Raising the standard of applied dementia care research : addressing the implementation error

Editoria

Diagnosing dementia with confidence by GPs

Contains fulltext : 51908.pdf (publisher's version ) (Closed access)BACKGROUND: Earlier reports suggest limited clinical reasoning and substantial uncertainty of GPs in assessing patients suspected of dementia. OBJECTIVE: To explore the predictors of GPs to decide on the presence and absence of dementia as well as the predictors of diagnostic confidence of GPs. DESIGN: An observational study was set up among 107 patients of 64 GPs. The GPs were instructed to use the Dutch national dementia guideline on consecutive patients newly suspected of dementia and to register their assessment on a detailed form. The predictors of the presence and absence of dementia according to the GPs and their diagnostic confidence were explored by logistic regression analyses. MAIN OUTCOME MEASURES: Dependent variables: (i) presence and absence of dementia according to GPs and (ii) diagnostic confidence. Independent variables: clinical (cognitive, behavioural, somatic, functional), applications of recommendations, patient related and GP related. RESULTS: Dementia was diagnosed in 67% of the suspected patients. The presence of dementia according to the GPs was positively associated with observed impairment of the higher cognitive functions, absence of depression and female gender of patients. The GPs expressed diagnostic confidence in 58% of the cases. This was positively associated with application of recommendations, ADL dependency, longer duration, informant availability, restless behaviour and a patient's female gender. Use of the Mini Mental Status Examination was not associated with confidence. CONCLUSIONS: GPs seem to base the diagnosis of dementia on rational grounds. Application of the dementia guideline's recommendations may contribute to more diagnostic confidence

INTERDEM network celebrates 20 years

Myrra Vernooij-Dassen, INTERDEM Chair, Esme Moniz-Cook,Co-chair and Rabih Chattat, Board member highlight some ofthe network’s key achievements of the past 20 years

Social health in dementia care: Harnessing an applied research agenda

Item does not contain fulltextThe notion of social health (Huber et al., 2011) as applied to dementia care research was introduced to redress the balance of empirical studies that tended to focus on biomedical, cognitive, and functional status in dementia (Vernooij-Dassen and Jeon, 2016). The introduction of social health has followed the zeitgeist of campaigners for a better life for those living with dementia, with initiatives to improve the social images of dementia (Alzheimers.org, 2017). Examples from social research in dementia to examine friendships and the social environments of people with dementia exist (Medeiros et al., 2012), but introduction of the paradigm of social health in dementia (Vernooij-Dassen and Jeon, 2016) has harnessed a growing research agenda (de Vugt and Droes, 2017). This paradigm provides an umbrella concept to study how social aspects influence the dynamic balance between opportunities and limitations in dementia. Social health goes beyond the neuropathology of dementia, to understand how people, their social networks and wider society with its norms, interact with the condition (Vernooij-Dassen and Jeon, 2016). It is not far removed from the ideas of Tom Kitwood, the pioneer of person-centered dementia care, who noted that "personhood is a standing or status that is bestowed upon one human being, by others, in the context of relationship and social being" (Kitwood, 1997). The INTERDEM (Early detection and timely INTERvention in DEMentia, www.interdem.org) psychosocial research agenda aspired to improve knowledge about social inclusion and reciprocal relationships for people with dementia (Moniz-Cook et al., 2011). The concept of social health (Vernooij-Dassen and Jeon, 2016) with its dimensions for dementia research (Droes et al., 2017) has begun to develop this knowledge-base

Cognitive impairment, dementia and quality of life.

Peer reviewe

Positive psychology outcome measures for family caregivers of people living with dementia: a systematic review

Background: Family caregivers of people living with dementia can have both positive and negative experiences of caregiving. Despite this, existing outcome measures predominately focus on negative aspects of caregiving such as burden and depression. This review aimed to evaluate the development and psychometric properties of existing positive psychology measures for family caregivers of people living with dementia to determine their potential utility in research and practice. Method: A systematic review of positive psychology outcome measures for family caregivers of people with dementia was conducted. The databases searched were as follows: PsychINFO, CINAHL, MEDLINE, EMBASE, and PubMed. Scale development papers were subject to a quality assessment to appraise psychometric properties. Results: Twelve positive outcome measures and six validation papers of these scales were identified. The emerging constructs of self-efficacy, spirituality, resilience, rewards, gain, and meaning are in line with positive psychology theory. Conclusions: There are some robust positive measures in existence for family caregivers of people living with dementia. However, lack of reporting of the psychometric properties hindered the quality assessment of some outcome measures identified in this review. Future research should aim to include positive outcome measures in interventional research to facilitate a greater understanding of the positive aspects of caregiving and how these contribute to well-being

Factors Affecting The Efficiency Of Fox (Vulpes Vulpes) Baiting Practices On The Central Tablelands Of New South Wales

The European red fox (Vulpes vulpes L.) is a well known predator of native species and domestic stock, and is recognised as one of Australia’s most devastating vertebrate pests. Current fox management relies heavily on poisoning using baits impregnated with sodium monofluoroacetate (1080). This reliance on 1080 is likely to continue given the lack of viable alternatives for controlling foxes, so that, in the meanwhile, it is important to improve the efficiency of the current techniques. Factors affecting the susceptibility of individual foxes to bait include their ability to locate it, as well as the bait’s palatability and toxicity. The economic costs associated with using different bait types, the pattern and density of their distribution will also affect the efficiency of control programs. It is essential to examine and refine all such issues to ensure efficient use of the 1080 baiting technique. This thesis focuses generally on problems associated with management of the fox in eastern Australia. More specifically, I investigate the factors affecting the efficiency of fox baiting practices on the central tablelands of New South Wales. The study was conducted largely on agricultural lands near the town of Molong (33010’ 37”S, 148087’15”E) on the central tablelands of New South Wales. This area was chosen as it is broadly representative, in terms of land use, of a large region of eastern Australia. The highly modified, predominantly agricultural landscapes near Molong are well suited to foxes, and conflict with the predominantly pastoral community means that fox management is widely undertaken. I determined the persistence of 1080 in two commonly used bait types, Foxoff® and chicken wingettes, under different climatic and rainfall conditions. The rate of 1080 degradation did not change significantly between the central tablelands and the relatively hotter and drier western slopes. Foxoff® baits remained lethal for longer than wingettes under all conditions, although their rate of degradation generally increased with increasing rainfall. I confirmed the presence of defluorinating micro-organisms in thesoils of eastern Australia for the first time, and suggest that, following removal from the bait, 1080 would not persist in the environment for long. Bait should be attractive and highly palatable to ensure that the target species will find and consume it upon discovery. Caching, where discovered food is removed but not immediately consumed, may potentially reduce the efficacy and cost-effectiveness of baiting campaigns. I quantified the caching of chicken wingette, day-old chick and Foxoff® baits by inserting transmitters into bait material and assessing whether it was eaten or cached following removal. The intensity of caching did not change significantly between seasons. Type of bait had the largest influence on caching intensity, with a greater percentage of non-toxic Foxoff® baits (66.9%) being cached than either wingettes (5.7%) or day-old chicks (4.5%). The percentage of toxic (1080) baits cached was even greater, suggesting that 1080 bait may be less palatable, and detectable to foxes. I also investigated the use of conditioned taste aversion to reduce multiple bait uptake by foxes. Levamisole, an illness-inducing chemical, was added to bait and the fate of removed bait was again monitored via radio-telemetry. Following consumption of a levamisole-treated bait, foxes avoided eating treated baits but consumed untreated baits. I concluded that a reduction in bait consumption was achieved through learned aversion to levamisole rather than via conditioned taste aversion to baits. Adding levamisole to baits, especially non-toxic bait such as rabies vaccines, could potentially be used to reduce bait monopolisation by individual foxes. Fox density and den site preferences were assessed by investigating the distribution and density of fox natal dens on one property (9.6 km2) over three consecutive years. A total of 9 natal dens were located in 2000 and 2001, declining to 6 in 2002. No preference was shown for den sites on the basis of habitat, slope or aspect, but more dens were located under, or adjacent to cover. Assuming that each natal den represents a breeding pair and that the population sex ratio did not differ from parity (1:1), the site contained a prebreeding density of 1.9 foxes/km2 in 2000 and 2001, and 1.25 foxes/km2 in 2002. Given that the mean number of cubs is 4.0, the post-breeding density was estimated at 5.6 and 3.75 foxes/km2 in 2000/2001 and 2002, respectively. The results demonstrated that high densities of foxes occur on agricultural lands. The success and likely accuracy of the technique to monitor fox density suggests that it may be used to calibrate more efficient abundance estimates that will be essential for the strategic management of foxes in future. Pest animal management strategies are traditionally assessed for their effectiveness, with less consideration being given to the efficiency or cost of achieving the desired effect. I used cost-effectiveness analyses to compare between different baiting strategies based on the longevity, palatability and handling/replacement costs associated with each bait type. The results indicated that, when measured on a total cost-per-bait-consumed basis, wingettes and day-old chicks were the most cost-effective baits for campaigns of up to 4 weeks duration. This demonstrates the importance of including the longevity, and particularly the palatability of bait, when assessing cost-effectiveness. However, it is recognised that other factors, including the consistency of dosage and uptake by nontarget species, may be equally or more important in deciding the appropriate baiting strategy. The spatial and temporal application of fox baiting in the region overseen by the Molong Rural Lands Protection Board was examined between January 1998 and December 2002 as a case study to evaluate the apparent effectiveness of cooperative management practices. Most landholders (78.8%) did not bait for foxes during this period. Based on known dispersal distances, the effect of fox immigration into baited areas was determined. The results indicated that no areas baited for foxes were separated by a sufficient buffer distance (>9.58 km) from unbaited areas to be protected from fox immigration. This suggests that, at current levels of coordination, the effectiveness of most baiting operations in eastern Australia is compromised over the long term by fox immigration. However, it is recognised that short-term reductions in fox density may sometimes be all that are required to reduce predation to acceptable levels, especially for seasonally-susceptible prey. Ultimately, the cost-effectiveness of control should be evaluated in terms of the response of the prey rather than that of the predator. This study has highlighted deficiencies in current ‘best-practice’ baiting techniques. Specific recommendations for current baiting practices, in addition to future research, are also given. In brief, these include minimising free-feed baiting, increasing the minimum distance between bait stations, and, where possible, presenting the most palatable bait. Continued research into conditioned taste aversion, aerial baiting, and techniques to reduce caching are recommended as potential techniques to improve the efficiency of baiting practices

Sense of coherence in family caregivers of people living with dementia: a mixed-methods psychometric evaluation

Background: Family caregivers of people living with dementia can experience feelings of burden and stress but the concept of sense of coherence has been identified as an important protective trait against the negative impact of caregiving. Despite this, there has been no psychometric evaluation of the Sense of Coherence scale-13 with this population. Therefore, a psychometric evaluation was conducted using a mixed-methods approach. Method: Five hundred and eighty-three caregivers of people living with dementia participated in the study. We examined the feasibility, internal consistency, construct validity, floor and ceiling effects, concurrent validity and face validity of the Sense of Coherence scale-13. Results: The Sense of Coherence scale-13 demonstrated adequate internal consistency. Sense of coherence was positively related to resilience, sense of competence and health related quality of life, demonstrating good concurrent validity. However, the face validity of the scale was assessed as poor. Conclusion: The sense of coherence scale performed well under psychometric evaluation however guidance for caregivers should be examined and revised to reflect feedback from caregivers who completed this study, which could lead to improved face validity for this scale

Low temperature adaption of wheat post head-emergence in northern Australia

OBJECTIVE: More than 50% of patients with cancer experience pain. Patient empowerment has been highlighted as central to success in pain management. Up to now, no clear model for this patient group exists, yet several strategies to empower patients have been used in clinical practice. This review examines how empowerment or related concepts have been described in relation to pain management in patients with cancer. With the help of a conceptual model, recommendations for clinical practice are provided. METHODS: An integrative review was conducted, using the databases PubMed, CINAHL and PsycINFO. We evaluated papers discussing empowerment or related concepts in relation to pain management in patients with cancer. We analyzed the term 'empowerment' semantically. RESULTS: From a total of 5984 identified papers, 34 were included for analysis. Empowerment has been described with the concepts self-efficacy, active patient participation, increasing abilities, and control of life. Most papers focus on pain treatment induced by the professional caregiver or on the active involvement of the patient, and not on the combination of both. The following elements of empowerment could be discriminated: role of the patient, role of the professional, resources, self-efficacy, active coping, and shared decision making. CONCLUSIONS: On the basis of these findings, we propose a conceptual model to empower patients in controlling cancer pain. We recommend focusing on pain treatment given by the professional, on the active involvement of the patient, and on the interaction of both. Our model might also be useful for other patient groups or specific contexts, especially in symptom management. Copyright (c) 2014 John Wiley & Sons, Ltd