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Bloomfield K, Hikaka J, Brookes J, Tatton A, Calvert C, Wu Z, Boyd M, Peri K, Bramley D, Connolly MJ. Changing the script: medicine optimisation recommendations made during proactive multidisciplinary meetings with older adults. N Z Med J 2024; 137:96-98. [PMID: 38603794 DOI: 10.26635/6965.6443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Affiliation(s)
- Katherine Bloomfield
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand; Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | | | - Annie Tatton
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Cheryl Calvert
- Te Whatu Ora Te Toka Tumai, Auckland, New Zealand; Te Whatu Ora Counties Manukau, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | - Kathy Peri
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand
| | | | - Martin J Connolly
- Faculty of Medical and Health Sciences, The University of Auckland, Takapuna, New Zealand; Te Whatu Ora Waitematā, Auckland, New Zealand
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Bloomfield K, Wu Z, Boyd M, Broad JB, Hikaka J, Peri K, Bramley D, Tatton A, Calvert C, Higgins AM, Connolly MJ. Changes in hospitalisation rates in older people before and after moving to a retirement village. Australas J Ageing 2023; 42:660-667. [PMID: 37036833 DOI: 10.1111/ajag.13197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 01/31/2023] [Accepted: 03/12/2023] [Indexed: 04/11/2023]
Abstract
OBJECTIVES An increasing proportion of older people live in Retirement Villages ('villages'). This population cites support for health-care issues as one reason for relocation to villages. Here, we examine whether relocation to villages is associated with a decline in hospitalisations. METHODS Retrospective, before-and-after observational study. SETTING Retirement villages, Auckland, New Zealand. PARTICIPANTS 466 cognitively intact village residents (336 [72%] female); mean (SD) age at moving to village was 73.9 (7.7) years. Segmented linear regression analysis of an interrupted time-series design was used. MAIN OUTCOME MEASURES all hospitalisations for 18 months pre- and postrelocation to village. SECONDARY OUTCOME acute hospitalisations during the same time periods. RESULTS The average hospitalisation rate (per 100 person-years) was 44.9 (95% confidence interval [CI] = 36.3-55.6) 18-10 months before village relocation, 58.9 (95% CI = 48.3-72.0) 9-1 months before moving, 47.9 (95% CI = 38.8-59.1) 1-9 months after moving and 62.4 (95% CI = 51.2-76.0) 10-18 months after moving. Monthly average hospitalisation rate (per 100 person-years) increased before relocation to village by an average of 1.2 (95% CI = 0.01-1.57, p = .04) per month from 18 to 1 month before moving, and there was a change in the level of the monthly average hospitalisation rate immediately after relocation (mean difference [MD] = -18.4 per 100 person-years, 95% CI = -32.8 to -4.1, p = .02). The trend change after village relocation did not differ significantly from that before moving. CONCLUSIONS Although we cannot reliably claim causality, relocation to a retirement village is, for older people, associated with a significant but non-sustained reduction in hospitalisation.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Annie Tatton
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Boyd M, Khobaragade B, Mumtaz S. Dimple piercings: a concerning trend. Br Dent J 2023; 235:197. [PMID: 37563387 DOI: 10.1038/s41415-023-6172-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 06/20/2023] [Indexed: 08/12/2023]
Affiliation(s)
- M Boyd
- Bedfordshire Hospitals NHS Trust, Luton, UK.
| | | | - S Mumtaz
- Bedfordshire Hospitals NHS Trust, Luton, UK.
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Oda K, Majeed S, Parsons J, Boyd M, Smith M. Putting the Mouth Into the Head-to-Toe Assessment: Nursing Oral Health Assessment Training With an Oral Health Therapist. J Nurs Educ 2023; 62:399-402. [PMID: 37413674 DOI: 10.3928/01484834-20230509-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Oral care is one of the most neglected nursing practices, lacking oral care protocols, efficient training, and awareness of the benefits for clients. In particular, there is a gap in research for nursing oral health assessment training for nursing curricula. METHOD This study explored the effects of interprofessional collaboration (IPC) training between nurses and oral health therapists (OHT) using newly developed oral health assessment tools with an aim of reducing barriers for nursing oral health assessment. The self-efficacy and confidence of nursing students in oral health assessment were evaluated using pre- and posttraining surveys, and a focus group. RESULTS Nursing students' confidence in incorporating oral health assessment into head-to-toe assessment improved after training. CONCLUSION Nursing oral health assessment training with IPC, onsite OHT support, and oral health assessment tools improved the confidence and attitudes of nursing students in oral health assessment and care provision. [J Nurs Educ. 2023;62(7):399-402.].
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Holden MA, Metcalf B, Lawford BJ, Hinman RS, Boyd M, Button K, Collins NJ, Cottrell E, Henrotin Y, Larsen JB, Master H, Skou ST, Thoma LM, Rydz R, Wellsandt E, White DK, Bennell K. Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group. Osteoarthritis Cartilage 2023; 31:386-396. [PMID: 36367486 DOI: 10.1016/j.joca.2022.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 09/27/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA). DESIGN A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains. RESULTS The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise. CONCLUSION The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.
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Affiliation(s)
- M A Holden
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - B Metcalf
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - B J Lawford
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
| | - M Boyd
- Patient Representative, Australia
| | - K Button
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, UK.
| | - N J Collins
- School of Health and Rehabilitation Sciences: Physiotherapy, The University of Queensland, Australia.
| | - E Cottrell
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK.
| | - Y Henrotin
- Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Belgium; musculoSKeletal Innovative research Lab (mSKIL), Motricity Sciences Department, Institute of Pathology, University of Liège, Belgium; Center for Interdisciplinary Research on Medicines (CIRM), Institute of Pharmacy, University of Liège, Belgium; The Osteoarthritis Foundation, Boncelles, Belgium.
| | - J B Larsen
- Musculoskeletal Health and Implementation, Department of Health Science and Technology, Aalborg University, Denmark.
| | - H Master
- Vanderbilt Institute of Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - S T Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Denmark.
| | - L M Thoma
- Division of Physical Therapy, Department of Allied Health Sciences, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - R Rydz
- Patient Representative, Australia.
| | - E Wellsandt
- Division of Physical Therapy Education, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - D K White
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA.
| | - K Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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Day C, Deetlefs M, O'Brien A, Smith J, Boyd M, Embling N, Patel S, Moody K, Ramabele T, Budge A, Tarwa T, Jim O, Maharaj T, Pandy S, Abrahams JM, Panieri A, Verhage S, Van der Merwe M, Geragotellis A, Amanjee W, Joseph C, Zhao Z, Moosa S, Bunting M, Pulani Y, Mukhari P, De Paiva M, Deyi G, Wonkam RP, Mancotywa N, Dunge A, Msimanga T, Singh A, Monnaruri O, Molale B, Butler TAG, Browde K, Muller C, Van der Walt J, Whitelaw R, Cronwright D, Sinha S, Binase U, Francis I, Boakye D, Dlamini S, Mendelson M, Peter J. Self-reported beta-lactam allergy in government and private hospitals in Cape Town, South Africa. S Afr Med J 2023; 113:69-74. [PMID: 36757070 DOI: 10.7196/samj.2023.v113i2.16760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Indexed: 02/10/2023] Open
Abstract
BACKGROUND Up to a quarter of inpatients in high-income countries (HICs) self-report beta-lactam allergy (BLA), which if incorrect,increases the use of alternative antibiotics, worsening individual health outcomes and driving bacterial resistance. In HICs, up to 95% ofself-reported BLAs are incorrect. The epidemiology of BLA in low- and middle-income African countries is unknown. OBJECTIVES To describe the epidemiology and de-labelling outcomes of self-reported BLA in hospitalised South African (SA) patients. METHODS Point-prevalence surveys were conducted at seven hospitals (adult, paediatric, government and privately funded, district andtertiary level) in Cape Town, SA, between April 2019 and June 2021. Ward prescription records and in-person interviews were conductedto identify and risk-stratify BLA patients using the validated PEN-FAST tool. De-labelling was attempted at the tertiary allergy clinic atGroote Schuur Hospital. RESULTS A total of 1 486 hospital inpatients were surveyed (1 166 adults and 320 children). Only 48 patients (3.2%) self-reported a BLA,with a higher rate in private than in government-funded hospitals (6.3% v. 2.8%; p=0.014). Using the PEN-FAST tool, only 10.4% (n=5/48)of self-reported BLA patients were classified as high risk for true penicillin hypersensitivity. Antibiotics were prescribed to 70.8% (n=34/48)of self-reported BLA patients, with 64.7% (n=22/34) receiving a beta-lactam. Despite three attempts to contact patients for de-labelling atthe allergy clinic, only 3/36 underwent in vivo testing, with no positive results, and 1 patient proceeded to a negative oral challenge. CONCLUSION Unlike HICs, self-reported BLA is low among inpatients in SA. The majority of those who self-reported BLA were low risk fortype 1 hypersensitivity, but outpatient de-labelling efforts were largely unsuccessful.
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Affiliation(s)
- C Day
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M Deetlefs
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A O'Brien
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - J Smith
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M Boyd
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - N Embling
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Patel
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - K Moody
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - T Ramabele
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Budge
- Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - T Tarwa
- Molecular Mycobacteriology Research Unit, Division of Medical Microbiology, Department of Pathology, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - O Jim
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - T Maharaj
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Pandy
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - J-M Abrahams
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Panieri
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Verhage
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M Van der Merwe
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Geragotellis
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - W Amanjee
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - C Joseph
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Z Zhao
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Moosa
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M Bunting
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - Y Pulani
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - P Mukhari
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M De Paiva
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - G Deyi
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - R P Wonkam
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - N Mancotywa
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Dunge
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - T Msimanga
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - A Singh
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - O Monnaruri
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - B Molale
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - T A G Butler
- Department of Paediatrics, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - K Browde
- Division of Allergology and Clinical Immunology, Department of Paediatrics, Red Cross War Memorial Children's Hospital and Faculty of Health Sciences, University of Cape Town, South Africa.
| | - C Muller
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
| | - J Van der Walt
- Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
| | - R Whitelaw
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Cronwright
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Sinha
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - U Binase
- Faculty of Health Sciences, University of Cape Town, South Africa.
| | - I Francis
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - D Boakye
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - S Dlamini
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - M Mendelson
- Division of Infectious Diseases and HIV Medicine, Department of Medicine, Faculty of Health Sciences, University of Cape Town, South Africa.
| | - J Peter
- Division of Allergology and Clinical Immunology, Department of Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa; Allergy and Immunology Unit, University of Cape Town Lung Institute, Cape Town, South Africa.
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Collier A, Balmer D, Dai L, Hikaka J, Bloomfield K, Boyd M. Older people, medication safety, and the role of the community pharmacist: a longitudinal ethnographic study. Pharmacy Practice and Res 2022. [DOI: 10.1002/jppr.1839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Aileen Collier
- Research Centre for Palliative Care, Death and Dying Flinders University Adelaide Australia
- Northern Adelaide Local Health Network Adelaide Australia
- School of Medicine University of Auckland Auckland New Zealand
| | - Deborah Balmer
- School of Nursing University of Auckland Auckland New Zealand
- WA Centre for Rural Health University of Western Australia Geraldton Australia
| | - Linda Dai
- School of Pharmacy University of Auckland Auckland New Zealand
| | - Joanna Hikaka
- Department of General Practice and Primary Health Care University of Auckland Auckland New Zealand
| | - Katherine Bloomfield
- School of Medicine University of Auckland Auckland New Zealand
- Te Whatu Ora Waitematā Auckland New Zealand
| | - Michal Boyd
- School of Nursing University of Auckland Auckland New Zealand
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Tatton A, Wu Z, Bloomfield K, Boyd M, Broad JB, Calvert C, Hikaka J, Peri K, Higgins AM, Connolly MJ. The prevalence and intensity of pain in older people living in retirement villages in Auckland, New Zealand. Health Soc Care Community 2022; 30:e4280-e4292. [PMID: 35543587 DOI: 10.1111/hsc.13821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 11/26/2021] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
Chronic pain is common in older people. However, little is known about how pain is experienced in residents of retirement villages ('villages'), and how pain intensity and associations are experienced in relation to characteristics of residents and village living. We thus aimed to examine pain levels, prevalence and associated factors in village residents. The current paper is a cross-sectional analysis of baseline data from the 'Older People in Retirement Villages' study in Auckland, New Zealand. Between July 2016 and August 2018, 578 village residents were interviewed face-to-face by gerontology nurse specialists, using interRAI Community Health Assessment (CHA) and customised survey. We used a validated pain scale and multivariable logistic regression analyses adjusted for pre-specified confounders. Residents' median age was 82 years; 420 (73%) were female; 270 (47%) exhibited/reported daily pain, and in 11% this was severe. After controlling for confounders, daily pain was positively associated with self-reported arthritis (OR = 3.88, 95% CI = 2.57-5.87), poor/fair self-reported health (OR = 3.19, 95% CI = 1.29-7.93), having no health clinic on-site (OR = 1.76, 95% CI = 1.10-2.83), and minimal fatigue (diminished energy but completes normal day-to-day activities) (OR = 1.77, 95% CI = 1.11-2.81). Similar associations were observed for levels of pain. We conclude that levels of pain and prevalence of daily pain are high in village residents. Self-reported arthritis, self-reported poor/fair health, no health clinic on-site and minimal fatigue are all independently associated with a higher risk of daily pain and with levels of pain. This study suggests potential opportunities for villages to better provide on-site support to decrease prevalence and severity of pain for their residents, and thus potentially increase wellbeing and quality-of-life, though as we cannot prove causality, more research is needed.
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Affiliation(s)
- Annie Tatton
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Jung I, Bloomfield K, Hikaka J, Tatton A, Boyd M. "Making an effort for the very elderly": The acceptability of a multidisciplinary intervention to retirement village residents. Health Soc Care Community 2022; 30:e5356-e5365. [PMID: 35913001 PMCID: PMC10087237 DOI: 10.1111/hsc.13957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 06/22/2022] [Accepted: 07/16/2022] [Indexed: 06/15/2023]
Abstract
The retirement village (RV) population is a growing one, with many residents having unmet healthcare needs. Despite this, there is a relative paucity of research in the RV community. We previously performed a randomised controlled trial (RCT) of a multidisciplinary (MD) nurse-led community intervention versus usual care within 33 RVs in Auckland, New Zealand. Participant acceptability is an important aspect in assessing intervention feasibility and effectiveness. The aim of this current qualitative study was to assess the acceptability of the intervention in participating residents. Data were collected using semi-structured interviews designed around the Theoretical Framework of Acceptability. Thematic analysis was undertaken using a general inductive approach. Of the 199 participants in the intervention arm of the original RCT, 27 were invited to take part in this qualitative study. Fifteen participants were recruited with a median age of 89 years, 10 were female and all were of European ethnicity. Participants were generally positive about the intervention and research processes. Three themes were identified: (1) participants' understanding of intervention aims and effectiveness; (2) the importance of older adult involvement and (3) level of comfort in the research process. Despite the MD intervention being deemed acceptable across several domains, results provided learning points for the future design of MD interventions in RV residents and older adults more generally. We recommend that future intervention studies incorporate co-design methodologies which may improve the likelihood of intervention success.
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Affiliation(s)
- Isabelle Jung
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Katherine Bloomfield
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
- Waitematā District Health BoardAucklandNew Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Annie Tatton
- Waitematā District Health BoardAucklandNew Zealand
| | - Michal Boyd
- Faculty of Medicine and Health SciencesUniversity of AucklandAucklandNew Zealand
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Abstract
This article details a narrative review that explored the barriers to and facilitators of integration of oral care into nursing practice in care homes to enhance nurses' delivery of oral care. Three themes were identified: gaps in oral care protocols and the complexity of nursing oral care; how interprofessional collaboration and education can improve oral care; and limitations and unresolved issues in nurses' oral care training. The review found that interprofessional collaboration and education were important in normalising oral care practice and nurse leadership in care homes. Nurse-led interprofessional oral care could enhance the quality of care in care homes by advancing interprofessional collaboration and education, coordinating care and improving organisational support.
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Affiliation(s)
- Keiko Oda
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - John Parsons
- Department of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Moira Smith
- Department of Public Health, University of Otago, Wellington, New Zealand
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11
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Ban N, Boyd M, Coates R, Cool DA, Lecomte JF, Schneider T. Perspectives on tolerability and reasonableness. J Radiol Prot 2022; 42:020514. [PMID: 35472700 DOI: 10.1088/1361-6498/ac6a88] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/26/2022] [Indexed: 06/14/2023]
Abstract
Judgements on tolerability and reasonableness are central to the optimisation of protection. There are currently several international developments regarding these key considerations which will contribute to the review and evolution of the system of radiological protection. The IRPA15 International Congress brought together the principal issues currently under discussion, and the outcome of these discussions is presented.
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Affiliation(s)
- N Ban
- Nuclear Regulation Authority, Tokyo, Japan
| | - M Boyd
- Former Chair CRPPH, NEA (Environmental Protection Agency, Washington, DC, United States of America
| | - R Coates
- Former IRPA President, Bouth, United Kingdom
| | - D A Cool
- Co-Chair, NCRP CC-1 (National Council on Radiation Protection and Measurements), Bethesda, MD, United States of America
| | - J-F Lecomte
- SFRP (French Society for Radiation Protection), IRSN (Institute for Radiological Protection and Nuclear Safety), Fontenay-aux-Roses, France
| | - T Schneider
- Chair ICRP TG114 Tolerability and Reasonableness, CEPN (Nuclear Protection Evaluation Centre), Fontenay-aux-Roses, France
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI derived frailty index predicts acute hospitalizations in older adults residing in retirement villages: A prospective cohort study. PLoS One 2022; 17:e0264715. [PMID: 35235598 PMCID: PMC8890727 DOI: 10.1371/journal.pone.0264715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 02/11/2022] [Indexed: 11/18/2022] Open
Abstract
Objectives The development of frailty tools from electronically recorded healthcare data allows frailty assessments to be routinely generated, potentially beneficial for individuals and healthcare providers. We wished to assess the predictive validity of a frailty index (FI) derived from interRAI Community Health Assessment (CHA) for outcomes in older adults residing in retirement villages (RVs), elsewhere called continuing care retirement communities. Design Prospective cohort study. Setting and participants 34 RVs across two district health boards in Auckland, Aotearoa New Zealand (NZ). 577 participants, mean age 81 years; 419 (73%) female; 410 (71%) NZ European, 147 (25%) other European, 8 Asian (1%), 7 Māori (1%), 1 Pasifika (<1%), 4 other (<1%). Methods interRAI-CHA FI tool was used to stratify participants into fit (0–0.12), mild (>0.12–0.24), moderate (>0.24–0.36) and severe (>0.36) frail groups at baseline (the latter two grouped due to low numbers of severely frail). Primary outcome was acute hospitalization; secondary outcomes included long-term care (LTC) entry and mortality. The relationship between frailty and outcomes were explored with multivariable Cox regression, estimating hazard ratios (HRs) and 95% confidence intervals (95%CIs). Results Over mean follow-up of 2.5 years, 33% (69/209) of fit, 58% (152/260) mildly frail and 79% (85/108) moderate-severely frail participants at baseline had at least one acute hospitalization. Compared to the fit group, significantly increased risk of acute hospitalization were identified in mildly frail (adjusted HR = 1.88, 95%CI = 1.41–2.51, p<0.001) and moderate-severely frail (adjusted HR = 3.52, 95%CI = 2.53–4.90, p<0.001) groups. Similar increased risk in moderate-severely frail participants was seen in LTC entry (adjusted HR = 5.60 95%CI = 2.47–12.72, p<0.001) and mortality (adjusted HR = 5.06, 95%CI = 1.71–15.02, p = 0.003). Conclusions and implications The FI derived from interRAI-CHA has robust predictive validity for acute hospitalization, LTC entry and mortality. This adds to the growing literature of use of interRAI tools in this way and may assist healthcare providers with rapid identification of frailty.
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Affiliation(s)
- Katherine Bloomfield
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
- * E-mail:
| | - Zhenqiang Wu
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- Centre for Health Services Research, University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J. Connolly
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
- Waitematā District Health Board, Auckland, New Zealand
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Yoshihara A, Bloomfield K, Wu Z, Tatton A, Hikaka J, Boyd M, Peri K, Connolly MJ. Opportunities to be active in retirement villages and factors associated with physical activity in residents. J Prim Health Care 2022; 15:6-13. [PMID: 37000549 DOI: 10.1071/hc22103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 10/30/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Physical activity (PA) in older people is associated with improved morbidity and mortality outcomes. Increasing numbers of older people are choosing to live in retirement villages, many of which promote themselves as providing opportunities for activity. Aim To explore the characteristics of PA village residents were undertaking and the associated individual and village factors. Methods Health, functional and wellbeing information was collected from 577 residents recruited from 34 villages in Auckland, New Zealand, using an International Resident Assessment Instrument and customised survey tools containing items on self-reported PA. Managers from villages completed a survey on village characteristics and facilities. Results The mean age (s.d.) of village residents was 82 (7) years, and 325 (56%) reporting doing one or more hours of PA in the 3 days prior to assessment. Moderate exercise was performed by 240 (42%) village residents, for a mean (s.d.) of 2.7 (3.4) h per week. The most common activities provided by villages included: bowls/petanque (22, 65%) and exercise classes (22, 65%), and walking was the most common activity undertaken (348, 60%). Factors independently associated with PA included individual factors (gender, fatigue, constipation, self-reported health, number of medications, moving to village for safety and security, utilising village fitness programme, use of the internet, and satisfaction with opportunities to be active) and village-related factors (access to unit, and ownership model). Discussion PA uptake is determined by many factors at both personal (physical and psychosocial) and environmental levels. Clinicians should focus on individualised PA promotion in those with identified risk factors for low levels of PA.
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Affiliation(s)
- Aoi Yoshihara
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; and Older Adult Services, Waitemata District Health Board, Auckland, New Zealand; and Waitemata Clinical Campus, North Shore Hospital, PO Box 93503, Takapuna, Auckland 0740, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adult Services, Waitemata District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand; and Older Adult Services, Waitemata District Health Board, Auckland, New Zealand
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14
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Factors associated with healthcare utilization and trajectories in retirement village residents. J Am Geriatr Soc 2021; 70:754-765. [PMID: 34910296 DOI: 10.1111/jgs.17602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 11/01/2021] [Accepted: 11/17/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND To study healthcare utilization and trajectories, and associated factors, in older adults in retirement villages (RVs), also known as continuing care retirement communities. METHODS Prospective cohort study of 578 cognitively intact residents from 34 RVs in Auckland, New Zealand (NZ). MEASUREMENT InterRAI-Community Health Assessment (includes core items that may trigger functional supplement (FS) completion in those with higher needs, and generates clinical assessment protocols (CAPs) in those with potential unmet needs). OUTCOMES time to acute hospitalization, long-term care (LTC), and death during average 2.5 years follow-up. RESULTS Three hundred seven (53%) residents had acute hospitalizations, 65 (11%) moved to LTC, and 51 (9%) died over a mean of 2.5 years. Factors associated with increased risk of acute hospitalization included CAP-falls (high risk) triggered, number of comorbidities, not having left RV in 2 weeks prior, moderate/severe hearing impairment, CAP-cardiorespiratory conditions triggered, acute hospitalization in year prior and age, with significant hazard ratios (HR) ranging between 1.03 and 2.90. Factors associated with reduced risk of hospitalization included other (non-NZ) European ethnicity (HR 0.73, 95% CI 0.55-0.98, p = 0.04), presence of on-site clinic (HR 0.62, 95% CI 0.45-0.85, p = 0.003), no influenza vaccination (HR 0.56, 95% CI 0.38-0.83, p = 0.004). Factors associated with LTC transition included FS triggered (HR 3.84, 95% CI 1.92-7.66, p < 0.001), CAP-instrumental activities of daily living (IADL) (HR 2.62, 95% CI 1.22-5.62, p = 0.01), CAP-social relationship triggered (HR 2.00, 95% CI 1.13-3.55, p = 0.02), and age (HR 1.13, 95% CI 1.07-1.18 p < 0.001). Factors associated with mortality included number of comorbidities (HR 3.75, 95% CI 1.54-9.10, p = 0.004 for 3-5 comorbidities), CAP-IADL triggered (HR 3.05, 95% CI 1.30-7.16, p = 0.01), and age (HR 1.11, 95% CI 1.05-1.18, p < 0.001). CONCLUSION A large proportion of cognitively intact RV residents are admitted to hospital in mean 2.5 years of follow-up. Multiple factors were associated with acute hospitalization risk. On-site clinics were associated with reduced risk and should be considered in RV development.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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15
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Aladwani A, Mullen A, Alrashidi M, Alfarisi O, Alterkait F, Aladwani A, Kumar A, Boyd M, Eldosouky ME. Comparing trastuzumab-related cardiotoxicity between elderly and younger patients with breast cancer: a prospective cohort study. Eur Rev Med Pharmacol Sci 2021; 25:7643-7653. [PMID: 34982426 DOI: 10.26355/eurrev_202112_27611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Trastuzumab is an HER-2 targeted humanized monoclonal antibody that significantly improves metastatic and non-metastatic breast cancer therapeutic outcomes. This study compares trastuzumab outcomes between two age cohorts in the Kuwait Cancer Control Centre (KCCC). PATIENTS AND METHODS In a prospective comparative observational study, 93 HER-2 positive breast cancer patients undergoing different chemotherapy protocols + trastuzumab between April 2016 and April 2019 were included and divided into two cohorts based on their age (<60 and ≥60 years old). The individual decline in the LVEF from the baseline was calculated and compared between the two age cohorts. Logistic regression analysis was applied to investigate the association between age, comorbidities, BMI, anthracycline treatment, and baseline LVEF value, and trastuzumab-induced cardiotoxicity after adjustments made for the disease stage. RESULTS The median baseline LVEF was 65% in both age cohorts (IQR 8% and 9% for older and younger patients, respectively). Whereas the median LVEF post-trastuzumab treatment was 51% and 55% in older and younger patients, respectively (IQR 8%; p-value = 0.22), even though older patients had significantly lower exposure to anthracyclines compared to younger patients (60% and 84.1%, respectively; p-value <0.001). 86.7% and 55.6% of older and younger patients, respectively, developed ≥10% decline in their LVEF from the baseline. Statistically, age was the only factor that significantly correlated with developing ≥10% decline in the LVEF (OR 4; p-value <0.012). CONCLUSIONS Breast cancer patients aged 60 years and above in Kuwait were at a 4-fold higher risk of developing ≥10% decline in their LVEF from the baseline value compared to younger patients during trastuzumab treatment. Previous exposure to anthracyclines and comorbidities were not associated with a significantly increased cardiotoxicity risk in this study.
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Affiliation(s)
- A Aladwani
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, UK.
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16
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Bloomfield K, Wu Z, Broad JB, Tatton A, Calvert C, Hikaka J, Boyd M, Peri K, Bramley D, Higgins AM, Connolly MJ. Learning from a multidisciplinary randomized controlled intervention in retirement village residents. J Am Geriatr Soc 2021; 70:743-753. [PMID: 34709659 DOI: 10.1111/jgs.17533] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 09/16/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Retirement villages (RVs), also known as continuing care retirement communities, are an increasingly popular housing choice for older adults. The RV population has significant health needs, possibly representing a group with needs in between community-dwelling older adults and those in long-term residential care (LTC). Our previous work shows Gerontology Nurse Specialist (GNS)-facilitated multidisciplinary team (MDT) interventions may reduce hospitalizations from LTC. This study tested whether a similar intervention reduced hospitalizations in RV residents. METHODS Open-label randomized controlled trial in which 412 older residents of 33 RVs were randomized (1:1) to an MDT intervention or usual care. SETTING RVs across two District Health Boards in Auckland, New Zealand. Residents were eligible if considered high risk of health/functional decline (triggering ≥3 interRAI Clinical Assessment Protocols or needing special consideration identified by GNS). INTERVENTION GNS-facilitated MDT intervention, including geriatrician/nurse practitioner and clinical pharmacist, versus usual care. Primary outcome was time from randomization to first acute hospitalization. Secondary outcomes were rate of acute hospitalizations, LTC admission, and mortality. Twelve residents died before randomization; all others (n = 400: MDT intervention = 199; usual care = 201) were included in intention-to-treat analyses. RESULTS Mean (SD) age was 82.2 (6.9) years, 302 (75.5%) were women, and 378 (94.5%) were European. Over median 1.5 years follow-up, no difference was found in hazard of acute hospitalization between the MDT intervention (51.8%) and usual care (49.3%) groups (Hazard ratio [HR] = 1.01, 95% CI = 0.77-1.34). No difference was found in the incidence rate of acute hospitalizations between the MDT intervention (0.69 per person-year) and usual care (0.86 per person-year) groups (incidence rate ratio = 0.81, 95% CI = 0.59-1.10). Similar results were seen for the proportion of residents with LTC transition (HR = 1.18, 95% CI = 0.65-2.11) and mortality (HR = 0.70, 95% CI = 0.36-1.35). CONCLUSION Further studies are needed to assess the effects of other patient-centered interventions and outcomes with adequate primary care integration.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joanna B Broad
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Cheryl Calvert
- Community and Long Term Conditions, Auckland District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Older Adults' Health, Waitematā District Health Board, Auckland, New Zealand
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Oda K, Montayre J, Parsons J, Boyd M. Oral Care in Hospital Settings: Breaking the Vicious Circle of Older Adult Deconditioning. J Gerontol Nurs 2021; 47:7-12. [PMID: 34044682 DOI: 10.3928/00989134-20210507-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Hospitalized older adults frequently develop aspiration pneumonia, swallowing dys-function (dysphagia), and sarcopenia. In the current study, we propose a framework that incorporates these three factors into a vicious circle that leads to deconditioning, a condition frequently experienced by this vulnerable population. Viewing aspiration pneumonia, dysphagia, and sarcopenia, along with their interrelationships through the lens of this vicious circle, illuminates the critical role that oral health plays in deconditioning. Moreover, this framework highlights oral care as a key nursing intervention for reducing deconditioning in hospitalized older adults. Supporting this view, several studies have shown that oral care can improve health outcomes for hospitalized older adults. However, despite oral care being an essential nursing intervention that restores oral function and promotes patient wellness, it is one of the most neglected nursing interventions. Missed oral care occurs due to staff's limited awareness of its significance for care-dependent older adults in hospital settings. We hope that this vicious circle paradigm helps raise awareness of the significance of oral care to prevent deconditioning in hospitalized older adults. [Journal of Gerontological Nursing, 47(6), 7-12.].
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Abstract
Abstract
Introduction
Significant alterations occur in human physiology and the way medications function in space (1). Understanding the efficacy and pitfalls of pharmacological intervention and developing space-related pharmacy services is therefore integral to ensuring a sustained presence for human spaceflight. In contemporary society, the pharmacist plays a significant role in a person’s health. However, pharmacist input towards the spaceflight participant’s health is minimal to nil.
Aim: T
o explore stakeholder perspectives towards the role of Astropharmacy in the space sector.
Methods
Pharmacists (n = 18) across the globe and space sector participants (n = 18) from governmental, commercial, and space tourism sectors participated, via 27 qualitative interviews and three focus groups. Participants were recruited via purposive and snowball sampling. A six-step thematic analysis was used and mapped into the Job Characteristics Model (JCM). JCM is a theory within work design, aiming to promote work experiences and personal outcomes. There are five job dimensions – skill variety, task identity, task significance, autonomy, and feedback which influence three psychological states required for a well-designed job. The three psychological states are meaningfulness, responsibility, and knowledge of work results, which lead to positive work and personal experiences (2).
Results
Three key themes were generated: medication management, medication research, and regulation/licensing. Medication management encompassed safeguarding the space traveller’s health, like space tourists, by conducting medication reviews (pre-and post-flight), medication advice (digital astro-telepharmacy information services during spaceflight) and developing personalised medication. Medication management also included ensuring shelf-life and continuous medication supply for deep space exploration. Medication research included novel drug development, innovative manufacturing, and understanding clinical applications of the pharmacokinetic and pharmacodynamic changes of medications in space. Innovative manufacturing like 3-D printing raises questions regarding the need for regulations/licensing of medications use and manufacturing in space. Based on the JCM our findings indicate that Astropharmacy possesses diverse duties eliciting meaningfulness, with clear responsibility and observable workplace results promoting task significance, and both the medication and patient focus promoting task identity. Autonomy was blurred within Astropharmacy as a degree of autonomy is needed due to the field’s novelty, but workforce regulations by governmental space agencies are expected. Lastly, workplace feedback can be achieved in Astropharmacy through performance reviews.
Conclusion
The Astropharmacy role is perceived to involve medication management, medication research and regulation/licensing of medications for space. The work design of astropharmacy is well-reflected in the JCM, implying that a novel and energising opportunity for the pharmacy profession is forthcoming. Although the data generated by qualitative research are not generalizable to other settings, these themes represent the first study to investigate the space sector qualitatively in the context of pharmacy, providing rich foundational data for future research. Consequently, the amalgamation of two previously distinct workplace domains may be a conceivable reality for the future of pharmacy practice.
References
1. Blue RS, Bayuse TM et al. Supplying a pharmacy for NASA exploration spaceflight: challenges and current understanding. Npj Microgravity. 2019;5(1):1–12.
2. Hackman RJ, Oldham G. Motivation through the design of work: Test of a theory. Organizational Behavior and Human Performance. 1976;16(2):250–279.
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Affiliation(s)
- L Sawyers
- University of Nottingham, School of Pharmacy
| | - C Anderson
- University of Nottingham, School of Pharmacy
| | - M Boyd
- University of Nottingham, School of Pharmacy
| | - P Williams
- University of Nottingham, School of Pharmacy
| | - L S Toh
- University of Nottingham, School of Pharmacy
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Joseph Connolly M, Hikaka J, Bloomfield K, Broad J, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. Research in the retirement village community-The problems of recruiting a representative cohort of residents in Auckland, New Zealand. Australas J Ageing 2021; 40:177-183. [PMID: 33594804 DOI: 10.1111/ajag.12898] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Retirement villages are semi-closed communities, access usually being gained via village managers. This paper explores issues recruiting a representative resident cohort, as background to a study of residents, to acquire sociodemographic, health and disability data and trial an intervention designed to improve outcomes. METHODS We planned approaching all Auckland/Waitematā District villages and, via managers, contacting residents ('letter-drop'; 'door-knocks'). In 'small' villages (n ≤ 60 units), we planned contacting all residents, randomly selecting in 'larger' villages. We excluded those with doubtful or absent legal capacity. RESULTS We approached managers of 53 of 65 villages. Thirty-four permitted recruitment. Some prohibited 'letter-drops' and/or 'door-knocks'. Hence, we recruited volunteers (23 villages) via meetings, posters, newsletters and word-of-mouth, that is representative sampling obtained from 11/34 villages. We recruited 578 residents (median age = 82 years; 420 = female; 217:361 sampled:volunteers), finding differences in baseline parameters of sampled vs. volunteers. CONCLUSION Due to organisational/managers' policy, and national legislation restrictions, our sample does not represent our intended population well. Researchers should investigate alternative data sources, for example electoral rolls and censuses.
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Affiliation(s)
- Martin Joseph Connolly
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Waitematā District Health Board, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Broad
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Michal Boyd
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,School of Nursing, University of Auckland, Auckland, New Zealand
| | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Cheryl Calvert
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Annie Tatton
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, University of Auckland and Waitematā District Health Board, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
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Cai B, Fulcher N, Boyd M, Spira A. CP01.05 Relapse Rate and Associated Healthcare Resource Utilization in Stage IIA-IIIB Adjuvant NSCLC Patients Treated in a US Oncology Community Network. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2020.10.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Bloomfield K, Wu Z, Tatton A, Calvert C, Peel N, Hubbard R, Jamieson H, Hikaka J, Boyd M, Bramley D, Connolly MJ. An interRAI-derived frailty index is associated with prior hospitalisations in older adults residing in retirement villages. Australas J Ageing 2020; 40:66-71. [PMID: 33118304 DOI: 10.1111/ajag.12863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 08/19/2020] [Accepted: 09/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To develop and validate a frailty index (FI) from interRAI-Community Health Assessments (CHA) on older adults in retirement villages (RVs). METHODS This is a cross-sectional analysis of a current RV research study. A FI was generated using the cumulative deficit model. Health-care utilisation measures were acute, and all, hospitalisations 12 months before baseline assessment. Associations between FI and hospitalisations were explored using multivariable logistic regression to estimate odds ratio (OR). RESULTS Of 577 included residents, mean (SD) age was 81 (7) and 419 (73%) were female. Mean (SD) FI was 0.16 (0.09); 260 (45%) were mildly frail, and 108 (19%) moderate-severely frail. In multivariate-adjusted analysis, odds of acute hospitalisation for mild (OR = 3.3, P < .001) and moderate-severely frail (OR = 6.4, P < .001) were significantly higher than fit residents. Higher odds were also observed for all hospitalisations. CONCLUSION A considerable proportion of RV residents were moderately-severely frail. FI was associated with acute and all hospitalisations.
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Affiliation(s)
- Katherine Bloomfield
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
| | - Zhenqiang Wu
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Waitematā District Health Board, Auckland, New Zealand
| | | | - Nancye Peel
- University of Queensland, Brisbane, Queensland, Australia
| | - Ruth Hubbard
- University of Queensland, Brisbane, Queensland, Australia
| | - Hamish Jamieson
- Department of Medicine, University of Otago, Christchurch, New Zealand
| | - Joanna Hikaka
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Waitematā District Health Board, Auckland, New Zealand
| | - Martin J Connolly
- Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.,Waitematā District Health Board, Auckland, New Zealand
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22
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Burholt V, Davies J, Boyd M, Mullins JM, Shoemark EZ. A research agenda for promoting continence for people living with dementia in the community: Recommendations based on a critical review and expert-by-experience opinion. J Clin Nurs 2020; 31:1933-1946. [PMID: 33091190 PMCID: PMC9292568 DOI: 10.1111/jocn.15537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/07/2020] [Accepted: 10/08/2020] [Indexed: 12/03/2022]
Abstract
Aims and objectives To identify research undertaken in the last decade addressing continence for people living with dementia (PLWD) in the community. To highlight gaps and develop recommendations for future research, taking into account the experiences and priorities of PLWD, caregivers and healthcare professionals. Methods A critical review with an Expert Review Group (ERG) comprising researchers, PLWD and facing continence issues, caregivers and other professional stakeholders. Findings are reported in line with the COREQ and Preferred Reporting Items for Systematic reviews and Meta‐Analyses extension for Scoping Reviews checklists. Background Caregivers rate the independent use of the toilet as the most important activity for PLWD to retain. However, in 2009 a review identified shortfalls in knowledge and praxis around promoting continence and managing incontinence for PLWD in the community. As absolute numbers of people with dementia are predicted to increase, it is imperative to examine whether these deficits have been addressed. Results Of 3,563 records identified, 57 full‐text articles were reviewed. The ERG developed a conceptual model to summarise research evidence according to the extent of the challenge (neuropathology and clinicopathology, prevalence and incidence), gateways to continence services, effectiveness of interventions, outcomes and the potential influences of personal resources, socio‐cultural factors and environmental contexts. Conclusions Research on (in)continence for PLWD in the community is under‐developed and has not increased substantially over the last decade. ERG recommendations for future research included user involvement to identify appropriate quality indicators to assess the effectiveness of interventions. Relevance to clinical practice There is insufficient evidence on which to base decisions on continence care for PLWD in the community. Omission from continence care guidelines has the effect of marginalising and silencing this population. User involvement in clinical research and developing practice guidelines has the potential for positive systems change.
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Affiliation(s)
- Vanessa Burholt
- Faculty of Medical and Health Sciences, School of Nursing, University of Auckland, Auckland, New Zealand.,Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Johanna Davies
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Michal Boyd
- School of Nursing and Freemasons' Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Jane M Mullins
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - E Zoe Shoemark
- Centre for Innovative Ageing, College of Human and Health Sciences, Swansea University, Swansea, UK
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23
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Adams S, Boyd M, Carryer J, Bareham C, Tenbensel T. A survey of the NP workforce in primary healthcare settings in New Zealand. N Z Med J 2020; 133:29-40. [PMID: 33032301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
AIM The aim of the survey was to describe the demographics, distribution, clinical settings and employment arrangements of the New Zealand nurse practitioner workforce in primary healthcare settings; and organisational factors limiting their practice. METHOD An online survey was developed and sent to all NPs in mid-2019. RESULTS The survey was completed by 160 nurse practitioners who worked in settings broadly defined as primary healthcare (response rate 71.4%). In addition to clinical work, nurse practitioners engaged in teaching and clinical supervision; leadership and management; policy development; locum work; and research; but 14% continued to do at least some work as a registered nurse. One hundred and fifty-one respondents were working clinically and 48% of these worked in more than one clinical setting. General practice-type settings (39%), of which over 40% were very low-cost access practices, and aged residential care (19%) were most commonly identified as the main clinical setting. Others included long-term conditions; mental health and addiction; sexual health/family planning; whānau ora; child/youth health; and various community nursing service roles. Seventy-three percent of nurse practitioners earned less than $120,000 per annum for full-time work; and 60% had $2,000 or less available for professional development. Three quarters had worked in the same setting for at least two years, and 60% intended to stay a further three years. Fourteen percent worked rurally. Employment models, models of care, and access to diagnostics, particularly radiology, were most limiting to their practice. CONCLUSION The nurse practitioner workforce offers stability and flexibility in working across multiple clinical settings in primary healthcare. They provide the potential solution to the general practitioner workforce shortage by improving access to primary healthcare and reducing health inequalities. As authorised prescribers able to enrol patients, receive capitation payments and claim general medical services, it is timely to facilitate the expansion of the nurse practitioner workforce in New Zealand.
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Affiliation(s)
- Sue Adams
- Senior Lecturer, School of Nursing, University of Auckland, Auckland
| | - Michal Boyd
- Associate Professor, School of Nursing, University of Auckland, Auckland
| | - Jenny Carryer
- Professor, School of Nursing, Massey University, Palmerston North
| | - Corinne Bareham
- Postdoctoral Research Fellow, School of Psychology, Victoria University of Wellington, Wellington
| | - Tim Tenbensel
- Associate Professor, School of Population Health, University of Auckland, Auckland
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24
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Broad JB, Wu Z, Bloomfield K, Hikaka J, Bramley D, Boyd M, Tatton A, Calvert C, Peri K, Higgins AM, Connolly MJ. Health profile of residents of retirement villages in Auckland, New Zealand: findings from a cross-sectional survey with health assessment. BMJ Open 2020; 10:e035876. [PMID: 32948550 PMCID: PMC7511621 DOI: 10.1136/bmjopen-2019-035876] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Retirement villages (RV) have expanded rapidly, now housing perhaps one in eight people aged 75+ years in New Zealand. Health service initiatives might better support residents and offer cost advantages, but little is known of resident demographics, health status or needs. This study describes village residents-their demographics, socio-behavioural and health status-noting differences between participants who volunteered and those who were sampled. DESIGN Cross-sectional study of village residents. The cohort formed will also be used for a longitudinal study and a randomised controlled trial. Village managers (sometimes after consulting residents) decided if representative sampling could be undertaken in each village. Where sampling was not approved, volunteers were sought. SETTING 33 RV were included from a total of 65 villages in Auckland, New Zealand. PARTICIPANTS Residents (n=578) were recruited either by sampling (n=217) or as volunteers (n=361) during 2016-2018. Each completed a survey and an International Resident Assessment Instrument (interRAI) health needs assessment with a gerontology nurse specialist. RESULTS Median age of residents was 82 years, 158 (27%) were men; 61% lived alone. Downsizing (77%), less stress (63%) and access to healthcare assistance (61%) were most common reasons for entry. During the 2 weeks prior to survey, 34% received home supports and 10% personal care. Hypertension, heart disease, arthritis and pain were reported by over 40%. Most common unmet needs related to managing cardiorespiratory symptoms (50%) and pain (48%). Volunteers and sampled residents differed significantly, mainly in socio-behavioural respects. CONCLUSIONS Common conditions including hypertension, arthritis and atrial fibrillation, are recorded in interRAI as text, and thus overlooked in interRAI reports. Levels of unmet need indicate opportunities to improve health services to better manage chronic conditions. Healthcare service providers and village operators could cooperate to design and test service initiatives that better meet residents' needs and offer cost benefits. TRIAL REGISTRATION NUMBER ACTRN12616000685415.
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Affiliation(s)
- Joanna B Broad
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Zhenqiang Wu
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Katherine Bloomfield
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
| | - Joanna Hikaka
- Department of Pharmacy, University of Auckland, Auckland, New Zealand
| | - Dale Bramley
- Executive Leadership Team, Waitematā District Health Board, Auckland, Auckland, New Zealand
| | - Michal Boyd
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Annie Tatton
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
| | | | - Kathy Peri
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Ann-Marie Higgins
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Martin J Connolly
- Department of Geriatric Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
- Health of Older People, Waitematā District Health Board, Auckland, New Zealand
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25
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Cowey C, Liu F, Kim R, Boyd M, Fulcher N, Krulewicz S, Smith J, Bhanegaonkar A. 1090P Real-world (RW) clinical outcomes in patients (pts) with locally advanced (LA) or metastatic Merkel cell carcinoma (mMCC) treated in United States (US) oncology clinical practices: Results from SPEAR-Merkel. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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26
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Cowey C, Boyd M, Aguilar K, Beeks A, Krepler C, Scherrer E. 1116P Real-world clinical outcomes with pembrolizumab (pembro) for treatment of advanced melanoma: Evidence from the United States community oncology setting. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.1239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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27
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Frey R, Barham S, Balmer D, Boyd M, Robinson J, Gott M. Palliative care delivery in residential aged care: bereaved family member experiences of the Supportive Hospice Aged Residential Exchange (SHARE) intervention. BMC Palliat Care 2020; 19:127. [PMID: 32807170 PMCID: PMC7433142 DOI: 10.1186/s12904-020-00633-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background The supportive hospice aged residential exchange (SHARE) is a new model of palliative care education that has been designed for residential aged care. The goal of SHARE is to help clinical staff improve palliative care within residential aged care facilities and to improve specialist palliative care nurses’ knowledge and skill to care for frail older people. Method The experiences of 18 bereaved families concerning the palliative care journey (both at the start and finish of a one-year implementation of SHARE) were explored using semi-structured interviews. Results Three themes were important to bereaved families’ experience: communication with staff, systems of care, and hospice involvement. Sub-themes indicating changes in these three components of care between the start and finish of SHARE was identified. A fourth theme highlighted challenges (relationship with GP, staff shortages, and turnover) that continued across SHARE. Conclusion Findings indicated that SHARE benefited families (improved communication and support) through the end of life journey of their relatives, but challenges remained.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Sophia Barham
- Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
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28
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Robinson J, Frey R, Boyd M, McLeod H, Meehan B, Gott M. InterRAI assessments: opportunities to recognise need for and implementation of palliative care interventions in the last year of life? Australas J Ageing 2020; 40:e22-e28. [PMID: 33739596 DOI: 10.1111/ajag.12840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/21/2020] [Accepted: 07/06/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To explore how interRAI assessments could be used to identify opportunities to integrate palliative care into a plan of care. METHODS A population-based, cross-sectional design using unique identifiers to link deaths with a national interRAI database. Data were analysed using logistic regression models and chi-square tests. RESULTS A total of 4869 people died over a 12-month period in one district health board area; 50.9% (n = 2478) received one or more interRAI assessments in the year before death. Diagnosis impacted on the type and timing of interRAI assessments and the recognition of end-stage disease. CONCLUSION People in the last year of life experience frequent interRAI assessments. There are opportunities to identify people who might benefit from a palliative care approach. Future research is needed to understand how interRAI assessors can be supported in the application of assessment items related to palliative care.
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Affiliation(s)
- Jackie Robinson
- School of Nursing, University of Auckland, Auckland, New Zealand.,Auckland District Health Board, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Heather McLeod
- School of Nursing, University of Auckland, Auckland, New Zealand
| | - Brigette Meehan
- Technical Advisory Services Limited (TAS), interRAI New Zealand, Wellington, New Zealand
| | - Merryn Gott
- School of Nursing, University of Auckland, Auckland, New Zealand
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29
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Davies RL, Boyd M, Lewin IJ, Duffield C, Woolley TG, Hall DP, Coley E. The UK defence anaesthesia experience with the Zambia Anaesthesia Development Programme. BMJ Mil Health 2020; 168:149-152. [PMID: 32753541 DOI: 10.1136/bmjmilitary-2020-001464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 11/04/2022]
Abstract
For 18 months UK military anaesthetic trainees have been travelling to Zambia for a 3-month fellowship under the auspices of the Zambia Anaesthesia Development Programme. In this article we will discuss the history, current state and future intent of the fellowship in order to better inform the anaesthetic cadre and wider UK Defence Medical Services.
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Affiliation(s)
- Rhys L Davies
- Shackleton Department of Anaesthetics, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M Boyd
- Department of Anaesthetics and Perioperative Medicine, Torbay and South Devon NHS Foundation Trust, Torquay, UK
| | - I Js Lewin
- Department of Anaesthesia and Perioperative Medicine, Royal National Throat Nose and Ear Hospital, London, UK
| | - C Duffield
- Department of Anaesthesia, King's College Hospital NHS Foundation Trust, London, UK
| | - T Gd Woolley
- Department of Anaesthesia, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - D P Hall
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - E Coley
- Department of Anaesthesia, Royal Infirmary of Edinburgh, Edinburgh, UK
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30
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Peri K, Broad JB, Hikaka J, Boyd M, Bloomfield K, Wu Z, Calvert C, Tatton A, Higgins AM, Bramley D, Connolly MJ. Study protocol: older people in retirement villages. A survey and randomised trial of a multi-disciplinary invention designed to avoid adverse outcomes. BMC Geriatr 2020; 20:247. [PMID: 32680465 PMCID: PMC7367387 DOI: 10.1186/s12877-020-01640-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 07/03/2020] [Indexed: 12/02/2022] Open
Abstract
Background There is increasing interest among older people in moving into retirement villages (RVs), an attractive option for those seeking a supportive community as they age, while still maintaining independence. Currently in New Zealand there is limited knowledge of the medical, service supports, social status and needs of RV residents. The objective of this study is to explore RV facilities and services, the health and functional status of RV residents, prospectively study their healthcare trajectories and to implement a multidisciplinary team intervention to potentially decrease dependency and impact healthcare utilization. Methods All RVs located in two large district health boards in Auckland, New Zealand were eligible to participate. This three-year project comprised three phases: The survey phase provided a description of RVs, residents’ characteristics and health and functional status. RV managers completed a survey of size, facilities and recreational and healthcare services provided in the village. Residents were surveyed to establish reasons for entry to the village and underwent a Gerontology Nurse Specialist (GNS) assessment providing details of demographics, social engagement, health and functional status. The cohort study phase examines residents’ healthcare trajectories and adverse outcomes, over three years. The final phase is a randomised controlled trial of a multidisciplinary team intervention aimed to improve health outcomes for more vulnerable residents. Residents who triggered potential unmet health needs during the assessment in the survey phase were randomised to intervention or usual care groups. Multidisciplinary team meetings included the resident and support person, a geriatrician or gerontology nurse practitioner, GNS, pharmacist and General Practitioner. The primary outcome of the randomised controlled trial will be first acute hospitalization. Secondary outcomes include all acute hospitalizations, long-term care admissions, and all-cause mortality. Discussion This paper describes the study protocol of this complex study. The study aims to inform policies and practices around health care services for residents in retirement villages. The results of this trial are expected early 2020 with publication subsequently. Trial registration Australia and New Zealand Clinical Trials Registry: ACTRN12616000685415. Registered 25.5.2016. Universal Trial Number (UTN): U111–1173-6083.
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Affiliation(s)
- K Peri
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - J Hikaka
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Private Bag 92 019, Auckland, 1142, New Zealand.,Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Auckland District Health Board, Private Bag 92 024, Auckland Mail Centre, Auckland, 1142, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - A-M Higgins
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - D Bramley
- Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand
| | - M J Connolly
- Department of Geriatric Medicine, University of Auckland, Level 1, Building 5, Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand. .,Waitemata District Health Board, PO Box 93 503, Auckland, Takapuna, 0740, New Zealand.
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Abstract
BACKGROUND A substantial number of older adults die in residential aged care facilities, yet little is known about the characteristics of and how best to optimise medication use in the last year of life. AIM The aim of this review was to map characteristics of medication use in aged care residents during the last year of life in order to examine key concepts related to medication safety and draw implications for further research and service provision. DESIGN A scoping review following Arskey and O'Malley's framework was conducted using a targeted keyword search, followed by assessments of eligibility based on title and content of abstracts and full papers. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the scoping review protocol was prospectively registered to the Open Science Framework on 27 November 2018. DATA SOURCES We searched MEDLINE, EMBASE, AMED, CINAHL and Cochrane databases to identify peer-reviewed studies published between 1937 and 2018, written in English and looking at medication use in individuals living in aged care facilities within their last year of life. RESULTS A total of 30 papers were reviewed. Five key overarching themes were derived from the analysis process: (1) access to medicines at the end of life, (2) categorisation and classes: medicines and populations, (3) polypharmacy and total medication numbers, (4) use of symptomatic versus preventive medications and (5) 'inappropriate' medications. CONCLUSION Number of prescriptions or blunt categorisations of medications to assess their appropriateness are unlikely to be sufficient to promote well-being and medication safety for older people in residential aged care in the final stages of life.
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Affiliation(s)
| | - Michal Boyd
- The University of Auckland, Auckland, New Zealand
| | | | - Aileen Collier
- The University of Auckland, Auckland, New Zealand.,Flinders University, Adelaide, SA, Australia.,University of Tasmania, Hobart, TAS, Australia
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32
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Balmer DG, Frey R, Gott M, Collier A, Boyd M. A Place to Live and to Die: A Qualitative Exploration of the Social Practices and Rituals of Death in Residential Aged Care. Omega (Westport) 2020; 85:38-58. [PMID: 32576125 DOI: 10.1177/0030222820935217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In many countries, an increasing proportion of deaths occur in residential aged care (RAC) (nursing homes) meaning that these have become both a place to live - a home- and a place to die. This paper reports on death practices and rituals in 49 RAC facilities in Aotearoa/New Zealand narrated in semi-structured interviews with staff. Themes coalesced around 'good death'. Dying alone was not seen as a good death and the demands of trying to prevent this caused tension for staff. Meeting family wishes, post death decision-making, after death practices and rituals, including communicating and remembrance of the death, were explored as part of good death. Overall, death rituals in RAC were limited. Balancing the needs of the living, the dying and the dead created tension. The rituals and practices facilities are currently enacting in death/post-death require attention, since more people will die in RAC with increasingly diverse needs.
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Affiliation(s)
- D G Balmer
- School of Nursing, University of Auckland, New Zealand
| | - R Frey
- School of Nursing, University of Auckland, New Zealand
| | - M Gott
- School of Nursing, University of Auckland, New Zealand
| | - A Collier
- School of Nursing, University of Auckland, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, New Zealand
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33
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Boyd M, Therrien I, Pazur RJ. CHARACTERIZATION AND CORRELATION OF THE NETWORK CHAIN DENSITY TO THE PROPERTIES OF FLUOROELASTOMER RUBBER. Rubber Chemistry and Technology 2020. [DOI: 10.5254/rct.20.80367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
ABSTRACT
The concentrations of triallyl isocyanurate (TAIC) in a peroxide-curable fluoroelastomer terpolymer containing 67 wt% of fluorine were varied to generate compounds of differing crosslink densities. Experimental analysis was undertaken using rheometry, hardness, stress–strain (Mooney–Rivlin), equilibrium solvent swell, and low-field nuclear magnetic resonance (NMR) using the double quantum (DQ) technique. Increasing the TAIC concentration caused a systematic rise in rheometry elastic torque, hardness, and tensile strength, whereas both elongation at break and swelling levels decreased. These results are concurrent with an enhanced overall level of crosslinking, which was confirmed by the steady increase of the Mooney–Rivlin C1 values. DQ NMR analysis using hydrogen and fluorine probes and subsequent application of fast Tikhonov regularization to the corrected intensity data were particularly useful in discerning the inhomogeneous nature of the compound morphology. The spatial distribution of the crosslink density suggests that the compound consists of small, highly crosslinked/entangled polymerized TAIC domains embedded within the elastic crosslinked matrix. A concentration of 3 phr of TAIC is optimal according to compression set testing.
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Affiliation(s)
- M. Boyd
- Department of National Defense, Quality Engineering Test Establishment, Polymer and Textile Science, Ottawa, Ontario, K1A 0K2 CANADA
| | - I. Therrien
- Department of National Defense, Quality Engineering Test Establishment, Polymer and Textile Science, Ottawa, Ontario, K1A 0K2 CANADA
| | - Richard. J. Pazur
- Department of National Defense, Quality Engineering Test Establishment, Polymer and Textile Science, Ottawa, Ontario, K1A 0K2 CANADA
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34
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Alderman OLG, Benmore CJ, Feller S, Kamitsos EI, Simandiras ED, Liakos DG, Jesuit M, Boyd M, Packard M, Weber R. Correction to "Short-Range Disorder in TeO 2 Melt and Glass". J Phys Chem Lett 2020; 11:1377. [PMID: 32017572 DOI: 10.1021/acs.jpclett.0c00336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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35
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Alderman OLG, Benmore CJ, Feller S, Kamitsos EI, Simandiras ED, Liakos DG, Jesuit M, Boyd M, Packard M, Weber R. Short-Range Disorder in TeO 2 Melt and Glass. J Phys Chem Lett 2020; 11:427-431. [PMID: 31867975 DOI: 10.1021/acs.jpclett.9b03231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
High-resolution X-ray pair distribution functions for molten and glassy TeO2 reveal coordination numbers nTeO ≈ 4. However, distinct from the known α-, β-, and γ-TeO2 polymorphs, there is considerable short-range disorder such that no clear cutoff distance between bonded and nonbonded interactions exists. We suggest that this is similar to disorder in δ-TeO2 and arises from a broad distribution of asymmetric Te-O-Te bridges, something that we observe becomes increasingly asymmetric with increasing liquid temperature. Such behavior is qualitatively consistent with existing interpretations of Raman scattering spectra, and equivalent to temperature-induced coordination number reduction, for sufficiently large cutoff radii. Therefore, TeO2 contains a distribution of local environments that are, furthermore, temperature dependent, making it distinct from the canonical single-oxide glass formers. Our results are in good agreement with high-level ab initio cluster calculations.
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Affiliation(s)
- O L G Alderman
- Materials Development, Inc. , Arlington Heights , Illinois 60004 , United States
| | - C J Benmore
- X-Ray Science Division, Advanced Photon Source , Argonne National Laboratory , Argonne , Illinois 60439 , United States
| | - S Feller
- Department of Physics , Coe College , Cedar Rapids , Iowa 52402 , United States
| | - E I Kamitsos
- National Hellenic Research Foundation , 48 Vassileos Constantinou Avenue , 11635 Athens , Greece
| | - E D Simandiras
- National Hellenic Research Foundation , 48 Vassileos Constantinou Avenue , 11635 Athens , Greece
| | - D G Liakos
- Max-Planck-Institut für Kohlenforschung , Kaiser-Wilhelm-Platz 1 , 45470 Mülheim an der Ruhr , Germany
| | - M Jesuit
- Department of Physics , Coe College , Cedar Rapids , Iowa 52402 , United States
| | - M Boyd
- Department of Physics , Coe College , Cedar Rapids , Iowa 52402 , United States
| | - M Packard
- Department of Physics , Coe College , Cedar Rapids , Iowa 52402 , United States
| | - R Weber
- Materials Development, Inc. , Arlington Heights , Illinois 60004 , United States
- X-Ray Science Division, Advanced Photon Source , Argonne National Laboratory , Argonne , Illinois 60439 , United States
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Balmer D, Frey R, Gott M, Robinson J, Boyd M. Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives. Aust J Prim Health 2020; 26:124-131. [DOI: 10.1071/py19081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022]
Abstract
This exploratory study examined general practitioners’ (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs’ life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility’s end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.
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Attwood J, Attwood D, Williams L, Collier A, Boyd M, Gott M. It all started with a green car … Exploring the meaning of happiness. Dementia (London) 2019; 19:31-40. [PMID: 31875720 DOI: 10.1177/1471301219876406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | | | | | | | | | - Merryn Gott
- Department of Nursing, University of Auckland, New Zealand
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Frey R, Balmer D, Robinson J, Boyd M, Gott M. What factors predict the confidence of palliative care delivery in long‐term care staff? A mixed‐methods study. Int J Older People Nurs 2019; 15:e12295. [DOI: 10.1111/opn.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 11/04/2019] [Accepted: 11/15/2019] [Indexed: 12/24/2022]
Affiliation(s)
- Rosemary Frey
- Faculty of Medical and Health Sciences School of Nursing University of Auckland Auckland New Zealand
| | - Deborah Balmer
- Faculty of Medical and Health Sciences School of Nursing University of Auckland Auckland New Zealand
| | - Jackie Robinson
- Faculty of Medical and Health Sciences School of Nursing University of Auckland Auckland New Zealand
| | - Michal Boyd
- Faculty of Medical and Health Sciences School of Nursing University of Auckland Auckland New Zealand
| | - Merryn Gott
- Faculty of Medical and Health Sciences School of Nursing University of Auckland Auckland New Zealand
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Cheung G, Appleton K, Boyd M, Cullum S. Perspectives of dementia from Asian communities living in New Zealand: A focus group of Asian health care professionals. Int J Geriatr Psychiatry 2019; 34:1758-1764. [PMID: 31389087 DOI: 10.1002/gps.5189] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/05/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The number of Asian New Zealanders with dementia is growing. The objective of this study was to explore with a group of Asian health care professionals about public attitudes towards dementia in Asian communities in New Zealand, the stigma of dementia, and how best to develop culturally appropriate services for Asian people and families living with dementia. METHODS A focus group was conducted with a group of bilingual Asian health care professionals. A topic guide was developed based on the discussion at a prior meeting with the Cross Cultural Interest Group. The data were independently analysed by three researchers using the thematic qualitative methodology. RESULTS Eleven overseas-born Asian health care professionals (Chinese: n = 9, 82%) participated in the focus group. Four main themes emerged from the data: (a) cultural interpretations of dementia; (b) stigma; (c) filial piety; and (d) inequity in the availability of resources. CONCLUSION Our findings suggest that much work is needed to destigmatise dementia in New Zealand Asian communities, through psychoeducation, public awareness, and the availability of readily accessible services that can meet their cultural and language needs.
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Affiliation(s)
- Gary Cheung
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
| | | | - Michal Boyd
- School of Nursing and Freemasons' Department of Geriatric Medicine, University of Auckland, Auckland, New Zealand
| | - Sarah Cullum
- Department of Psychological Medicine, The University of Auckland, Auckland, New Zealand
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Frey R, Balmer D, Boyd M, Robinson J, Gott M. Palliative care nurse specialists' reflections on a palliative care educational intervention in long-term care: an inductive content analysis. BMC Palliat Care 2019; 18:103. [PMID: 31744507 PMCID: PMC6864945 DOI: 10.1186/s12904-019-0488-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/12/2019] [Indexed: 12/02/2022] Open
Abstract
Background Older people in long-term care facilities are at a greater risk of receiving care at the end of life that does not adequately meet their needs, yet staff in long-term care are often unprepared to provide palliative care. The objective of the study was to explore palliative care nurse specialists’ experiences regarding the benefits of and barriers to the implementation of a palliative care educational intervention, Supportive Hospice Aged Residential Exchange (SHARE) in 20 long-term care facilities. Methods Reflective logs (465), recorded over the course of the yearlong SHARE intervention by the three palliative care nurse specialists from two local hospices, who were the on-site mentors, were qualitatively analyzed by two researchers utilizing inductive content analysis. Results Categories emerging from the logs include the importance of relationships, knowledge exchange, communication, and the challenges of providing palliative care in a long-term care setting. Conclusion Evidence from the logs indicated that sustained relationships between the palliative care nurse specialists and staff (registered nurses, healthcare assistants) as well as reciprocal learning were key factors supporting the implementation of this palliative care educational intervention. Challenges remain however in relation to staffing levels, which further emphasizes the importance of palliative care nurse specialist presence as a point of stability.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, 85 Park Road, Grafton, Auckland, New Zealand
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Waterhouse D, Nwokeji E, Boyd M, Penrod J, Espirito J, Robert N, Daumont M. P2.06-04 Treatment Patterns and Outcomes of Advanced Malignant Pleural Mesothelioma (MPM) Patients in a Community Practice Setting. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.1622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Pan E, Bloomfield K, Boyd M. Resilience, not frailty: A qualitative study of the perceptions of older adults towards “frailty”. Int J Older People Nurs 2019; 14:e12261. [DOI: 10.1111/opn.12261] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 06/12/2019] [Accepted: 07/01/2019] [Indexed: 01/20/2023]
Affiliation(s)
- Edmund Pan
- Freemasons' Department of Geriatric Medicine, School of Medicine University of Auckland Auckland New Zealand
| | - Katherine Bloomfield
- Freemasons' Department of Geriatric Medicine, School of Medicine University of Auckland Auckland New Zealand
| | - Michal Boyd
- School of Nursing University of Auckland Auckland New Zealand
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Connolly MJ, Hikaka J, Bloomfield K, Broad JB, Wu Z, Boyd M, Peri K, Calvert C, Tatton A, Higgins AM, Bramley D. 83RESEARCH IN THE RETIREMENT VILLAGE COMMUNITY: DOES THE RECRUITED SAMPLE REFLECT THE RESIDENT POPULATION? Age Ageing 2019. [DOI: 10.1093/ageing/afz061.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J Hikaka
- Waitemata District Health Board, Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - Z Wu
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - M Boyd
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - K Peri
- School of Nursing, University of Auckland, Grafton, New Zealand
| | - C Calvert
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - A Tatton
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - A -M Higgins
- Department of Geriatric Medicine, University of Auckland, Takapuna, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
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Foster S, Balmer D, Gott M, Frey R, Robinson J, Boyd M. Patient-centred care training needs of health care assistants who provide care for people with dementia. Health Soc Care Community 2019; 27:917-925. [PMID: 30729629 DOI: 10.1111/hsc.12709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 11/08/2018] [Accepted: 11/29/2018] [Indexed: 06/09/2023]
Abstract
It is well documented that Health care assistants (HCAs) provide the most hands-on care to residents in aged care facilities, and play a critical role in the provision of care to dementia residents. Over the last 25 years, a philosophy of person-centred care has become the preferred approach to care and this has meant that HCAs are encouraged to get to know the resident very well. This paper reports the experiences of HCAs in caring for people at end-of-life, identifies the skills required for their work and examines the education provided against these skills. Semi-structured interviews were conducted in 49 facilities (n = 34) across New Zealand and data analysed thematically, with the aim of critically examining the adequacy of education for health care assistants which meets their needs within a person-centred environment. The results confirm that the skills include traditional tasks of care (showering, feeding, toileting, and dressing) but the increasingly important communication and de-escalation skills, both verbal and non-verbal, have become central to their care skills. Education provided has not sufficiently shifted focus to include these more complex skills. Provision of educations that acknowledges the increased complexities of their role needs to be provided. As well, facilities need to be challenged to reconsider the HCA's position in the facility care tem.
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Affiliation(s)
- Susan Foster
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Deborah Balmer
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Rosemary Frey
- School of Nursing, The University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Auckland District Health Board, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, The University of Auckland, Auckland, New Zealand
- Freemasons' Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand
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Boyd M, Frey R, Balmer D, Robinson J, McLeod H, Foster S, Slark J, Gott M. End of life care for long-term care residents with dementia, chronic illness and cancer: prospective staff survey. BMC Geriatr 2019; 19:137. [PMID: 31117991 PMCID: PMC6532195 DOI: 10.1186/s12877-019-1159-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 05/14/2019] [Indexed: 11/10/2022] Open
Abstract
Background Little is known about the quality of end of life care in long-term care (LTC) for residents with different diagnostic trajectories. The aim of this study was to compare symptoms before death in LTC for those with cancer, dementia or chronic illness. Methods After-death prospective staff survey of resident deaths with random cluster sampling in 61 representative LTC facilities across New Zealand (3709 beds). Deaths (n = 286) were studied over 3 months in each facility. Standardised questionnaires - Symptom Management (SM-EOLD) and Comfort Assessment in End of life with Dementia (CAD-EOLD) - were administered to staff after the resident’s death. Results Primary diagnoses at the time of death were dementia (49%), chronic illness (30%), cancer (17%), and dementia and cancer (4%). Residents with cancer had more community hospice involvement (30%) than those with chronic illness (12%) or dementia (5%). There was no difference in mean SM-EOLD in the last month of life by diagnosis (cancer 26.9 (8.6), dementia 26.5(8.2), chronic illness 26.9(8.6). Planned contrast analyses of individual items found people with dementia had more pain and those with cancer had less anxiety. There was no difference in mean CAD-EOLD scores in the week before death by diagnosis (total sample 33.7(SD 5.2), dementia 34.4(SD 5.2), chronic illness 33.0(SD 5.1), cancer 33.3(5.1)). Planned contrast analyses showed significantly more physical symptoms for those with dementia and chronic illness in the last month of life than those with cancer. Conclusions Overall, symptoms in the last week and month of life did not vary by diagnosis. However, sub-group planned contrast analyses found those with dementia and chronic illness experienced more physical distress during the last weeks and months of life than those with cancer. These results highlight the complex nature of LTC end of life care that requires an integrated gerontology/palliative care approach.
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Affiliation(s)
- Michal Boyd
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand. .,Freemasons' Department of Geriatric Medicine, The University of Auckland, Auckland, New Zealand.
| | - Rosemary Frey
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Deborah Balmer
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Jackie Robinson
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Heather McLeod
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Susan Foster
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Julia Slark
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
| | - Merryn Gott
- School of Nursing, The University of Auckland, Private Bag, Auckland, 92019, New Zealand
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Frey R, Balmer D, Robinson J, Gott M, Boyd M. The Effect of Residential Aged Care Size, Ownership Model, and Multichain Affiliation on Resident Comfort and Symptom Management at the End of Life. J Pain Symptom Manage 2019; 57:545-555.e1. [PMID: 30508638 DOI: 10.1016/j.jpainsymman.2018.11.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/20/2018] [Accepted: 11/22/2018] [Indexed: 01/30/2023]
Abstract
CONTEXT In most resource-rich countries, a large and growing proportion of older adults with complex needs will die while in a residential aged care (RAC) facility. OBJECTIVES This study describes the impact of facility size (small/large), ownership model (profit/nonprofit) and provider (independent/chain) on resident comfort, and symptom management as reported by RAC staff. METHODS This retrospective "after-death" study collected decedent resident data from a subsample of 51 hospital-level RAC facilities in New Zealand. Symptom Management at the End-of-Life in Dementia and Comfort Assessment in Dying at End of life with Dementia (SM-EOLD and CAD-EOLD, respectively) scales were used by RAC staff who were closely associated with 217 deceased residents. Data collection occurred from January 2016 to February 2017. RESULTS Results indicated that residents of large, nonprofit facilities experienced greater comfort at the end of life (CAD-EOLD) as indicated by a higher mean score of 37.21 (SD = 4.85, 95% CI = 34.4, 40.0) than residents of small for-profit facilities who recorded a lower mean score of 31.56 (SD = 6.20, 95% CI = 29.6, 33.4). There was also evidence of better symptom management for residents of chain facilities, with a higher mean score for symptom management (SM-EOLD total score) recorded for residents of chain facilities (mean = 28.07, SD = 7.64, 95% CI = 26.47, 29.66) than the mean score for independent facilities (mean = 23.93, SD = 8.72, 95% CI = 21.65, 26.20). CONCLUSION Findings suggest that there are differences in the quality of end-of-life care given in RAC based on size, ownership model, and chain affiliation.
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Affiliation(s)
- Rosemary Frey
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand.
| | - Deborah Balmer
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Jackie Robinson
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Merryn Gott
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
| | - Michal Boyd
- School of Nursing, Faculty of Medical and Health Sciences University of Auckland, Auckland, New Zealand
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Haridy J, Wigg A, Muller K, Ramachandran J, Tilley E, Waddell V, Gordon D, Shaw D, Huynh D, Stewart J, Nelson R, Warner M, Boyd M, Chinnaratha MA, Harding D, Ralton L, Colman A, Liew D, Iyngkaran G, Tse E. Real-world outcomes of unrestricted direct-acting antiviral treatment for hepatitis C in Australia: The South Australian statewide experience. J Viral Hepat 2018; 25:1287-1297. [PMID: 29888827 DOI: 10.1111/jvh.12943] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/30/2018] [Indexed: 02/06/2023]
Abstract
In March 2016, the Australian government offered unrestricted access to direct-acting antiviral (DAA) therapy for chronic hepatitis C virus (HCV) to the entire population. This included prescription by any medical practitioner in consultation with specialists until sufficient experience was attained. We sought to determine the outcomes and experience over the first twelve months for the entire state of South Australia. We performed a prospective, observational study following outcomes of all treatments associated with the state's four main tertiary centres. A total of 1909 subjects initiating DAA therapy were included, representing an estimated 90% of all treatments in the state. Overall, SVR12 was 80.4% in all subjects intended for treatment and 95.7% in those completing treatment and follow-up. 14.2% were lost to follow-up (LTFU) and did not complete SVR12 testing. LTFU was independently associated with community treatment via remote consultation (OR 1.50, 95% CI 1.04-2.18, P = .03), prison-based treatment (OR 2.02, 95% CI 1.08-3.79, P = .03) and younger age (OR 0.98, 95% CI 0.97-0.99, P = .05). Of the 1534 subjects completing treatment and follow-up, decreased likelihood of SVR12 was associated with genotype 2 (OR 0.23, 95% CI 0.07-0.74, P = .01) and genotype 3 (OR 0.23, 95% CI 0.12-0.43, P ≤ .01). A significant decrease in treatment initiation was observed over the twelve-month period in conjunction with a shift from hospital to community-based treatment. Our findings support the high responses observed in clinical trials; however, a significant gap exists in SVR12 in our real-world cohort due to LTFU. A declining treatment initiation rate and shift to community-based treatment highlight the need to explore additional strategies to identify, treat and follow-up remaining patients in order to achieve elimination targets.
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Affiliation(s)
- J Haridy
- University of Melbourne, Parkville, Vic., Australia.,Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - A Wigg
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - K Muller
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - J Ramachandran
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - E Tilley
- Hepatology and Liver Transplantation Unit, Flinders Medical Centre, Adelaide, SA, Australia
| | - V Waddell
- Department of Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, SA, Australia
| | - D Gordon
- Department of Microbiology and Infectious Diseases, Flinders Medical Centre, Adelaide, SA, Australia.,Flinders University, Bedford Park, SA, Australia
| | - D Shaw
- Department of Infectious Diseases, Royal Adelaide Hospital, Adelaide, SA, Australia.,Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - D Huynh
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - J Stewart
- Department of Gastroenterology, The Queen Elizabeth Hospital, Adelaide, SA, Australia.,Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - R Nelson
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - M Warner
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Infectious Diseases, The Queen Elizabeth Hospital, Adelaide, SA, Australia
| | - M Boyd
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Infectious Diseases, Lyell-McEwin Hospital, Adelaide, SA, Australia
| | - M A Chinnaratha
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.,Department of Gastroenterology, Lyell-McEwin Hospital, Adelaide, SA, Australia
| | - D Harding
- Department of Gastroenterology, Lyell-McEwin Hospital, Adelaide, SA, Australia
| | - L Ralton
- Department of Infectious Diseases, Lyell-McEwin Hospital, Adelaide, SA, Australia
| | - A Colman
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA, Australia
| | - D Liew
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Vic., Australia
| | - G Iyngkaran
- Department of Gastroenterology, Royal Melbourne Hospital, Melbourne, Vic., Australia
| | - E Tse
- Department of Gastroenterology, Royal Adelaide Hospital, Adelaide, SA, Australia
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Abstract
Aim The purpose of this study was to clone and express cDNA genes of heavy and light chains of the mouse/human chimeric antibody rcM4, which recognize the sialosyl-Tn epitope of the TAG72 antigen. Methods The cDNA genes of chimeric heavy-chain M4H2 and light-chain M4K4 were cloned from the cDNA library of the ccM4 transfectoma. The M4H2 and M4K4 genes were modified in polymerase chain reaction and ligated into mpSV2neo-EP-PA and mpSV2gpt-EP-PA to form the heavy- and the light-chain expression vectors mpSV2neo-EP-M4H2-PA and mpSV2gpt-EP-M4K4-PA, respectively. These two expression vectors were then co-transfected into the myeloma cell line SP2/0Ag14. Transfectants were selected in media containing G418 and mycophenolic acid. The rcM4 antibody was purified from transfectant culture supernates by protein A affinity chromatography. Results The yield of the recombinant chimeric antibody rcM4 from its culture supernates was 6 μg/ml. We demonstrated that the rcM4 antibody retained its binding reactivity for sialosyl-Tn and that it was able to mediate effective antibody-dependent cellular cytotoxicity to the human ovarian cancer cell line OVCAR 3 in a manner comparable to the original ccM4 antibody. Conclusion The cDNA genes of chimeric heavy-chains (M4H2) and light-chains (M4K4) could be functionally expressed in the SP2/0Ag14 myeloma cell line. They thus have potential utility in the construction of some novel hybrid proteins such as those containing both antitumor immunoglobulins and cytokine molecules for use in cancer immunotherapy.
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MESH Headings
- Amino Acid Sequence
- Animals
- Antibodies, Monoclonal/biosynthesis
- Antibodies, Monoclonal/genetics
- Antibodies, Monoclonal/immunology
- Antibodies, Neoplasm/biosynthesis
- Antibodies, Neoplasm/genetics
- Antibodies, Neoplasm/immunology
- Base Sequence
- Blotting, Western
- Cloning, Molecular
- DNA, Complementary/genetics
- Enzyme-Linked Immunosorbent Assay
- Genes, Immunoglobulin/genetics
- Genes, Immunoglobulin/immunology
- Genetic Vectors
- Humans
- Immunoglobulin Heavy Chains/genetics
- Immunoglobulin Light Chains/genetics
- Mice
- Molecular Sequence Data
- Multiple Myeloma
- Recombinant Fusion Proteins/biosynthesis
- Recombinant Fusion Proteins/genetics
- Recombinant Fusion Proteins/immunology
- Transfection
- Tumor Cells, Cultured
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Affiliation(s)
- M Boyd
- Saskatoon Cancer Center, Department of Microbiology, University of Saskatchewan, Canada
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Connolly MJ, Broad JB, Bish T, Zhang X, Bramley D, Kerse N, Bloomfield K, Boyd M. Reducing emergency presentations from long-term care: A before-and-after study of a multidisciplinary team intervention. Maturitas 2018; 117:45-50. [PMID: 30314560 DOI: 10.1016/j.maturitas.2018.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The complexity of care required by many older people living in long-term care (LTC) facilities poses challenges that can lead to potentially avoidable referrals to a hospital emergency department (ED). The Aged Residential Care Intervention Project (ARCHIP) ran an implementation study to evaluate a multidisciplinary team (MDT) intervention supporting LTC facility staff to decrease potentially avoidable ED presentations by residents. METHODS ARCHIP (conducted in 21 facilities [1,296 beds] with previously noted high ED referral rates) comprised clinical coaching for LTC facility staff by a gerontology nurse specialist (GNS) and an MDT (facility senior nurse, resident's general practitioner, GNS, geriatrician, pharmacist) review of selected high-risk residents' care-plans. A before-after repeated measures analysis was conducted for 9 months before and 9 months after intervention commencement (a 29-month period because of staggered facility enrolment). Modelling was adjusted for time trend, seasonality, facility size, and cluster effect. RESULTS ED admission rate ratio post- versus pre-intervention was 0.75 (95% C.I. 0.63, 0.89, p-value = 0.0008), a 25% reduction in ED presentations post-intervention. A sensitivity model used a shorter, staggered time period centred on intervention start (9 months pre-intervention and 9 months post-intervention) for each facility, and a four-level categorical intervention variable testing intervention effect over time. The sensitivity test showed a 24% reduction in ED presentations in months 1-3 post-intervention (p-value = 0.07), a 34% reduction in months 4-6 (p-value = 0.01), and a 32% reduction in ED presentations in months 7-9 (p-value = 0.03). However, when the higher ED referral rates for 3 months immediately pre-intervention were modelled, the impact of the intervention on ED presentation rates reverted almost to previous levels. KEY CONCLUSIONS A GNS-led MDT outreach intervention, targeted at selected conditions, decreases avoidable ED admissions of high-risk residents from selected facilities.
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Affiliation(s)
- M J Connolly
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand.
| | - J B Broad
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - T Bish
- Waitemata District Health Board, Auckland, New Zealand
| | - X Zhang
- Department of Geriatric Medicine, University of Auckland, New Zealand
| | - D Bramley
- Waitemata District Health Board, Auckland, New Zealand
| | - N Kerse
- School of Population Health, University of Auckland, New Zealand
| | - K Bloomfield
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand
| | - M Boyd
- Department of Geriatric Medicine, University of Auckland, New Zealand; Waitemata District Health Board, Auckland, New Zealand; School of Nursing, University of Auckland, New Zealand
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Frey R, Balmer D, Robinson J, Slark J, McLeod H, Gott M, Boyd M. “To a better place”: The role of religious belief for staff in residential aged care in coping with resident deaths. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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