The relationship between clinical presentation and the nature of care in adults with intellectual disability and epilepsy - national comparative cohort study

BACKGROUND

A quarter of People with Intellectual Disabilities (PwID) have epilepsy compared with 1% of the general population. Epilepsy in PwID is a bellwether for premature mortality, multimorbidity and polypharmacy. This group depends on their care provider to give relevant information for management, especially epilepsy. There is no research on care status relationship and clinical characteristics of PwID and epilepsy.

AIM

Explore and compare the clinical characteristics of PwID with epilepsy across different care settings.

METHOD

A retrospective multicentre cohort study across England and Wales collected information on seizure characteristics, intellectual disability severity, neurodevelopmental/biological/psychiatric comorbidities, medication including psychotropics/anti-seizure medication, and care status. Clinical characteristics were compared across different care settings, and those aged over and younger than 40 years.

RESULTS

Of 618 adult PwID across six centres (male:female = 61%:39%), 338 (55%) received professional care whereas 258 (42%) lived with family. Significant differences between the care groups existed in intellectual disability severity (P = 0.01), autism presence (P < 0.001), challenging behaviour (P < 0.001) and comorbid physical conditions (P = 0.008). The two groups did not vary in intellectual disability severity/genetic conditions/seizure type and frequency/psychiatric disorders. The professional care cohort experienced increased polypharmacy (P < 0.001) and antipsychotic/psychotropic use (P < 0.001/P = 0.008).The over-40s cohort had lower autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD) comorbidity (P < 0.001/P = 0.007), increased psychiatric comorbidity and challenging behaviour (P < 0.05), physical multimorbidity (P < 0.001), polypharmacy (P < 0.001) and antipsychotic use (P < 0.001) but reduced numbers of seizures (P = 0.007).

CONCLUSION

PwID and epilepsy over 40 years in professional care have more complex clinical characteristics, increased polypharmacy and antipsychotic prescribing but fewer seizures.

Fix my food: An urgent call to action from adolescents on how they experience and want to see change in their food systems

BACKGROUND

Global food systems are failing adolescents. Poor diet quality driving malnutrition among adolescents around the world and the quality of foods eaten by adolescents not only determines their health and development, but also is the foundation of thriving communities. The present study aimed to engage adolescents across low-income, middle-income and high-income countries to determine their lived experience of food, food systems and the challenges they face within their food systems.

METHODS

The study used the Distributed Data Generation method pioneered by the Young and Resilient Research Centre, at Western Sydney University, to conduct workshops with adolescents aged 10-19 years across the globe in collaboration with UNICEF. Participatory workshops were designed to capture qualitative data on adolescents lived experiences and perspectives of their food systems, food sustainability and food security, and how improvements can be made. Thematic analysis was undertaken to analyse qualitative data. Descriptive statistics were generated for demographic data captured.

RESULTS

Six hundred and forty adolescents across 18 countries participated. Three key themes emerged, which included experiences of food, challenges to food systems and strengthening food systems. Adolescents saw potential in empowering communities to create change and contribute to food system transformation. Adolescents called for inclusion in decision-making from local food practice to large global policy development.

CONCLUSIONS

The study results demonstrated how adolescents experience their food systems and want to see sustainable change, although they also want to be a part of the change. Adolescents described that there needs to be an active choice to work with them, listen to their lived experience and across all levels of society strengthen food systems. To achieve this, adolescents need to be involved in decision-making around their food systems for a sustainable future.

Current Status of Pediatric Oncology Clinics and Nursing Practices in Turkey

Background: Cancer is a significant health problem in Turkey with pediatric cancer being the fourth leading cause of death among children. Pediatric oncology has been acknowledged as a pediatric subspecialty since 1983, and 3,000 new cases of childhood cancer are expected every year. Method: We describe our country's geography, the number and distribution of pediatric oncology centers, the profile of clinical and academic nurses, and our clinical practice. We present two nurse-led research projects. Results: Although nursing practice differs according to centers, treatment and care are usually evidence-based, especially in university and public hospitals in big cities. Nurses with an undergraduate education work in pediatric oncology units; however, few nurses with graduate degrees work in clinical settings. The Turkish Oncology Nurses Association supports the development and implementation of guidelines for evidence-based nursing care. Nurses' clinical responsibilities include patient admission to the clinic, patient and family education, care coordination, patient care, symptom management, palliative, and intensive care services. Results of two recent nurse-led studies highlight challenges to meet the needs of patients and families from surrounding countries, including refugees, and opportunities for nurses to provide holistic support to parents of hospitalized children. Discussion: Increasing the number of nurses is a priority to improve pediatric oncology nursing care. Actions to advance pediatric oncology nursing include developing advanced clinical roles for nurses with graduate degrees; supporting nurses caring for children and families from outside Turkey, including language support services; and resources to conduct national and international studies related to professional and holistic care delivery.

Validity and Reliability Evidence of the Munro Scale for Perioperative Patients Part II: Construct Validity

Background and Purpose: The Munro Pressure Injury Risk Assessment Scale for Perioperative Patients (Munro Scale) is the first three-phase risk instrument designed specifically for perioperative patients. The purpose of this study was to establish validity and reliability evidence for the Munro Scale. This study also had a goal to reduce the data into more manageable constructs with fewer items. Methods: Exploratory and confirmatory factor analyses were used to test the hypothesized model for risk assessment using the Munro Scale to identify latent variables. A retrospective review of charts from 630 risk assessments was analyzed from two community acute care hospital settings. Results: The model explained 95% of the variance in the cumulative final risk level, R² = .95, F(20, 588) = 501.88, p < .001. Six latent variables emerged in the model with a cumulative contribution rate of 56% of the variance. Similar results were obtained in studies with Chinese and Turkish translations of the Munro Scale. Conclusions: The validity and reliability evidence obtained in this study supports the implementation of the Munro Scale for clinical practice in the perioperative setting.

Effects of a Pretend Play Intervention on Health-Related Quality of Life in Children With Cancer: A Swedish-German Study

Background: Cancer diagnosis can lead to massive physical, emotional, and social burdens on children and their families. Although children have the right to be informed and participate in their care, research shows that children's views are often not considered in care situations. Thus, it is essential to strengthen children's communication and self-efficacy (SE) to convey desires and needs. The present study explores whether a play intervention is associated with improved health-related quality of life (HrQoL) and SE for communication in care situations. We hypothesize that HrQoL and SE for communication will increase from the beginning to after the pretend play intervention. Methods: Children with cancer from Germany and Sweden were enrolled. The pretend play intervention consisted of six to 10 play sessions. A heterogenic selection of questionnaires was used to measure children's HrQoL and SE before the first pretend play session and after the last play intervention. Results: Nineteen families were included in the presented analyses, including 14 self-reports of children and 19 proxy reports of parents. We found improvements in child-reported communication, and emotional and psychosocial well-being using generic and cancer-specific HrQoL measurements. Further, children's SE in care situations improved during the play intervention. Parents also reported minor improvements in the physical dimensions in both generic and chronic-generic HrQoL, along with improvements in independence. Discussion: Overall, the cancer-specific pretend play intervention offers young children with cancer a secure environment and can contribute to their well-being, and communication skills, during or after cancer treatment.

General and COVID-19-Related Mortality by Pre-Existing Chronic Conditions and Care Setting during 2020 in Emilia-Romagna Region, Italy

In 2020, the number of deaths increased in Italy, mainly because of the COVID-19 pandemic; mortality was among the highest in Europe, with a clear heterogeneity among regions and socio-demographic strata. The present work aims to describe trends in mortality and to quantify excess mortality variability over time and in relation to demographics, pre-existent chronic conditions and care setting of the Emilia-Romagna region (Northern Italy). This is a registry-based cross-sectional study comparing the 2020 observed mortality with figures of the previous five years by age, sex, month, place of death, and chronicity. It includes 300,094 deaths in those 18 years of age and above resident in the Emilia-Romagna region. Excess deaths were higher during the first pandemic wave, particularly among men and in March. Age-adjusted risk was similar among both men and women (Mortality Rate Ratio 1.15; IC95% 1.14–1.16). It was higher among females aged 75+ years and varied between sub-periods. Excluding COVID-19 related deaths, differences in the risk of dying estimates tended to disappear. Metabolic and neuropsychiatric diseases were more prevalent among those that deceased in 2020 compared to the deaths that occurred in 2015–2019 and therefore can be confirmed as elements of increased frailty, such as being in long-term care facilities or private homes as the place of death. Understanding the impact of the pandemic on mortality considering frailties is relevant in a changing scenario.

Impact of primary care involvement and setting on multidisciplinary heart failure management: a systematic review and meta-analysis

Multidisciplinary disease management programmes (DMPs) are a cornerstone of modern guideline-recommended care for heart failure (HF). Few programmes are community initiated or involve primary care professionals, despite the importance of home-based care for HF. We compared the outcomes of different multidisciplinary HF DMPs in relation to their recruitment setting and involvement of primary care health professionals. We conducted a systematic review and meta-analysis of randomized controlled trials published in MEDLINE, Embase, and Cochrane between 2000 and 2020 using Cochrane Collaboration methodology. Our meta-analysis included 19 randomized controlled trials (7577 patients), classified according to recruitment setting and involvement of primary care professionals. Thirteen studies recruited in the hospital (n = 5243 patients) and six in the community (n = 2334 patients). Only six studies involved primary care professionals (n = 3427 patients), with two of these recruited in the community (n = 225 patients). Multidisciplinary HF DMPs that recruited in the community had no significant effect on all-cause and HF readmissions nor on mortality, irrespective of primary care involvement. Studies that recruited in the hospital demonstrated a significant reduction in mortality (relative risk 0.87, 95% confidence interval [CI] [0.76, 0.98]), HF readmissions (0.70, 95% CI [0.54, 0.89]), and all-cause readmissions (0.72, 95% CI [0.60, 0.87]). However, the difference in effect size between recruitment setting and involvement of primary care was not significant in a meta-regression analysis. Multidisciplinary HF DMPs that recruit in the community have no significant effect on mortality or hospital readmissions, unlike DMPs that recruit in the hospital, although the difference in effect size was not significant in a meta-regression analysis. Only six multidisciplinary studies involved primary care professionals. Given demographic evolutions and the importance of integrated home-based care for patients with HF, future multidisciplinary HF DMPs should consider integrating primary care professionals and evaluating the effectiveness of this model.

Using touchscreen tablets to support social connections and reduce responsive behaviours among people with dementia in care settings: A scoping review

The use of touchscreen tablets, such as the iPad, offers potential to support the person with dementia staying in a care setting, ranging from a long-term care home to an adult day programme. Although electronic devices are used among people with dementia, a comprehensive review of studies focusing on their impact and how they may be used effectively in care settings is lacking. We conducted a scoping review to summarize existing knowledge about the impact of touchscreen tablets in supporting social connections and reducing responsive behaviours of people with dementia in care settings. Our research team consists of patient partners and family partners, physicians, nurses, a medical student and an academic professor. A total of 17 articles were included in the review. Our analysis identified three ways in which touchscreen tablets support dementia care: (1) increased the person’s engagement, (2) decreased responsive behaviours and (3) positive effect on enjoyment/quality of life for people with dementia. Lessons learned and barriers to the use of touchscreen tablets in the care of people with dementia are described. Overall, only a few studies delineated strategies that helped to overcome barriers to technology adoption in care settings. Knowledge translation studies are needed to identify effective processes and practical tips to overcome barriers and realize the potential of assistive technology in dementia care.

Differences in Caregiver Reports of the Quality of Hospice Care Across Settings

OBJECTIVES

To examine variation in reported experiences with hospice care by setting.

DESIGN

Consumer Assessment of Healthcare Providers and Systems Hospice (CAHPS®) Survey data from 2016 were analyzed. Multivariate linear regression analysis was used to examine differences in measure scores by setting of care (home, nursing home [NH], hospital, freestanding hospice inpatient unit [IPU], and assisted living facility [ALF]).

SETTING

A total of 2636 US hospices.

PARTICIPANTS

A total of 311 635 primary caregivers of patients who died in hospice.

MEASUREMENTS

Outcomes were seven hospice quality measures, including five composite measures that assess aspects of hospice care important to patients and families, including hospice team communication, timeliness of care, treating family member with respect, symptom management, and emotional and spiritual support, and two global measures of the overall rating of the hospice and willingness to recommend it to friends and family. Analyses were adjusted for mode of survey administration and differences in case-mix between hospices.

RESULTS

Caregivers of decedents who received hospice care in a NH reported significantly worse experiences than caregivers of those in the home for all measures. ALF scores were also significantly lower than home for all measures, except providing emotional and spiritual support. Differences in NH and ALF settings compared to home were particularly large for hospice team communication (ranging from -11 to -12 on a 0-100 scale) and getting help for symptoms (ranging from -7 to -10). Consistently across all care settings, hospice team communication, treating family member with respect, and providing emotional and spiritual support were most strongly associated with overall rating of care.

CONCLUSIONS

Important opportunities exist to improve quality of hospice care in NHs and ALFs. Quality improvement and regulatory interventions targeting the NH and ALF settings are needed to ensure that all hospice decedents and their family receive high-quality, patient- and family-centered hospice care. J Am Geriatr Soc 68:1218-1225, 2020.

The use of finger foods in care settings: an integrative review

BACKGROUND

Reduced food intake is prevalent in people in residential and hospital care settings. Little is known about the use of finger foods (i.e. foods eaten without cutlery) with respect to increasing feeding independence and food intake. The Social Care Institute for Excellence (Malnutrition Task Force: State of the Nation, 2017) recommends the use of finger foods to enable mealtime independence and to prevent loss of dignity and embarrassment when eating in front of others. The aim of this review is to identify and evaluate the existing literature regarding the use and effectiveness of finger foods among adults in health and social care settings.

METHODS

An integrative review methodology was used. A systematic search of electronic databases for published empirical research was undertaken in October 2018. Following screening of titles and abstracts, the full texts of publications, which investigated outcomes associated with the provision of finger foods in adult care settings, were retrieved and assessed for inclusion. Two independent investigators conducted data extraction and quality assessment using Critical Appraisal Skills Programme checklists. Thematic analysis was used to summarise the findings.

RESULTS

Six studies met the inclusion criteria. Four themes were identified: Finger food menu implementation; Importance of a team approach; Effect on nutrition; and Influence on wellbeing. Study designs were poorly reported, with small sample sizes.

CONCLUSIONS

There is some evidence that the provision of finger foods may positively affect patient outcomes in long-term care settings. There is a paucity of research evaluating the use of a finger food menu in acute care settings, including economic evaluation. Future high quality trials are required.

Use of touch screen tablets to support social connections and reduce responsive behaviours among people with dementia in care settings: a scoping review protocol

INTRODUCTION

The disabilities associated with dementia make the adjustment to staying in a care setting stressful. Separation from family can exacerbate the effects of stress. The use of touch screen tablets such as an iPad may offer potential to support the person with dementia staying in a care setting. Although electronic devices are used among people with dementia for a variety of purposes, a comprehensive review of studies focusing on their impact in care settings for social connection and patient/resident behaviour is lacking. This scoping review will focus on the use of touch screen tablets to support social connections and reducing responsive behaviours of people with dementia while in a care setting, such as a hospital ward.

METHODS AND ANALYSIS

This scoping review will follow Joanna Briggs Institute scoping review methodology. The review team consists of two patient partners and three family partners, a nurse researcher, a research assistant and an academic professor. All authors including patient and family partners were involved in preparing this scoping review protocol. In the scoping review, we will search the following databases: MEDLINE, AgeLine, Cochrane, CINAHL, PsycINFO and IEEE. Google and Google Scholar will be used to search for additional literature. A hand search will be conducted using the reference lists of included studies to identify additional relevant articles. Included studies must report on the impact of using a touch screen technology intervention that involves older adults with dementia in care settings, published in English since 2009.

ETHICS AND DISSEMINATION

This review study does not require ethics approval. By examining the current state of using touch screen tablets to support older people with dementia in care settings, this scoping review can offer useful insight into users' needs (eg, patients' and care providers' needs) and inform future research and practice. We will share the scoping review results through conference presentations and an open access publication in a peer-reviewed journal.

Care Settings and Clinical Characteristics of Older Adults with Moderately Severe Dementia

OBJECTIVES

Little population-level evidence exists to guide the development of interventions for people with dementia in non-nursing home settings. We hypothesized people living at home with moderately severe dementia would differ in social, functional, and medical characteristics from those in either residential care or nursing home settings.

DESIGN

Retrospective cohort study using pooled data from the National Health and Aging Trends Study, an annual survey of a nationally representative sample of Medicare beneficiaries.

SETTING

US national sample.

PARTICIPANTS

Respondents newly meeting criteria for incident moderately severe dementia, defined as probable dementia with functional impairment: 728 older adults met our definition between 2012 and 2016.

MEASUREMENTS

Social characteristics examined included age, sex, race/ethnicity, country of origin, income, educational attainment, partnership status, and household size. Functional characteristics included help with daily activities, falls, mobility device use, and limitation to home or bed. Medical characteristics included comorbid conditions, self-rated health, hospital stay, symptoms, and dementia behaviors.

RESULTS

Extrapolated to the population, an estimated 3.3 million older adults developed incident moderately severe dementia between 2012 and 2016. Within this cohort, 64% received care at home, 19% in residential care, and 17% in a nursing facility. social, functional, and medical characteristics differed across care settings. Older adults living at home were 2 to 5 times more likely to be members of disadvantaged populations and had more medical needs: 71% reported bothersome pain compared with 60% in residential care or 59% in nursing homes.

CONCLUSION

Over a 5-year period, 2.1 million people lived at home with incident moderately severe dementia. People living at home had a higher prevalence of demographic characteristics associated with systematic patterns of disadvantage, more social support, less functional impairment, worse health, and more symptoms compared with people living in residential care or nursing facilities. This novel study provides insight into setting-specific differences among people with dementia. J Am Geriatr Soc 67:1907-1912, 2019.

"If walls could talk": A photo-elicitation-based observation of service users' perceptions of the care setting and of its influence on the therapeutic alliance in addiction treatment

A good quality therapeutic alliance is central to the support and treatment of people who use psychoactive substances. Although previous research has suggested that place has an important role in sustaining the therapeutic alliance, this issue has been insufficiently explored in the field of addiction treatment. We conducted a qualitative study using photo-elicitation and interviewing service users in an outpatient addiction treatment centre. They reported both strongly positive and negative perceptions of the place, alongside an unstable therapeutic alliance. Apprehending the place in which care is delivered as a dynamic relational network helps to understand the role of place in shaping the therapeutic alliance in addiction treatment. There is a need for careful design and layout, and thoughtful organisation of these places.

The Where is Norovirus Control Lost (WINCL) Study: an enhanced surveillance project to identify norovirus index cases in care settings in the UK and Ireland

BACKGROUND

Norovirus outbreaks have a significant impact on all care settings; little is known about the index cases from whom these outbreaks initiate.

AIM

To identify and categorise norovirus outbreak index cases in care settings.

METHODS

A mixed-methods, multi-centre, prospective, enhanced surveillance study identified and categorised index cases in acute and non-acute care settings.

RESULTS

From 54 participating centres, 537 outbreaks were reported (November 2013 to April 2014): 383 (71.3%) in acute care facilities (ACF); 115 (21.4%) in residential or care homes (RCH) and 39 (7.3%) in other care settings (OCS). Index cases were identified in 424 (79%) outbreaks. Of the 245 index cases who were asymptomatic on admission and not transferred within/into the care setting, 123 (50%) had been an inpatient/resident for 4 days. Four themes emerged: missing the diagnosis, care service under pressure, delay in outbreak control measures and patient/resident location and proximity.

CONCLUSION

The true index case is commonly not identified as the cause of a norovirus outbreak with at least 50% of index cases being misclassified. Unrecognised norovirus cross-transmission occurs frequently suggesting that either Standard Infection Control Precautions (SICPs) are being insufficiently well applied, and or SICPs are themselves are insufficient to prevent outbreaks.

The main cost drivers in dementia: a systematic review

OBJECTIVES

Because of the increasing prevalence of dementia worldwide, combined with limited healthcare expenditures, a better understanding of the main cost drivers of dementia in different care settings is needed.

METHODS

A systematic review of cost-of-illness (COI) studies in dementia was conducted from 2003 to 2012, searching the following databases: PubMed (Medline), Cochrane Library, ScienceDirect (Embase) and National Health Service Economic Evaluations Database. Costs (per patient) by care setting were analyzed for total, direct, indirect and informal costs and related to the following: (1) cost perspective and (2) disease severity.

RESULTS

In total, 27 studies from 14 different healthcare systems were evaluated. In the included studies, total annual costs for dementia of up to $70,911 per patient (mixed setting) were estimated (average estimate of total costs = $30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are informal costs due to home based long term care and nursing home expenditures rather than direct medical costs (inpatient and outpatient services, medication).

CONCLUSIONS

The results of this review highlight the significant economic burden of dementia for patients, families and healthcare systems and thus are important for future health policy planning. The significant variation of cost estimates for different care settings underlines the need to understand and address the financial burden of dementia from both perspectives. For health policy planning in dementia, future COI studies should follow a quality standard protocol with clearly defined cost components and separate estimates by care setting and disease severity.

Most appropriate placement for people with dementia: individual experts' vs. expert groups' decisions in eight European countries

AIMS

To investigate the extent of variability in individuals' and multidisciplinary groups' decisions about the most appropriate setting in which to support people with dementia in different European countries.

BACKGROUND

Professionals' views of appropriate care depend on care systems, cultural background and professional discipline. It is not known to what extent decisions made by individual experts and multidisciplinary groups coincide.

DESIGN

A modified nominal group approach was employed in eight countries (Estonia, Finland, France, Germany, the Netherlands, Spain, Sweden and the UK) as part of the RightTimePlaceCare Project.

METHODS

Detailed vignettes about 14 typical case types of people with dementia were presented to experts in dementia care (n = 161) during November and December 2012. First, experts recorded their personal judgements about the most appropriate settings (home care, assisted living, care home, nursing home) in which to support each of the depicted individuals. Second, participants worked in small groups to reach joint decisions for the same vignettes.

RESULTS

Considerable variation was seen in individuals' recommendations for more than half the case types. Cognitive impairment, functional dependency, living situation and caregiver burden did not differentiate between case types generating high and low degrees of consensus. Group-based decisions were more consistent, but country-specific patterns remained.

CONCLUSIONS

A multidisciplinary approach would standardize the decisions made about the care needed by people with dementia on the cusp of care home admission. The results suggest that certain individuals could be appropriately diverted from care home entry if suitable community services were available.