Systematic review of dyadic psychoeducational programs for persons with dementia and their family caregivers

Aims and Objectives Synthesising evidence for effects of dyadic psychoeducational support programs on both people with dementia and their caregivers\u27 health and well-being. Background There is an increasing need for psychoeducational support programs for people with dementia and their caregivers; therefore, it is important to identify the benefits and practical implications of the programs on the dyads. Methods Guided by Joanna Briggs Institute (JBI) methodology, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, a systematic search of literature was conducted on dyadic psychoeducational programs published in English between January 2012 and January 2021 from four electronic databases. Results Twenty-four studies evaluating 27 psychoeducational programmes were included in this review. Programs varied in activity types, intensity and duration. Outcome effects on people with dementia were grouped into seven categories: quality of life, cognitive function, psychological and mental health, physical health, changed behaviours, communication and relationship, institutionalisation or mortality. Outcome effects on caregivers were grouped into six: psychological and mental health, quality of life, impact of caregiving, communication and relationship, physical health, and competency. Dyadic psychoeducational programs which were goal oriented and tailored to address individual needs had consistent benefits on various aspects of health and quality of life for the dyads. Conclusions Multicomponent psychoeducational support programs combined with addressing individual needs, identifying goals and providing support to attain specific outcomes are recommended. Given the progressive deterioration of people with dementia, and the increased needs for homecare by family members, delivering long-term, support programs are recommended to maintain the positive effects on the dyads. Relevance to Clinical Practice The findings contribute to dementia-care provision and policy making and inform the development of person-centred interventions and governance. Patient or Public Contribution This systematic review was a part of a larger service evaluation project which involved a dementia consumer advisory group

Evaluation of an educational program for people with dementia and their caregivers

Objectives: This study evaluated the impact of a 5-week educational and supportive program for people newly diagnosed with dementia and their caregivers. Methods: The study involved a pretest–posttest survey followed by interviews. Wilcoxon signed-rank test was conducted to determine postprogram changes. Kruskal–Wallis tests measured variation in responses between the people with dementia and their caregivers. Interviews were analysed using the NVivo software identifying themes against the program objectives of improving knowledge on dementia, coping strategies, communication and support services for people with dementia and their caregivers. Results: Fifty-three dyads (n = 106) completed the survey. There were significant improvements in participants\u27 level of understanding of dementia (z = −8.04, p \u3c 0.001), knowledge of local services (z = −8.11, p \u3c 0.001) and coping with life with dementia (z = −6.93, p \u3c 0.001). These findings were consistent with interview data from 16 dyads. Conclusions: The increasing number of people with dementia and their caregivers living in the community present health challenges. Programs that assist this group to function well in the community are important. Evaluation of this program indicated improved outcomes in relation to adjusting to life with dementia, enhancing knowledge, fostering communication and reducing feelings of isolation. Areas of improvement included lengthening the program with ongoing contact sessions with program facilitators and other participants. Given the positive effects of the program on this vulnerable group of people, it maybe useful for health-care agencies involved in dementia care to conduct this type of program as a matter of routine treatment and care for people newly diagnosed with dementia

A retrospective cohort study of factors associated with severity of falls in hospital patients

Severity of falls in hospital patients are threat to patient safety which can result in a financial burden on the patient’s family and health care services. Both patient specific and environmental and organisational factors are associated with severity of falls in hospital. It is important to continuously analyse the factors associated with severity of fall which can inform the implementation of any fall preventive strategies. This study aims to identify factors associated with the severity of falls in hospitalised adult patients in Western Australia. This study involved a retrospective cohort analysis of inpatient falls records extracted from the hospital’s Clinical Incident Database from May 2014 to April 2019. Severity of falls were classified as three Severity Assessment Code (SAC): SAC 1 was “high” causing serious harm or death; SAC 2 was “medium” causing moderate or minor harm; and SAC 3 was “low” indicating no harm. Univariable and multivariable generalised ordinal logistic regression models were used to quantify the magnitude of effects of the potential risk factors on severity of falls at 5 % level of significance and reported the crude odds and adjusted odds ratio of falling at a higher severity level. There were 3705 complete reported cases of falls with the average age of the patients was 68.5 ± 17.0 years, with 40.2 % identified as female. The risk of falling at a higher level of severity increased by patient age over 50 years. Females were 15.1 % more likely to fall at higher severity level compared to females. Fall incidents occurred during toileting and showering activities and incidents in a communal area were 14.5 % and 26 % more likely to occur at a higher severity respectively. Similarly, depression (167 %), influence of alcohol or illicit drugs (more than 300 %), use of medications (86 %) and fragile skin (75 %) significantly increased the odds of falling at higher level of severity. Identification of underlying risk factors associated with fall severity provides information which can guide nurses and clinicians to design and implement effective interventional strategies that mitigate the risk of serious fall injuries. The results suggest that fall prevention strategies should target patients with these risk factors to avoid severity of falls

The validity and utility of violence risk assessment tools to predict patient violence in acute care settings: An integrative literature review

To examine risk assessment tools to predict patient violence in acute care settings. An integrative review of the literature. Five electronic databases – CINAHL Plus, MEDLINE, OVID, PsycINFO, and Web of Science were searched between 2000 and 2018. The reference list of articles was also inspected manually. The PICOS framework was used to refine the inclusion and exclusion of the literature, and the PRISMA statement guided the search strategy to systematically present findings. Forty-one studies were retained for review. Three studies developed or tested tools to measure patient violence in general acute care settings, and two described the primary and secondary development of tools in emergency departments. The remaining studies reported on risk assessment tools that were developed or tested in psychiatric inpatient settings. In total, 16 violence risk assessment tools were identified. Thirteen of them were developed to assess the risk of violence in psychiatric patients. Two of them were found to be accurate and reliable to predict violence in acute psychiatric facilities and have practical utility for general acute care settings. Two assessment tools were developed and administered in general acute care, and one was developed to predict patient violence in emergency departments. There is no single, user-friendly, standardized evidence-based tool available for predicting violence in general acute care hospitals. Some were found to be accurate in assessing violence in psychiatric inpatients and have potential for use in general acute care, require further testing to assess their validity and reliability

Staff perceptions of the effectiveness of managerial communication during the COVID-19 pandemic: A cross-sectional study

Aims: This work aims to explore staff perceptions of (1) the effectiveness of organizational communication during the COVID-19 pandemic and (2) the impact of organizational communication on staff well-being and ability to progress their work and patient care. Background: Effective coordination and communication are essential in a pandemic management response. However, the effectiveness of communication strategies used during the COVID-19 pandemic is not well understood. Design: An exploratory cross-sectional research design was used. A 33-item survey tool was created for the study. Methods: The study was conducted at a tertiary teaching hospital in Western Australia. Convenience sampling was used to recruit participants from nursing, medical, allied health services, administrative and clerical, and personal support services (N = 325). Data were collected between December 2020 and May 2021. Results: Overall, all occupational groups found working during the COVID-19 pandemic stressful, and all groups wanted accessible and accurate communication from management and new policies, procedures, and protocols for future outbreaks. Conclusions: The use of occupational group-relevant strategies and COVID-19 protocols, as well as the on-going use of email, face-to-face meetings with debrief sessions, are needed to improve communication and support staff to fulfil their roles

Identifying key elements to assess patient’s acceptability of neurorehabilitation in stroke survivors–a Delphi method

Purpose: Assessing patient acceptability of treatment is a clinical concern. No guidance exists to determine the best way to measure acceptability in stroke neurorehabilitation. This study identifies key elements to measure patient’s acceptance of stroke neurorehabilitation by establishing expert consensus. Materials and methods: A four-phase Delphi method with a three-round electronic-based survey was conducted. Experts were considered as stroke survivors or their caregivers and professionals in stroke neurorehabilitation. A twenty-five-item list was sourced from a literature review and discussion with a consumer panel (n = 22). In Round-1 (n = 118) and Round-2 (n = 80), experts ranked the items on a five-point scale. Consensus levels were validated by a Validation group in Round-3 (n = 50). Validity of the results was considered if consensus reached ≥70%, a non-bimodal pattern of response central tendency, SD in Round-2 was lower than that in Round-1, and the agreement scores of responses were similar between all rounds. Results: In Round-1&2 and Round-3, 77.5% (n = 62) and 74.0% (n = 37) respectively, of the respondents were professionals, 20.0% (n = 16, n = 10 respectively) were either stroke survivors or caregivers, and 2.57% (n = 2) and 6.0% (n = 3) respectively were professionals who themselves were stroke survivors or caregivers. The key elements which met all priori criteria are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks. Conclusions: Patient’s acceptance is crucial to developing the appropriate neurorehabilitation interventions. Future clinical trials should consider these items when measuring patient’s acceptance of stroke neurorehabilitation interventions during the development and evaluation phases.Implications for rehabilitation Assessing patient acceptability of treatment is a clinical concern in stroke neurorehabilitation. This study has identified nine key elements to assess patient acceptability of stroke neurorehabilitation. These key elements are: Goal setting, Measurable progress, Functional improvement, Challenging, Motivation, Interactive, Communications with health professionals, Knowledge of treatment, and No risks. Professionals should consider these elements when measuring patient’s acceptance of an intervention during the development, piloting, evaluation, and implementation phases. These findings provide a framework in designing neurorehabilitation programs and clinical trials on acceptance of and adherence to treatment in stroke survivors

Exploring parental country of birth differences in the use of psychostimulant medications for ADHD: a whole‐population linked data study

Abstract Objective: To explore parental country of birth differences in the use of stimulants for attention deficit hyperactivity disorder (ADHD) in Western Australian (WA) children and adolescents. Methods: Statutory WA stimulant notification and dispensing records from 2003 to 2007 were linked to whole‐population state data from 1980 to 2007. Parental attributes were obtained through the WA Family Connections genealogical linkage system. Using multivariate logistic and linear regression, the differences in WA stimulant use for ADHD by parental country of birth, socioeconomic status and geographical remoteness were examined. Results: Of 671,231 people born in WA between 1980 and 2007, 13,555 (2%) used stimulants for ADHD. Of these, 734 (5%) had parents born in Africa, Asia, the Middle East or South America, and 12,006 (87%) had parents born in Australia, North America and Europe. Children and adolescents with parents born in traditionally non‐Anglophonic countries were less likely to be treated with stimulants (OR=0.17, 95%CI 0.14–0.21) than those with parents born in Anglophonic countries. Socioeconomic advantage and residential remoteness were also significant independent predictors of a decreased likelihood of stimulant use. Conclusions: The results highlight the importance of improving knowledge about cultural differences in access to and attitudes towards the diagnosis of ADHD and different approaches to its treatment

Additional file 1: of Use of prescription stimulant for Attention Deficit Hyperactivity Disorder in Aboriginal children and adolescents: a linked data cohort study

Mean age in years at initial prescription in those receiving a stimulant medication for ADHD according to cultural and demographic factors. (DOCX 18 kb

<b>Supplemental Material - A Systematic Review of Dementia Research Priorities</b>

Supplemental Material for A Systematic Review of Dementia Research Priorities by Manonita Ghosh, Pelden Chejor, Melanie Baker, and Davina Porock in Journal of Geriatric Psychiatry and Neurology.</p

Postgraduate nurse education and the implications for nurse and patient outcomes: A systematic review

© 2020 Elsevier Ltd Objectives: To synthesise the current evidence of the implications of postgraduate nursing qualifications on patient and nurse outcomes. Design: A systematic review. Data sources: Primary research findings. Review methods: A systematic search following PRISMA guidelines and the Joanna Briggs Institute\u27s framework was conducted. A structured and comprehensive search of three electronic databases CINAHL, MEDLINE, PsychINFO, search engine Google Scholar, and a manual-search of reference lists was undertaken. The search was limited to articles in English between 2000 and 2019. The combined search yielded 3710 records. Search records were exported to EndNote X8 and duplicates were removed. Inclusion eligibility was assessed by title, abstract and full text. All team members were involved in selecting the studies and assessing methodical quality. Discrepancies were resolved through rigorous discussion between the reviewers. Twenty studies (quantitative and qualitative) were finally selected as suitable for inclusion in the review. A qualitative descriptive synthesis was undertaken to summarise and report the findings. Results: This systematic review has shown that the empirical evidence to date does not support nurses\u27 perceptions of the implications of postgraduate education. The findings from this review fell into three major themes: perceived implications of postgraduate study, clinical outcomes and patient satisfaction. Nurses perceived that postgraduate qualifications had improved their knowledge and skills and thus clinical practice, patient outcomes and health services. This perception has not been borne out by measurable outcomes as yet. The literature also suggests that postgraduate education should improve career opportunities and progression for nurses. This is not supported by the nurses\u27 perceptions in the research available to date. It should be noted that these findings predominantly came from qualitative data. A few studies did report descriptive statistical analysis: demographics, knowledge levels, qualifications etc. None conducted any inferential statistical analysis. Conclusion: Although the literature suggests that postgraduate nursing qualifications improve outcomes for patients, the level of evidence is weak. Exploration methods are suggested to move beyond examining nurses\u27 perceptions, to empirical measures of the value of postgraduate education on nurse and patient outcomes