Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development

Citation: Syme, M. L., Yelland, E., Cornelison, L., Poey, J. L., Krajicek, R., & Doll, G. (2016). Content analysis of public opinion on sexual expression and dementia: Implications for nursing home policy development. Health Expectations. doi:10.1111/hex.12509Purpose: We examined public opinion of sexual expression and dementia to inform nursing home policy and practice. Design and Methods: A content analysis was conducted on public comments (N=1194) posted in response to a New York Times article about a highly publicized legal case involving a husband engaging in sexual acts with his wife who had dementia, living in a nursing home. Researchers utilized constant comparative analysis to code the comments; reliability analysis showed moderately strong agreement at the subcategory level. Data were also coded to indicate whether the commenter thought the couple should or should not have been allowed to be sexual. Results: One primary theme was identified: conditions necessary for someone to be sexual. Six categories were identified within this theme, with the public commentary considering factors such as marital relationships, intimacy needs and several sexual consent-related issues as key conditions necessary to be sexual in a nursing home setting. Overall, the majority of commenters were in support of sexual expression for an individual with dementia in the described situation. Discussion: This study revealed sexual expression among individuals with dementia is a contentious issue with strong public opinions about how this should be managed in a nursing home setting. These opinions should be considered as policy related to sexual expression in nursing homes is developed. © 2016 John Wiley & Sons Ltd

Development of a Molecular-Imprinted-Polymer based sensor for the electrochemical determination of Triacetone Triperoxide (TATP)

.The explosive triacetone triperoxide (TATP), which can be prepared from commercially readily available reagents following an easy synthetic procedure, is one of the most common components of improvised explosive devices (IEDs). Molecularly-imprinted polymer (MIP) electrochemical sensors have proved useful for the determination of different compounds in different matrices with the required sensitivity and selectivity. In this work, a highly sensitive and selective molecularly imprinted polymer with electrochemical capabilities for the determination of TATP has been developed. The molecular imprinting has been performed via electropolymerisation onto a glassy carbon electrode surface by cyclic voltammetry from a solution of pyrrole functional monomer, TATP template and LiClO4. Differential Pulse Voltammetry of TATP, with LiClO4 as supporting electrolyte, was performed in a potential range of −2.0 V to +1.0 V (vs. Ag/AgCl). Three-factor two-level factorial design was used to optimise the monomer concentration at 0.1 mol·L−1 , template concentration at 100 mmol·L−1 and the number of cyclic voltammetry scan cycles to 10. The molecularly imprinted polymer-modified glassy carbon electrode demonstrated good performance at low concentrations for a linear range of 82–44,300 µg·L−1 and a correlation coefficient of r2 = 0.996. The limits of detection (LoD) and quantification (LoQ) achieved were 26.9 μg·L−1 and 81.6 μg·L−1, respectively. The sensor demonstrated very good repeatability with precision values (n = 6, expressed as %RSD) of 1.098% and 0.55% for 1108 and 2216 µg·L−1 , respectively. It also proved selective for TATP in the presence of other explosive substances such as PETN, RDX, HMX, and TNT

A primary care, multi-disciplinary disease management program for opioid-treated patients with chronic non-cancer pain and a high burden of psychiatric comorbidity

BACKGROUND: Chronic non-cancer pain is a common problem that is often accompanied by psychiatric comorbidity and disability. The effectiveness of a multi-disciplinary pain management program was tested in a 3 month before and after trial. METHODS: Providers in an academic general medicine clinic referred patients with chronic non-cancer pain for participation in a program that combined the skills of internists, clinical pharmacists, and a psychiatrist. Patients were either receiving opioids or being considered for opioid therapy. The intervention consisted of structured clinical assessments, monthly follow-up, pain contracts, medication titration, and psychiatric consultation. Pain, mood, and function were assessed at baseline and 3 months using the Brief Pain Inventory (BPI), the Center for Epidemiological Studies-Depression Scale scale (CESD) and the Pain Disability Index (PDI). Patients were monitored for substance misuse. RESULTS: Eighty-five patients were enrolled. Mean age was 51 years, 60% were male, 78% were Caucasian, and 93% were receiving opioids. Baseline average pain was 6.5 on an 11 point scale. The average CESD score was 24.0, and the mean PDI score was 47.0. Sixty-three patients (73%) completed 3 month follow-up. Fifteen withdrew from the program after identification of substance misuse. Among those completing 3 month follow-up, the average pain score improved to 5.5 (p = 0.003). The mean PDI score improved to 39.3 (p < 0.001). Mean CESD score was reduced to 18.0 (p < 0.001), and the proportion of depressed patients fell from 79% to 54% (p = 0.003). Substance misuse was identified in 27 patients (32%). CONCLUSIONS: A primary care disease management program improved pain, depression, and disability scores over three months in a cohort of opioid-treated patients with chronic non-cancer pain. Substance misuse and depression were common, and many patients who had substance misuse identified left the program when they were no longer prescribed opioids. Effective care of patients with chronic pain should include rigorous assessment and treatment of these comorbid disorders and intensive efforts to insure follow up

Lengthy article analyzing the successes and failures of Maine\u27s Dirigo Health pr

Lengthy article analyzing the successes and failures of Maine\u27s Dirigo Health program, which tries to control hospital costs, improve health care quality, and offer subsidized insurance to low-income people. Maine is a poor, rural state with many small businesses, seasonal workers, and a large elderly population. The state projected that 130,000 uninsured residents would enroll by 2009, but so far only 18,800 have signed up, 60 percent of whom were previously insured, though not as well. The coverage is comprehensive, but many find it too expensive. Gov. John Baldacci is proposing an overhaul that includes requiring that people have insurance and that employers offer it. With remarks by some who have chosen Dirigo coverage and others who can\u27t afford it