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

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

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

Agreement of nursing home staff with palliative care principles : a pace cross-sectional study among nurses and care assistants in five european countries

Contains fulltext : 215538.pdf (publisher's version ) (Open Access)CONTEXT: To provide high-quality palliative care to nursing home residents, staff need to understand the basic principles of palliative care. OBJECTIVES: To evaluate the extent of agreement with the basic principles of palliative care of nurses and care assistants working in nursing homes in five European countries and to identify correlates. METHODS: This is a cross-sectional study in 214 homes in Belgium, England, Italy, the Netherlands, and Poland. Agreement with basic principles of palliative care was measured with the Rotterdam MOVE2PC. We calculated percentages and odds ratios of agreement and an overall score between 0 (no agreement) and 5 (total agreement). RESULTS: Most staff in all countries agreed that palliative care involves more than pain treatment (58% Poland to 82% Belgium) and includes spiritual care (62% Italy to 76% Belgium) and care for family or relatives (56% Italy to 92% Belgium). Between 51% (the Netherlands) and 64% (Belgium) correctly disagreed that palliative care should start in the last week of life and 24% (Belgium) to 53% (Poland) agreed that palliative care and intensive life-prolonging treatment can be combined. The overall agreement score ranged between 1.82 (Italy) and 3.36 (England). Older staff (0.26; 95% confidence interval [CI]: 0.09-0.43, P = 0.003), nurses (0.59; 95% CI: 0.43-0.75, P < 0.001), and staff who had undertaken palliative care training scored higher (0.21; 95% CI: 0.08-0.34, P = 0.002). CONCLUSIONS: The level of agreement of nursing home staff with basic principles of palliative care was only moderate and differed between countries. Efforts to improve the understanding of basic palliative care are needed

No difference in effects of ‘PACE steps to success’ palliative care program for nursing home residents with and without dementia : a pre-planned subgroup analysis of the seven-country PACE trial

Background: 'PACE Steps to Success' is a multicomponent training program aiming to integrate generalist and non-disease-specific palliative care in nursing homes. This program did not improve residents' comfort in the last week of life, but it appeared to improve quality of care and dying in their last month of life. Because this program included only three dementia-specific elements, its effects might differ depending on the presence or stage of dementia. We aimed to investigate whether the program effects differ between residents with advanced, non-advanced, and no dementia. Methods: Pre-planned subgroup analysis of the PACE cluster-randomized controlled trial in 78 nursing homes in seven European countries. Participants included residents who died in the previous 4 months. The nursing home staff or general practitioner assessed the presence of dementia; severity was determined using two highly-discriminatory staff-reported instruments. Using after-death questionnaires, staff assessed comfort in the last week of life (Comfort Assessment in Dying-End-of-Life in Dementia-scale; primary outcome) and quality of care and dying in the last month of life (Quality of Dying in Long-Term Care scale; secondary outcome). Results: At baseline, we included 177 residents with advanced dementia, 126 with non-advanced dementia and 156 without dementia. Post-intervention, respectively in the control and the intervention group, we included 136 and 104 residents with advanced dementia, 167 and 110 with non-advanced dementia and 157 and 137 without dementia. We found no subgroup differences on comfort in the last week of life, comparing advanced versus without dementia (baseline-adjusted mean sub-group difference 2.1; p-value = 0.177), non-advanced versus without dementia (2.7; p = 0.092), and advanced versus non-advanced dementia (- 0.6; p = 0.698); or on quality of care and dying in the last month of life, comparing advanced and without dementia (- 0.6; p = 0.741), non-advanced and without dementia (- 1.5; p = 0.428), and advanced and non-advanced dementia (0.9; p = 0.632). Conclusions: The lack of subgroup difference suggests that while the program did not improve comfort in dying residents with or without dementia, it appeared to equally improve quality of care and dying in the last month of life for residents with dementia (regardless of the stage) and those without dementia. A generalist and non-disease-specific palliative care program, such as PACE Steps to Success, is a useful starting point for future palliative care improvement in nursing homes, but to effectively improve residents' comfort, this program needs further development

Huisarts en dementie : de begeleiding van patiënt en centrale verzorger

Contains fulltext : 24040___.PDF (publisher's version ) (Open Access

'Het is zaliger te geven dan te ontvangen'

Contains fulltext : 45146_het_iszat.pdf (publisher's version ) (Open Access)Inaugural address Radboud University Nijmegen21 p

Meaningful activities for people with dementia.

Contains fulltext : 53532.pdf (publisher's version ) (Closed access

Social health : bron van kracht in een kwetsbaar bestaan

Contains fulltext : 159913.pdf (publisher's version ) (Open Access)Rede uitgesproken bij het afscheid als hoogleraar Psychosociale aspecten van zorg voor kwetsbare ouderen - de Joop Michels-leerstoel - aan de Radboud Universiteit/het Radboudumc op 9 oktober 201519 p. p

Reading Across the Pacific: Australia–United States Intellectual Histories. Front matter and table of contents.

Contains fulltext : mmubn000001_159916305.pdf (publisher's version ) (Open Access)Promotores : J. Persoon en A. FellingXII, 209 p