Exploring registered health professionals' assessment of older adults in care facilities : a thesis presented in partial fulfilment of the requirements for the degree of Master of Philosophy at Massey University, Turitea Campus, Palmerston North, New Zealand /

Older adults in care facilities are increasingly frail, with a number of co-existing conditions and complex health care needs. Before entry into a care facility, and while they are residing in a care facility, older adults are assessed by health professionals from different disciplines. The aim of this research is to gain insight into registered health professionals' 1 Registered health professionals: For this research, the term 'Registered health professionals' includes Dietitians, Diversional Therapists, General Practitioners, Occupational Therapists, Pharmacists, Physiotherapists, Registered Nurses and Social Workers, who are employed or contracted by a care facility. understanding of assessment of older adults in care facilities and how these assessments are utilised by Registered Nurses to create a plan for care. Assessment is an integral part of clinical practice for health professionals. Health professionals assess older adults to plan and deliver care, to instruct others about the care to be provided to the older adult, and to meet contract and audit requirements. For this pilot project, fourteen health professionals who perform assessments of older adults in care facilities participated in this research. Participants were approached via their place of employment. Data were gathered through semi-structured interviews and analysed by Thematic Content Analysis. The following theme was clearly identified in this research: ▪ Fragmentation of the assessment and care planning process, with sub-themes related to ▪ human resource issues ▪ the focus on physical aspects by contracted health professionals ▪ the single-discipline approach to care planning ▪ the lack of formal information sharin

Treating homozygous familial hypercholesterolemia in a real-world setting: Experiences with lomitapide

Homozygous familial hypercholesterolaemia (HoFH) is a rare genetic disease characterised by markedly elevated plasma levels of low-density lipoprotein-cholesterol (LDL-C). Lomitapide is a microsomal triglyceride transfer protein (MTP) inhibitor approved as an adjunct to other lipid-lowering therapies (LLTs), with or without lipoprotein apheresis (LA), for the treatment of adult HoFH. Diet with <20% calories from fat is required. Due to a varying genetic and phenotypic profile of patients with HoFH, individual patients may respond to therapy differently; therefore examining individual cases in a 'real-world' setting provides valuable information on the effective day-to-day management of HoFH cases. Four HoFH cases were selected for analysis and discussion: a 20-year-old female compound heterozygote; a 62-year old female homozygote; a 42-year-old female compound heterozygote; and a 36-year-old male homozygote. Each patient was commenced on lomitapide according to the prescribed protocol and subjected to routine follow-up. All four patients experienced clinically meaningful reductions in LDL-C levels of 35-73%. Three of the patients had evidence of steatosis or mildly elevated liver function tests) before lomitapide was started, but effects of lomitapide on hepatic function were not universal. Three of the patients experienced gastrointestinal adverse events, but were managed with appropriate dietary control. Lomitapide is an effective adjunct LLT in the management of patients with HoFH, with or without LA. Real-world use of lomitapide has a side-effect profile consistent with clinical trials and one that can be managed by adherence to recommendations on dose escalation, dietary modification and dietary supplements

Elucidating the backbone conformation of photoswitchable foldamers using vibrational circular dichroism

The backbone conformation of amphiphilic oligo(azobenzene) foldamers is investigated using vibrational circular dichroism (VCD) spectroscopy on a mode involving the stretching of the N=N bonds in the backbone. From denaturation experiments, we find that the VCD response in the helical conformation arises mainly from through-space interaction between the N=N-stretch transition-dipole moments, so that the coupled-oscillator model can be used to predict the VCD spectrum associated with a particular conformation. Using this approach, we elucidate the origin of the VCD signals in the folded conformation, and can assign the observed partial loss of VCD signals upon photo-induced unfolding to specific conformational changes. Our results show that the N=N-stretch VCD response provides an excellent probe of the helical conformation of the N=N bonds in this type of switchable molecular system

First clinical experiences with inclisiran in a real-world setting

Background and objective: Inclisiran is the first-in-class small interfering RNA (siRNA) PCSK9 inhibitor. In clinical trials inclisiran showed effective and sustained LDL-C reduction of ± 50 %. As data in clinical setting are scarce, we aim to investigate the efficacy and safety in clinical practice. Methods:We describe a registry of consecutive patients who started with inclisiran at a lipid clinic of a university hospital. Patients were eligible if they fulfilled the reimbursement criteria in the Netherlands. Patients were included if they started with inclisiran as first line (group 1) or switched from PCSK9 monoclonal antibody (mAbs) to inclisiran (group 2). LDL-C levels were measured at 3 and 9 months after initiation of inclisiran. Median change of LDL-C levels was calculated on an individual and group level. Results: We analysed 65 patients (36 women), median [25th percentile; 75th percentile] age of 63 [54; 68] years. Of these, 44 patients had both a 3 month and 9 month visit. At 3 months, patients who newly started inclisiran (group 1, n = 45) showed a LDL-C decrease of 38 [-49;-33] %. Patients who used statins as co-medication (n = 15) had a higher median LDL-C decrease compared to those without statin use (n=30; 45 % vs 38 %). However, patients who switched from mAbs to inclisiran (group 2, n = 20) had an increase in LDL-C of 38 [+4; +97] %. Adverse effects associated with inclisiran were mild and consisted of mild injection site reactions. Efficacy was slightly less whereas safety results were similar at 9 months. Conclusion: Our initial experience of inclisiran in a clinical setting showed less reduction in LDL-C levels compared to clinical trials but a similar safety profile. Moreover, patients who switched from PCSK9 mAbs to inclisiran generally showed an increase in LDL-C levels implying that inclisiran is less potent in LDL-C reduction compared to PCSK9 mAbs.</p