Strategies to address the shortcomings of commonly used advanced chronic heart failure descriptors to improve recruitment in palliative care research: A parallel mixed-methods feasibility study

Background:Recruitment challenges contribute to the paucity of palliative care research with advanced chronic heart failure patients.Aim:To describe the challenges and outline strategies of recruiting advanced chronic heart failure patients.Design:A feasibility study using a pre–post uncontrolled design.Setting:Advanced chronic heart failure patients were recruited at two nurse-led chronic heart failure disease management clinics in IrelandResults:Of 372 patients screened, 81 were approached, 38 were recruited (46.9% conversion to consent) and 25 completed the intervention. To identify the desired population, a modified version of the European Society of Cardiology definition was used together with modified New York Heart Association inclusion criteria to address inter-study site New York Heart Association classification subjectivity. These modifications substantially increased median monthly numbers of eligible patients approached (from 8 to 20) and median monthly numbers recruited (from 4 to 9). Analysis using a mortality risk calculator demonstrated that recruited patients had a median 1-year mortality risk of 22.7 and confirmed that the modified eligibility criteria successfully identified the population of interest. A statistically significant difference in New York Heart Association classification was found in recruited patients between study sites, but no statistically significant difference was found in selected clinical parameters between these patients.Conclusion:Clinically relevant modifications to the European Society of Cardiology definition and strategies to address New York Heart Association subjectivity may help to improve advanced chronic heart failure patient recruitment in clinical settings, thereby helping to address the paucity of palliative care research this population

Evaluation of an Interprofessional Geriatric Clinical Skills Fair

Objectives •Describe the utilization of an interprofessional geriatric clinical skills fair to impart knowledge and skills pertaining to both core geriatric and IPE competencies. •Prepare to introduce an Interprofessional Geriatric Clinical Skills Fair at one’s own institution •Recognize essential elements of a measurement tool that evaluates the effectiveness of an Interprofessional Geriatric Clinical Skills Fai

Using an Interdisciplinary Falls Assessment Clinic to develop collaborative team skills among medical and health professions students.

In new practice models, such as the Chronic Care Model, there is an emphasis on interdisciplinary collaboration; however health profession students have little or no opportunity to practice together during their educational training. Students need learning experiences in which they work collaboratively with groups in other disciplines to solve healthcare problems. The Eastern Pennsylvania-Delaware Geriatric Education Center (EPaD GEC) has developed an Interdisciplinary Falls Assessment Clinic which uses evidence based standard of care practice to evaluate and manage older adults who have fallen or at risk for falling. Older adults are at increased risk for falls and fall-related injuries, leading to loss of independence, disability, and increased mortality. The interdisciplinary clinic provides a clinical educational opportunity for students in medicine, nursing, physical therapy, occupational therapy, pharmacy, and social work to train and work together as an interdisciplinary team. The objective is for health care profession students to be able to identify roles and responsibilities of professionals on the health care team and practice communication and collaboration skills in a interprofessional care team. The Falls Assessment Clinic also provides an educational venue to increase the knowledge of students in medicine, physical therapy, occupational therapy, pharmacy, social work, and nursing regarding prevention and management of falls in the elderly. This session will focus on the educational impact of an Interdisciplinary Falls Assessment clinic to enhance interprofessional learning in geriatrics for health profession students. Based on the evaluation data, the interdisciplinary clinic facilitated the students’ recognition of the important roles each profession play in caring for a patient in a health care team. The experience of working in a team was reported as very rewarding and beneficial in increasing the students’ knowledge of teamwork in a clinical scenario. Students reported enjoying the team meeting experience and regarded this as a valuable part of their education. Learning Objectives: At the end of this session, participants will: 1. Discuss common barriers and challenges to incorporating learners from different disciplines 2. Discuss strategies and methods to assess competency and evaluate learners from different disciplines in different stages of learning 3. Identify a strategy to develop and implement an interdisciplinary clinic at their home institution

Understanding how a palliative-specific patient-reported outcome intervention works to facilitate patient-centred care in advanced heart failure:A qualitative study

Background: Palliative care needs of patients with chronic heart failure are poorly recognised. Policy makers advise a patient-centred approach to holistically assess patients’ needs and care goals. Patient-reported outcome measures are proposed to facilitate patient-centred care. Aim: To explore whether and how a palliative care–specific patient-reported outcome intervention involving the Integrated Palliative care Outcome Scale influences patients’ experience of patient-centred care in nurse-led chronic heart failure disease management clinics. Design: A feasibility study using a parallel mixed-methods embedded design was undertaken. The qualitative component which examined patients and nurses experience of the intervention is reported here. Semi-structured interviews were conducted and analysed using framework analysis. Setting/participants: Eligible patients attended nurse-led chronic heart failure disease management clinics in two tertiary referral centres in Ireland with New York Heart Association functional class II–IV. Nurses who led these clinics were eligible for inclusion. Results: In all, 18 patients and all 4 nurses involved in the nurse-led clinics were interviewed. Three key themes were identified: identification of unmet needs, holistic assessment and patient empowerment. The intervention impacted on processes of care by enabling a shared understanding of patients’ symptoms and concerns, facilitating patient–nurse communication by focusing on these unmet needs and empowering patients to become more involved in clinical discussions. Conclusion: This Integrated Palliative care Outcome Scale–based intervention empowered patients to become more engaged in the clinical consultation and to highlight their unmet needs. This study adds to the evidence for the mechanism of action of patient-reported outcome measures to improve patient-centred care and will help inform outcome selection for future patient-reported outcome measure research. </jats:sec

Genome-Wide Association Study Reveals Multiple Loci Influencing Normal Human Facial Morphology

<div><p>Numerous lines of evidence point to a genetic basis for facial morphology in humans, yet little is known about how specific genetic variants relate to the phenotypic expression of many common facial features. We conducted genome-wide association meta-analyses of 20 quantitative facial measurements derived from the 3D surface images of 3118 healthy individuals of European ancestry belonging to two US cohorts. Analyses were performed on just under one million genotyped SNPs (Illumina OmniExpress+Exome v1.2 array) imputed to the 1000 Genomes reference panel (Phase 3). We observed genome-wide significant associations (p < 5 x 10⁻⁸) for cranial base width at 14q21.1 and 20q12, intercanthal width at 1p13.3 and Xq13.2, nasal width at 20p11.22, nasal ala length at 14q11.2, and upper facial depth at 11q22.1. Several genes in the associated regions are known to play roles in craniofacial development or in syndromes affecting the face: <i>MAFB</i>, <i>PAX9</i>, <i>MIPOL1</i>, <i>ALX3</i>, <i>HDAC8</i>, and <i>PAX1</i>. We also tested genotype-phenotype associations reported in two previous genome-wide studies and found evidence of replication for nasal ala length and SNPs in <i>CACNA2D3</i> and <i>PRDM16</i>. These results provide further evidence that common variants in regions harboring genes of known craniofacial function contribute to normal variation in human facial features. Improved understanding of the genes associated with facial morphology in healthy individuals can provide insights into the pathways and mechanisms controlling normal and abnormal facial morphogenesis.</p></div

LocusZoom plots showing genome-wide significant associations observed in the meta-analysis for intercanthal width (Fig 1H).

<p>(A) chromosome 1 and (B) chromosome X. LocusZoom plots show the association (left y-axis; log10-transformed p-values) with facial traits. Genotyped SNPs are depicted by stars and imputed SNPs are depicted by circles. Shading of the points represent the linkage disequilibrium (r², based on the 1000 Genomes Project Europeans) between each SNP and the top SNP, indicated by purple shading. The blue overlay shows the recombination rate (right y-axis). Positions of genes are shown below the plot.</p

LocusZoom plots showing genome-wide significant associations observed in the meta-analysis for nasal width (Fig 1K) and nasal ala length (Fig 1N).

<p>(A) nasal width on chromosome 20 and (B) nasal ala length on chromosome 14. LocusZoom plots show the association (left y-axis; log10-transformed p-values) with facial traits. Genotyped SNPs are depicted by stars and imputed SNPs are depicted by circles. Shading of the points represent the linkage disequilibrium (r², based on the 1000 Genomes Project Europeans) between each SNP and the top SNP, indicated by purple shading. The blue overlay shows the recombination rate (right y-axis). Positions of genes are shown below the plot.</p

Testing of previously identified genome-wide significant SNPs in European samples.

<p>Testing of previously identified genome-wide significant SNPs in European samples.</p

LocusZoom plots showing genome-wide significant associations observed in the meta-analysis for cranial base width (Fig 1A).

<p>(A) chromosome 14 and (B) chromosome 20. LocusZoom plots show the association (left y-axis; log10-transformed p-values) with facial traits. Genotyped SNPs are depicted by stars and imputed SNPs are depicted by circles. Shading of the points represent the linkage disequilibrium (r², based on the 1000 Genomes Project Europeans) between each SNP and the top SNP, indicated by purple shading. The blue overlay shows the recombination rate (right y-axis). Positions of genes are shown below the plot.</p