CARE-PACT: a new paradigm of care for acutely unwell residents in aged care facilities

Describes the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities. Background Ageing population trends create a strong imperative for healthcare systems to develop models of care that reduce dependence on hospital services. People living in residential aged care facilities (RACFs) currently have high rates of presentation to emergency departments. The care provided in these environments may not optimally satisfy the needs of frail older persons from RACFs.   Objective To describe the Comprehensive Aged Residents Emergency and Partners in Assessment, Care and Treatment (CARE-PACT) program: a hospital substitutive care and demand management project that aims to improve, in a fiscally efficient manner, the quality of care received by residents of aged care facilities when their acute healthcare needs exceed the scope of the aged care facility staff and general practitioners to manage independently of the hospital system.   Discussion The project delivers high-quality gerontic nursing and emergency specialist assessment, collaborative care planning, skills sharing across the care continuum and an individualised, resident-focused approach

Quality indicators in the care of older persons in the emergency department: a systematic review of the literature

ObjectiveA systematic review of the literature was undertaken to assess the methodological quality of existing quality indicators (QIs) for the emergency department (ED) care of older persons

Correspondence between genomic- and genealogical/coalescent-based inference of homozygosity by descent in large French-Canadian genealogies

Research on the genetics of complex traits overwhelmingly focuses on the additive effects of genes. Yet, animal studies have shown that non-additive effects, in particular homozygosity effects, can shape complex traits. Recent investigations in human studies found some significant homozygosity effects. However, most human populations display restricted ranges of homozygosity by descent (HBD), making the identification of homozygosity effects challenging. Founder populations give rise to higher HBD levels. When deep genealogical data are available in a founder population, it is possible to gain information on the time to the most recent common ancestor (MRCA) from whom a chromosomal segment has been transmitted to both parents of an individual and in turn to that individual. This information on the time to MRCA can be combined with the time to MRCA inferred from coalescent models of gene genealogies. HBD can also be estimated from genomic data. The extent to which the genomic HBD measures correspond to the genealogical/coalescent measures has not been documented in founder populations with extensive genealogical data. In this study, we used simulations to relate genomic and genealogical/coalescent HBD measures. We based our simulations on genealogical data from two ongoing studies from the French-Canadian founder population displaying different levels of inbreeding. We simulated single-nucleotide polymorphisms (SNPs) in a 1-Mb genomic segment from a coalescent model in conjunction with the observed genealogical data. We compared genealogical/coalescent HBD to two genomic methods of HBD estimation based on hidden Markov models (HMMs). We found that genomic estimates of HBD correlated well with genealogical/coalescent HBD measures in both study genealogies. We described generation time to coalescence in terms of genomic HBD estimates and found a large variability in generation time captured by genomic HBD when considering each SNP. However, SNPs in longer segments were more likely to capture recent time to coalescence, as expected. Our study suggests that estimating the coalescent gene genealogy from the genomic data to use in conjunction with observed genealogical data could provide valuable information on HBD

Solutions to the chronic wounds problem in Australia: A call to action

Background: Chronic wounds are a silent epidemic in Australia. They are an under-recognised public health issue, and their significant health and economic impact is underestimated. Evidence-based practice in wound care has significant health and economic benefits, yet there are still considerable evidence–practice gaps. Methods: Stakeholders attended a national forum to refine and prioritise solutions to the chronic wounds problem in Australia. A survey was administered to identify key priorities and recommendations. Results: Stakeholders agreed on 17 recommendations and strategies to improve the outcomes of Australians with chronic wounds. The identified priorities for immediate action were to raise awareness of the significance of chronic wounds, and to make chronic wounds a strategic priority for governments. The Chronic Wounds Solutions Collaborating Group was established to encourage, support and monitor action on the implementation of these recommendations. Conclusions: Large health and economic gains can be achieved with modest investments in evidence-based strategies for the prevention and control of chronic wounds in Australia. We call for a critical and sustained national effort to prevent and treat chronic wounds in Australia. Urgent action is needed at all levels if Australia is to reduce the significant preventable burden of chronic wounds and improve patient outcomes

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

A comparative analysis of risk stratification tools for emergency department patients with chest pain

Background: Appropriate disposition of emergency department (ED) patients with chest pain is dependent on clinical evaluation of risk. A number of chest pain risk stratification tools have been proposed. The aim of this study was to compare the predictive performance for major adverse cardiac events (MACE) using risk assessment tools from the National Heart Foundation of Australia (HFA), the Goldman risk score and the Thrombolysis in Myocardial Infarction risk score (TIMI RS). Methods: This prospective observational study evaluated ED patients aged ≥30 years with non-traumatic chest pain for which no definitive non-ischemic cause was found. Data collected included demographic and clinical information, investigation findings and occurrence of MACE by 30 days. The outcome of interest was the comparative predictive performance of the risk tools for MACE at 30 days, as analyzed by receiver operator curves (ROC). Results: Two hundred eighty-one patients were studied; the rate of MACE was 14.1%. Area under the curve (AUC) of the HFA, TIMI RS and Goldman tools for the endpoint of MACE was 0.54, 0.71 and 0.67, respectively, with the difference between the tools in predictive ability for MACE being highly significant [chi2 (3) = 67.21, N = 276, p < 0.0001]. Conclusion: The TIMI RS and Goldman tools performed better than the HFA in this undifferentiated ED chest pain population, but selection of cutoffs balancing sensitivity and specificity was problematic. There is an urgent need for validated risk stratification tools specific for the ED chest pain population

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Aim: The aim of this study was to undertake a systematic review of the literature and evaluate interventions used to improve continuity of medication management upon transition of care from an acute hospital setting to a residential aged care facility (RACF). Data sources: Embase, PubMed, The Cochrane Database of Systematic Reviews, Google Scholar, Informit Health Collection, grey literature and reference mining of included studies (from inception to March 2018). Study selection: Interventions aimed at improving the continuity of medication management upon discharge of patients from hospital to an RACF or similar facility were included. Interventions were defined as a communication tool or a service initiated by any healthcare professional. Studies were excluded if they were not available in English, had certain study designs (i.e. qualitative, observational and systematic review) and if no abstract and full-text article could be obtained. Results: Seven studies met the inclusion criteria. All interventions involved a multidisciplinary approach to discharge facilitation including the provision of discharge medication information. Six studies included pharmacist-led medication reconciliation. Two studies used an RACF-specific medication chart. Although positive findings were shown for most interventions, critical analysis of the studies included identified many limitations. Conclusion: Interventions involving a multidisciplinary team, pharmacist-led medication reconciliation and the provision of accurate discharge information have been identified as improving continuity of medication management during transitions of care from hospital to RACF. Importantly, this systematic review has identified an ongoing need for development of a comprehensive intervention that addresses all barriers to optimal continuity of medications encountered during this high-risk transition

Interventions to improve the continuity of medication management upon discharge of patients from hospital to residential aged care facilities

Aim: The aim of this study was to undertake a systematic review of the literature and evaluate interventions used to improve continuity of medication management upon transition of care from an acute hospital setting to a residential aged care facility (RACF). Data sources: Embase, PubMed, The Cochrane Database of Systematic Reviews, Google Scholar, Informit Health Collection, grey literature and reference mining of included studies (from inception to March 2018). Study selection: Interventions aimed at improving the continuity of medication management upon discharge of patients from hospital to an RACF or similar facility were included. Interventions were defined as a communication tool or a service initiated by any healthcare professional. Studies were excluded if they were not available in English, had certain study designs (i.e. qualitative, observational and systematic review) and if no abstract and full-text article could be obtained. Results: Seven studies met the inclusion criteria. All interventions involved a multidisciplinary approach to discharge facilitation including the provision of discharge medication information. Six studies included pharmacist-led medication reconciliation. Two studies used an RACF-specific medication chart. Although positive findings were shown for most interventions, critical analysis of the studies included identified many limitations. Conclusion: Interventions involving a multidisciplinary team, pharmacist-led medication reconciliation and the provision of accurate discharge information have been identified as improving continuity of medication management during transitions of care from hospital to RACF. Importantly, this systematic review has identified an ongoing need for development of a comprehensive intervention that addresses all barriers to optimal continuity of medications encountered during this high-risk transition