Effective health care for older people resident in care homes: the optimal study protocol for realist review

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.Background: Care homes in the UK rely on general practice for access to specialist medical and nursing care as well as referral to therapists and secondary care. Service delivery to care homes is highly variable in both quantity and quality. This variability is also evident in the commissioning and organisation of care home-specific services that range from the payment of incentives to general practitioners (GPs) to visit care homes, to the creation of care home specialist teams and outreach services run by geriatricians. No primary studies or systematic reviews have robustly evaluated the impact of these different approaches on organisation and resident-level outcomes. Our aim is to identify factors which may explain the perceived or demonstrated effectiveness of programmes to improve health-related outcomes in older people living in care homes. Methods/Design: A realist review approach will be used to develop a theoretical understanding of what works when, why and in what circumstances. Elements of service models of interest include those that focus on assessment and management of residents’ health, those that use strategies to encourage closer working between visiting health care providers and care home staff, and those that address system-wide issues about access to assessment and treatment. These will include studies on continence, dignity, and speech and language assessment as well as interventions to promote person centred dementia care, improve strength and mobility, and nutrition. The impact of these interventions and their different mechanisms will be considered in relation to five key outcomes: residents’ medication use, use of out of hours’ services, hospital admissions (including use of Accident and Emergency) and length of hospital stay, costs and user satisfaction. An iterative three-stage approach will be undertaken that is stakeholder-driven and optimises the knowledge and networks of the research team. Discussion: This realist review will explore why and for whom different approaches to providing health care to residents in care homes improves access to health care in the five areas of interest. It will inform commissioning decisions and be the basis for further research. This systematic review protocol is registered on the PROSPERO database reference number: CRD42014009112NIHR Health Services & Delivery Research Programme. Project number 11/1021/0

Aquilegia, Vol. 35 No. 4, Winter 2011: Newsletter of the Colorado Native Plant Society

https://epublications.regis.edu/aquilegia/1109/thumbnail.jp

Development of a Krypton target for Cyclone-30 at KFSH&RC

Introduction Krypton-81m is a radioactive gas with a half-life of 13 s, and found to be useful in many applications in nuclear medicine, particularly for lung perfusion studies and ventilations. Due to high demands for 81mKr, we have developed an automated Krypton system to be installed in one of the Cyclotron’s beamlines at King Faisal Specialist Hospital and Research Centre (KFSH&RC) and to deliver large activity of the radioactive gas. Material and Methods The effective cross section of producing 81Rb is between 15 and 30 MeV [1]. Therefore, range and stopping power of the effective cross section were calculated with respect to gas density of 0.0185 g/cm3. This value is equivalent to gas density at 5.0 bars at room temperature. SRIM calculations resulted in a range of 589 mm. However, due to limitation in fabricating such long target chamber, the target length is chosen to be 250 mm. Attached to the end of target body is a special water circulating flange ‘back-pool’, its purpose is to absorb the rest of the energy and protons Bragg peak. The target body is made of Aluminum with the inner part being electroplated with nickel. The target body is of conical shape. The target body is electrically isolated from other parts to allow accurate beam current reading. Full access to the target loading/unloading steps is made through touch screen technology (FIG. 2) for user access. Additionally, the target control system is designed to be protected through chain of interlock steps. The production cycle of 81Rb is explained as follow. Target is evacuated to approximately 10−3 mbar before being filled with natKr at pressure of 5 bars. At the end of bombardment, recovery of natKr is done via cryogenic vessel. Finally, the radioactivity is washed with KCl and pushed to Hotcells through the nitrogen gas for chemistry processing. Irradiation time was approximately 30 min. Results and Conclusion Experimental results clearly showed a fairly good activity of 81mKr as shown in TABLE 1. In all experiments, the radionuclidic purity of 81mKr was above 99.59%. 79mKr and 79Kr were also measured with a percentage of, respectively, 0.34 and 0.07 %. Special attention has to be drawn to last experiment where the yield significantly in-creased, due to the period where the KCl left inside the target (10 min) before pushing the solution to the Hotcell

Aquilegia, Vol. 33 No. 4, Fall 2009, Newsletter of the Colorado Native Plant Society

https://epublications.regis.edu/aquilegia/1129/thumbnail.jp

Aquilegia, Vol. 32 No. 4, Winter 2008, Newsletter of the Colorado Native Plant Society

https://epublications.regis.edu/aquilegia/1126/thumbnail.jp