery and exposure. Conclusions: The results speak to workforce inadequacies that have been central to problems in the Australian aged care sector to date. We identified issues around clinical and pain assessment, lack of consideration to advance care directives and poor communication among all parties. We also highlighted the role that emergency departments play in identifying unmet clinical needs, substandard care and neglect. Given the inadequate clinical care available in some residential aged care facilities, transferring residents to a hospital emergency department may be making the best of a bad situation. If the objective of reducing unnecessary transfers to emergency departments is to be achieved, then access to appropriate clinical care is the first step

Measuring the ‘dose’ of person-centred care in aged care: Development of staff and family questionnaires

Aims: To develop a theoretically and psychometrically sound instrument to measure the ‘dose’ of person-centred care practice in long-term care. Background: Although person-centred care has been adopted for long-term care across the world, there is a lack of theory-based instruments to measure its impact. Two questionnaires were developed to measure person-centred care from the perspectives of staff and family based on current person-centred care frameworks: Kitwood, Nolan, and Eden Alternative. Methods: Phase I: literature review and focus groups identified potential items for the questionnaires. Phase II: academic experts, local staff, and family members of residents assessed content validity. Phase III: psychometric testing. Results: A 34-item staff questionnaire (Cronbach\u27s Alpha = 0.942) with two factors “Making person-centredness real” and “Making the environment meaningful for life and work”. A 30-item family questionnaire (Cronbach\u27s Alpha = 0.947), with three factors “Staff care about what is meaningful to my family member”, “Staff know and respect my family member”, and “We are all part of a family”. The factors did not directly reflect the theoretical constructs from Kitwood\u27s and Nolan\u27s work. Conclusion: Two instruments, capturing the ‘dose’ or active practice of delivering person-centred care, have demonstrated sound psychometric properties. The study contributes to understanding the theoretical components of person-centred care. Impact: The study addressed the lack of robust tools to measure how much person-centred care is taking place in aged care facilities. Staff and family questionnaires were produced based on strong theoretical foundations combining concepts of prominent person-centred theories and rigorous psychometric testing. The instruments can be used to determine if person-centred care makes a difference, to compare if person-centred care changes or develops over time or between facilities. Ultimately residents, families, and staff will benefit from the ability to measure how much person-centred care residents receive

Factors associated with daytime sleep in nursing home residents

A retrospective, cross-sectional study was conducted to describe the occurrence of daytime sleep (DS) and to examine factors associated with DS in nursing home residents. We used the Minimum Data Set 2.0 records of 300 residents in a nursing home from January 2005 to March 2010. Descriptive statistics, independent t-test, chi-square, Pearson correlations, and logistic regression were utilized in analysis. About 71.3% of the residents slept more than 2 hours during the day, and this was significantly associated with residents’ comorbidity (t = 2.0, p = .04), cognitive performance (t = 7.3, p = .01), activities of daily living (t = 3.7, p = .01), and social involvement (t = −7.6, p = .01). Cognitive performance and social involvement significantly predicted the occurrence of DS with social involvement being the strongest predictor (odds ratio: .58; 95% confidence interval: [.45, .75]). The findings suggest that interventions to engage nursing home residents in more social activities during the day may be beneficial to minimize their DS, especially for those who have difficulties with engaging socially on their own

Physical activity for people with young-onset dementia and carers: protocol for a scoping review

Background: Physical activity has been cited as a potential symptomatic treatment option for people living with dementia. At present, much of the research concerning physical activity and dementia considers older adults, and there are several review articles summarising the evidence in this area. Less is known about physical activity for younger people with dementia, despite the marked differences in needs and preferences between the two groups. The aim of this scoping review is to systematically explore and critically appraise the current state of the evidence regarding physical activity for people with young-onset dementia and carers. Methods: Several electronic databases (i.e. MEDLINE, SPORTDiscus, CINAHL, Cochrane Library, PsycINFO, Applied Social Sciences Index & Abstracts (ASSIA) and Scopus), grey literature (i.e. NICE Evidence Search (UK) and targeted international organisations e.g. Alzheimer's Society (UK), Age UK, Young Dementia UK, Alzheimer's Association (USA), Dementia Australia) and trial registries (i.e. UK Clinical Trials Gateway, International Clinical Trials Registry Platform and EU Clinical Trials Register) will be searched for published and unpublished evidence regarding physical activity for people with young-onset dementia and carers. Studies included in the review will be subjected to a narrative synthesis to explore similarities and differences, both within and between studies, to identify patterns and themes and to postulate explanations for research findings (e.g. how and why certain interventions or programmes have worked (or not); factors that might have influenced the findings ). Discussion: This will be the first review to systematically explore and critically appraise the current state of the evidence regarding physical activity for people with young-onset dementia and carers. It is hoped that findings from this review will be used to inform the development of future physical activity interventions, to serve as a basis for consultation with key stakeholders and to identify appropriate outcome measures relevant to people with young-onset dementia and carers. Systematic review registration: At present, scoping reviews are not eligible for registration on the international prospective register of systematic reviews (i.e. PROSPERO). © 2018 The Author(s)

Dementia care for people from culturally and linguistically diverse backgrounds: Qualitative secondary analysis of the aged care Australian royal commission data

Objective: Understanding the concerns and experiences of people living with dementia from culturally and linguistically diverse backgrounds is critical to ensure culturally appropriate care is delivered. This study aimed to describe the current experiences and concerns of older people from culturally and linguistically diverse backgrounds using the publicly available evidence from the Australian Royal Commission into Aged Care Quality and Safety. Methods: This was a qualitative secondary analysis of the Australian Royal Commission into Aged Care Quality and Safety data to explore new and nuanced insights about care for culturally and linguistically diverse people living with dementia. Using the keywords to search the data corpus, we extracted a topic-specific data set focused on dementia care and cultural diversity. Thematic analysis was used to identify and describe the present practices and challenges. Results: Our findings showed that the need for cultural connection for older people from culturally and linguistically diverse backgrounds increases as dementia progresses. Access to culture-specific food and music facilitated connection with their culture of origin. Many older people from culturally and linguistically diverse backgrounds with dementia reverted to their language of origin; however, the inability to communicate due to a lack of language support impacted their health and well-being, and care provision. Conclusions: Further work is needed to provide the necessary cultural experiences and language support to ensure comfort and equity in the provision of dementia care for Australians from migrant backgrounds

Palliative and end-of-life care access for immigrants living in high-income countries: A scoping review

This scoping review aimed to explore what is known about palliative and End-of-Life (EOL) care access by immigrants with culturally and linguistically diverse (CALD) background living in high-income Organization for Economic Co-operation and Development (OECD) countries. CaLD immigrants have low utilization of palliative care services with patients’ family members taking up the role of caring, leading to immigrants not fully benefiting from the specialized services that are offered to alleviate suffering and promote quality of life. While there is some research in this area mainly in Europe, it cannot be said about all high-income OECD countries. Achieving person-centered care in high-income countries, requires identifying and addressing barriers to care access, especially by immigrants with CaLD background. Five-stage methodological framework by Arksey and O’Malley was used to undertake the review. Immigrants in OECD countries experience challenges in accessing palliative and EOL care services. The review also identified limited literature on the subject and establishes need for more research on the subject

Experiences of older immigrants living with dementia and their carers: A systematic review and meta-synthesis

Objective To systematically review and synthesise evidence on the experiences of older immigrants living with dementia and their carers. Design A systematic review and meta-synthesis of qualitative studies. Methods Studies exploring the experiences of older immigrants living with dementia and their carers were eligible. Databases were searched including CINAHL, MEDLINE, PsycINFO, PubMed, Embase, Web of Science and Cochrane Library from January 2000 to April 2021. Quality assessment was undertaken using the Critical Appraisal Skills Programme checklist for qualitative studies. Data were then synthesised using the thematic synthesis approach. Results The results of this meta-synthesis were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement and Enhancing transparency in reporting the synthesis of qualitative research statement. A total of 3857 studies were returned from the database search. Eighteen studies were included for meta-synthesis. Five synthesised findings were identified: living with dementia and caregiving; family relationships; barriers to dementia care services; stigma and discrimination; and legal and financial issues. The experiences of living with dementia and caregiving presented multiple challenges for older immigrants living with dementia and their families. However, there seems to be very little difference between the experiences of those who have migrated to a new country and those who were born and aged in the same country, but the ability to access and use the available services is different. Conclusion A lack of culturally appropriate dementia services, language barriers and dementia stigma can impede access to dementia care for older immigrants. Strategies to mitigate these barriers are urgently needed to ensure people from culturally and linguistically diverse backgrounds with dementia and their families have the information, education and support to access dementia services, in addition to research that explores the experiences of culturally and linguistically diverse populations. PROSPERO registration number CRD42021277913

Relationship between residential aged care facility characteristics and breaches of the Australian aged care regulatory standards: Non-compliance notices and sanctions

Objectives To examine the relationship between structural characteristics of Australian residential aged care facilities (RACFs) and breaches of the aged care quality standards. Methods Facility-level analysis of audits, sanctions and non-compliance notices of all accredited Australian RACFs between 2015/16 and 2018/19. Structural factors of interest included RACF size, remoteness, ownership type and jurisdiction. Two government data sources were joined. Each outcome was analysed to calculate time trends, unadjusted rates and relative risks. Results Non-compliance notices were imposed on 369 RACFs (13%) and 83 sanctions on 75 RACFs (3%). Compared with New South Wales (NSW), non-compliance notices were less likely in Victoria, Queensland and the Northern Territory (NT), more likely in South Australia (SA), and comparable in Western Australia (WA), Tasmania and the Australian Capital Territory (ACT). RACFs with more than 100 beds and RACFs located in remote and outer regional areas (vs. major cities) also increased the likelihood of non-compliance notices. Compared with NSW, sanctions were less likely in Victoria, Queensland, NT and WA and comparable in SA, Tasmania and ACT. Additionally, the likelihood of sanctions was higher for RACFs with more than 40 beds. For both non-compliance notices and sanctions, no significant relationship was found with RACF ownership type. Conclusions We partially confirmed other Australian findings about the relationship between RACF structural characteristics and regulatory sanctions and reported new findings about non-compliance notices. Routine and standardised public reporting of RACF performance is needed to build trust that Australia\u27s latest aged care reforms have led to sustained quality improvements