-
Journal of Alzheimer's Disease : JAD 2022Effective therapeutics for Alzheimer's disease are needed. However, previous clinical trials have pre-determined a single treatment modality, such as a drug candidate or... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Effective therapeutics for Alzheimer's disease are needed. However, previous clinical trials have pre-determined a single treatment modality, such as a drug candidate or therapeutic procedure, which may be unrelated to the primary drivers of the neurodegenerative process. Therefore, increasing data set size to include the potential contributors to cognitive decline for each patient, and addressing the identified potential contributors, may represent a more effective strategy.
OBJECTIVE
To determine whether a precision medicine approach to Alzheimer's disease and mild cognitive impairment is effective enough in a proof-of-concept trial to warrant a larger, randomized, controlled clinical trial.
METHODS
Twenty-five patients with dementia or mild cognitive impairment, with Montreal Cognitive Assessment (MoCA) scores of 19 or higher, were evaluated for markers of inflammation, chronic infection, dysbiosis, insulin resistance, protein glycation, vascular disease, nocturnal hypoxemia, hormone insufficiency or dysregulation, nutrient deficiency, toxin or toxicant exposure, and other biochemical parameters associated with cognitive decline. Brain magnetic resonance imaging with volumetrics was performed at baseline and study conclusion. Patients were treated for nine months with a personalized, precision medicine protocol, and cognition was assessed at t = 0, 3, 6, and 9 months.
RESULTS
All outcome measures revealed improvement: statistically significant improvement in MoCA scores, CNS Vital Signs Neurocognitive Index, and Alzheimer's Questionnaire Change score were documented. No serious adverse events were recorded. MRI volumetrics also improved.
CONCLUSION
Based on the cognitive improvements observed in this study, a larger, randomized, controlled trial of the precision medicine therapeutic approach described herein is warranted.
Topics: Alzheimer Disease; Cognition; Cognitive Dysfunction; Humans; Pilot Projects; Precision Medicine
PubMed: 35811518
DOI: 10.3233/JAD-215707 -
Nursing Open Jan 2020A benchmark of 4 has been determined for the reduction of self-reported stress by nursing students' status post 5 weeks of holistic educational activities and...
AIM
A benchmark of 4 has been determined for the reduction of self-reported stress by nursing students' status post 5 weeks of holistic educational activities and interventions provided by a nurse educator.
DESIGN
Provision 5 in the American Nurses Association Code of Ethics for Nurses with Interpretive Statements emphasizes the duty of the nurse to not only promote the health and safety of others, but to self as well (ANA, 2015, Code of ethics with interpretive statements, http://Nursebooks.org). A self-care for nurses' pilot project was trialled with 25 accelerated nursing students over the course of 5 weeks. Holistic education programmes were facilitated by a nurse educator uninvolved in providing clinical or classroom education to the students.
METHODS
The Standards for Quality Improvement Reporting Excellence (SQUIRE) guidelines are used in this pilot project as a framework to explore standardization of education of nursing students about self-care in nursing programmes and to promote positive health behaviours and student nurses' insight into how nurses' self-care can have an impact on patient outcomes. The self-care pilot project introduced the importance of self-care for the pre-licensure nursing student by teaching healthy eating, physical exercise, the value of sleep, use of positive affirmations and aromatherapy to a cohort of accelerated nursing students over the course of 5 weeks. The Star Model of Knowledge Transformation was the theoretical framework for the pilot study. Two questionnaires were used by the principal investigator to obtain participant data, the Project Participant Questionnaire and the Final-Year Group Questionnaire.
RESULTS
On completion of the self-care for nurses' pilot, the nursing students reported a reduction in stress and an increased ability to cope with stress after exposure to different holistic stress reduction strategies. An average benchmark of 4.36 was achieved indicating that the nursing students' self-care had improved status post the interactive teaching intervention.Self-care taught to pre-licensure nursing students by nurse educators can enhance their self-awareness of the importance of stress reduction and care of themselves while enduring the academic rigour and simultaneous clinical practicum experiences in nursing programmes.Applying self-care behaviours to reduction of stress for nursing students may be of benefit to of students as they transition from the pre-licensure to graduate nurse roles. Hence, teaching health behaviours that are self-protective and contribute to maintaining safe clinical environments for nurses and the patients in their care.
Topics: Faculty, Nursing; Humans; Pilot Projects; Self Care; Students, Nursing
PubMed: 31871706
DOI: 10.1002/nop2.384 -
Canadian Journal of Surgery. Journal... 2022Given Canada's geographically dispersed population, initial trauma care may occur at rural sites that may not manage patients with trauma frequently; thus, telementoring...
BACKGROUND
Given Canada's geographically dispersed population, initial trauma care may occur at rural sites that may not manage patients with trauma frequently; thus, telementoring can play a life-saving role. In this article, we describe a rural trauma telementoring pilot program in British Columbia and report the results of an evaluation of its strengths and weaknesses.
METHODS
Trauma surgeons from a quaternary trauma centre in Vancouver helped facilitate 3 in situ trauma simulation sessions at a rural BC hospital between fall 2019 and summer 2020. The sessions involved 4 physician participants (a trauma surgeon telementor, a family physician with additional expertise in emergency medicine acting as trauma team leader, a family physician with additional expertise in anesthesia and a family physician with Enhanced Surgical Skills), an emergency department nurse, 2 operating room/trauma team nurses, and laboratory and radiology technicians. The sessions involved simulated damage-control procedures and lasted about 2 hours. The participants completed surveys assessing comfort and confidence regarding aspects of trauma care and use of the telehealth unit before and after each session, and the facilitators assessed team dynamics using the Modified Non-Technical Skills for Trauma (T-NOTECHS) tool. Focus groups were held to gather qualitative data, and costs were tracked.
RESULTS
The average presimulation confidence survey score was 19.6/30, and the average postsimulation score was 24.0/30. The mean score improved significantly after both the first and second sessions ( = 0.01 and = 0.004, respectively). Across the 3 sessions, the average T-NOTECHS score improved significantly, from 18.5/25 to 21.5/25 ( = 0.02). Qualitative analysis identified 3 dominant themes: telementoring increased provider confidence, telementoring increased order to the resuscitation procedure and the technical aspects of telementorship. The telementoring program was well received by all participants.
CONCLUSION
A significant improvement was seen across simulations in physician confidence and trauma team dynamics with telementorship support. Telementoring in trauma may provide a way to lessen the difference between rural and urban patient outcomes within Canada's geographically dispersed population, although further work investigating the impact of its use in real-life patients, as well as barriers to its implementation, is required.
Topics: Humans; Pilot Projects; Resuscitation; Emergency Medicine; Rural Population; Telemedicine
PubMed: 36302133
DOI: 10.1503/cjs.015020 -
Zeitschrift Fur Gerontologie Und... May 2022With the growing number of older and old patients as well as patients affected by multimorbidity, cognitive impairments and frailty in hospital and expansion of... (Review)
Review
BACKGROUND
With the growing number of older and old patients as well as patients affected by multimorbidity, cognitive impairments and frailty in hospital and expansion of long-term care, the challenges in the various geriatric and gerontological care settings are also increasing. Social networks and resources become fragile due to the changing family structures. A strong interprofessional team building and networking of the main actors in the nursing and healthcare systems become necessary.
OBJECTIVE
A qualification program for students of medicine, social work and relevant study courses for nursing was established. In this program participants should collectively learn to deal with the concerns and needs of geriatric patients in a case-related manner and to develop suitable plans for treatment and interventions.
METHOD
The qualification program for interprofessional team building was evaluated during the development phase as a pilot project and scientifically evaluated (n = 78) using the Freiburg questionnaire on interprofessional learning evaluation (FILE).
RESULTS
The program experienced a high level of approval by approximately 98% of the participants. The measurement of change showed an improvement in team skills and ability to work in a team.
CONCLUSION
Opening up a learning field for interprofessional learning and working to students of different disciplines and professions during their studies creates a good basis for successful interprofessional team building in the subsequent professional practice. The interuniversity and interprofessional teaching project presented is now firmly anchored in the curriculum at the participating universities with the teaching module "The geriatric patient". It is therefore a possible model for similar projects.
Topics: Aged; Curriculum; Delivery of Health Care; Geriatrics; Humans; Learning; Patient Care Team; Pilot Projects
PubMed: 35092455
DOI: 10.1007/s00391-022-02021-x -
The Journal of Nursing Education Sep 2023
Topics: Humans; Pilot Projects
PubMed: 37672495
DOI: 10.3928/01484834-20230712-03 -
Menopause (New York, N.Y.) Mar 2021Despite increasing representation of older women in US jail and prison facilities, their menopause experiences and access to related care remain uncharacterized. Our...
OBJECTIVE
Despite increasing representation of older women in US jail and prison facilities, their menopause experiences and access to related care remain uncharacterized. Our objective is to explore the menopause experiences of women incarcerated in jail and prison facilities.
METHODS
We conducted a pilot study of four semi-structured in-depth interviews with women in the community who experienced menopause symptoms while incarcerated in either a prison or jail facility.
RESULTS
Preliminary findings suggest critical gaps in access to menopause-related resources and medical care. Participants described that lifestyle and medical interventions for menopause in prison were inaccessible, and that untreated symptoms contributed to significant distress. Participants reported feeling as though medical staff did not believe their concerns and were dismissive of their complaints. In some cases, menopause symptoms and symptom management exacerbated the ways in which institutional barriers reproduce criminalization within the carceral system.
CONCLUSIONS
Individuals going through the menopause transition while experiencing incarceration have significant unmet needs and poor access to relieving lifestyle changes or medical interventions. Policy and practice changes should address menopause-related needs of individuals experiencing incarceration.
Topics: Aged; Correctional Facilities; Female; Humans; Menopause; Pilot Projects
PubMed: 33739317
DOI: 10.1097/GME.0000000000001762 -
International Journal of Environmental... Sep 2022This manuscript offers findings from a pilot project which prepares nursing students for embodied professional practice through the lens of ethics. Four undergraduate...
This manuscript offers findings from a pilot project which prepares nursing students for embodied professional practice through the lens of ethics. Four undergraduate nursing students were mentored by two nursing faculty in the Dundon-Berchtold Institute Faculty Fellowship Program in the Application of Ethics through an exploration on the ethics of embodiment using an arts pedagogy across one academic year. Inspired by the intersection of nature and health, this project explores the impact of an arts-integrated pedagogy on the human body. The findings from this project provide a natural first step for nursing students to consider multiple interpretations of the human body and to facilitate the students' development of an embodied ethical practice that is perceptive, empathic, and attuned to themselves as natural beings as well as diverse individuals and populations. The findings from this pilot project presents a pivotal opportunity to guide future nursing curricular development toward holistic, nature-inspired, and mindful-based interventions in order to increase resilience, decrease risk factors of compassion fatigue and burnout, and support nursing students to develop strength-based skills to use in their professional nursing practice.
Topics: Education, Nursing, Baccalaureate; Faculty, Nursing; Human Body; Humans; Pilot Projects; Students, Nursing
PubMed: 36141876
DOI: 10.3390/ijerph191811603 -
European Journal of Surgical Oncology :... Sep 2023Multidisciplinary and multi-professional collaboration is vital in providing better outcomes for patients The aim of the INTERACT-EUROPE Project (Wide Ranging... (Review)
Review
INTRODUCTION
Multidisciplinary and multi-professional collaboration is vital in providing better outcomes for patients The aim of the INTERACT-EUROPE Project (Wide Ranging Cooperation and Cutting Edge Innovation As A Response To Cancer Training Needs) was to develop an inter-specialty curriculum. A pilot project will enable a pioneer cohort to acquire a sample of the competencies needed.
METHODS
A scoping review, qualitative and quantitative surveys were undertaken. The quantitative survey results are reported here. Respondents, including members of education boards, curriculum committees, trainee committees of European specialist societies and the ECO Patient Advisory Committee, were asked to score 127 proposed competencies on a 7-point Likert scale as to their value in achieving the aims of the curriculum. Results were discussed and competencies developed at two stakeholder meetings. A consultative document, shared with stakeholders and available online, requested views regarding the other components of the curriculum.
RESULTS
Eleven competencies were revised, three omitted and three added. The competencies were organised according to the CanMEDS framework with 13 Entrustable Professional Activities, 23 competencies and 127 enabling competencies covering all roles in the framework. Recommendations regarding the infrastructure, organisational aspects, eligibility of trainees and training centres, programme contents, assessment and evaluation were developed using the replies to the consultative document.
CONCLUSIONS
An Inter-specialty Cancer Training Programme Curriculum and a pilot programme with virtual and face-to-face components have been developed with the aim of improving the care of people affected by cancer.
Topics: Humans; Pilot Projects; Clinical Competence; Curriculum; Europe; Neoplasms
PubMed: 37556988
DOI: 10.1016/j.ejso.2023.106989 -
Clinical Pharmacology and Therapeutics Jan 2020Pharmacogenomics (PGx) decision support and return of results is an active area of precision medicine. One challenge of implementing PGx is extracting genomic variants...
Pharmacogenomics (PGx) decision support and return of results is an active area of precision medicine. One challenge of implementing PGx is extracting genomic variants and assigning haplotypes in order to apply prescribing recommendations and information from the Clinical Pharmacogenetics Implementation Consortium (CPIC), the US Food and Drug Administration (FDA), the Pharmacogenomics Knowledgebase (PharmGKB), etc. Pharmacogenomics Clinical Annotation Tool (PharmCAT) (i) extracts variants specified in guidelines from a genetic data set derived from sequencing or genotyping technologies, (ii) infers haplotypes and diplotypes, and (iii) generates a report containing genotype/diplotype-based annotations and guideline recommendations. We describe PharmCAT and a pilot validation project comparing results for 1000 Genomes Project sequences of Coriell samples with corresponding Genetic Testing Reference Materials Coordination Program (GeT-RM) sample characterization. PharmCAT was highly concordant with the GeT-RM data. PharmCAT is available in GitHub to evaluate, test, and report results back to the community. As precision medicine becomes more prevalent, our ability to consistently, accurately, and clearly define and report PGx annotations and prescribing recommendations is critical.
Topics: Decision Support Techniques; Genomics; Genotype; Genotyping Techniques; Humans; Pharmacogenetics; Pilot Projects; Precision Medicine
PubMed: 31306493
DOI: 10.1002/cpt.1568 -
Public Health Nursing (Boston, Mass.) Jan 2021A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
OBJECTIVE
A program evaluation to demonstrate the feasibility of a recuperative care pilot project to address the needs of unhoused individuals.
DESIGN
The study is a descriptive postprogram evaluation.
SAMPLE
A total of 73 referrals were made to the project with 23 admissions.
MEASURE
Data regarding number and type of referrals for admission, cost of respite care per guest and per day, hospital costs avoided, referrals to community services, and discharge destination were collected.
INTERVENTION
A case management care model was used. The project staff included a public health nurse and an outreach worker.
RESULTS
One local hospital accounted for 65% of all admissions. Admitting diagnoses were abscess/wound care (44%) followed by postsurgery recovery (17%). Housing resources (65%) was a common referral with 22% of guests discharged to stable housing. Actual length of stay exceeded the planned length by an average of 24 days. Total cost per guest per day was $157.45 which is an estimated savings to referring acute care facilities of between $18,000 and $48,000 per day.
CONCLUSIONS
The project demonstrated an ability to provide unhoused individuals a place to recuperate following hospitalization in a cost-effective manner. Challenges and recommendations of the program going forward were identified.
Topics: Aftercare; Cost-Benefit Analysis; Humans; Pilot Projects; Program Evaluation
PubMed: 33190328
DOI: 10.1111/phn.12834