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Trials May 2024Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not...
BACKGROUND
Elder abuse often goes unreported and undetected. Older people may be ashamed, fearful, or otherwise reticent to disclose abuse, and many health providers are not confident in asking about it. In the No More Shame study, we will evaluate a co-designed, multi-component intervention that aims to improve health providers' recognition, response, and referral of elder abuse.
METHODS
This is a single-blinded, pragmatic, cluster randomised controlled trial. Ten subacute hospital sites (i.e. clusters) across Australia will be allocated 1:1, stratified by state to a multi-component intervention comprising a training programme for health providers, implementation of a screening tool and use of site champions, or no additional training or support. Outcomes will be collected at baseline, 4 and 9 months. Our co-primary outcomes are change in health providers' knowledge of responding to elder abuse and older people's sense of safety and quality of life. We will include all inpatients at participating sites, aged 65 + (or aged 50 + if Aboriginal or Torres Strait Islander), who are able to provide informed consent and all unit staff who provide direct care to older people; a sample size of at least 92 health providers and 612 older people will provide sufficient power for primary analyses.
DISCUSSION
This will be one of the first trials in the world to evaluate a multi-component elder abuse intervention. If successful, it will provide the most robust evidence base to date for health providers to draw on to create a safe environment for reporting, response, and referral.
TRIAL REGISTRATION
ANZCTR, ACTRN12623000676617p . Registered 22 June 2023.
Topics: Humans; Elder Abuse; Aged; Single-Blind Method; Health Personnel; Pragmatic Clinical Trials as Topic; Australia; Multicenter Studies as Topic; Health Knowledge, Attitudes, Practice; Quality of Life; Inservice Training; Time Factors; Middle Aged; Attitude of Health Personnel
PubMed: 38778386
DOI: 10.1186/s13063-024-08160-3 -
NEJM Evidence Apr 2024AbstractIntestinal ischemia can result from various pathologic conditions. The presentations of ischemia can range from acute to subacute and mild to severe. Diagnosis... (Review)
Review
AbstractIntestinal ischemia can result from various pathologic conditions. The presentations of ischemia can range from acute to subacute and mild to severe. Diagnosis of this condition may pose challenges, particularly in the early, potentially salvageable, stages of disease. This review offers an evidence-based approach to understanding the diagnosis and management of inadequate intestinal perfusion.
Topics: Humans; Ischemia; Intestines
PubMed: 38776634
DOI: 10.1056/EVIDra2400057 -
Journal of Neurologic Physical Therapy... Jul 2024Rehabilitation professionals use subjective and objective outcome measures to assess stroke-related impact and impairment. Understanding if subjective and objective...
BACKGROUND AND PURPOSE
Rehabilitation professionals use subjective and objective outcome measures to assess stroke-related impact and impairment. Understanding if subjective and objective findings correlate among stroke survivors, especially if these associations differ between females and males, can inform care decisions.
METHODS
A retrospective cross-sectional design was used, with data selected from subacute to chronic stroke survivors on age, time since stroke, the hand domain from the Stroke Impact Scale version 3.0 (SIS-H), and the Fugl-Meyer Upper Extremity (FMUE) Assessment. Group differences were assessed for all outcomes based on sex and time poststroke. Separate correlations for females and males were performed between the subjective (SIS-H) and objective measures (FMUE) of upper limb function and impairment.
RESULTS
Data from 148 participants (44 females) were included in this study. SIS-H was significantly correlated with FMUE in both females and males ( P s ≤ 0.001). No significant differences were found between the groups' mean SIS-H or FMUE scores based on sex or time poststroke.
DISCUSSION AND CONCLUSIONS
Subjective and objective measures of physical functioning were correlated in both females and males. Although we found no sex differences in our primary outcomes, the sample size of females was disproportionately lower than the males. This is consistent with an ongoing problem in the stroke recovery research field, where females are often underrepresented and understudied, and where females who experience higher levels of impairment are less likely to participate in research.
Topics: Humans; Male; Female; Upper Extremity; Cross-Sectional Studies; Middle Aged; Aged; Retrospective Studies; Stroke; Sex Factors; Stroke Rehabilitation; Disability Evaluation; Survivors; Adult; Aged, 80 and over; Sex Characteristics
PubMed: 38768068
DOI: 10.1097/NPT.0000000000000481 -
European Archives of... May 2024The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for...
INTRODUCTION
The Video Head Impulse Test (vHIT) is a safe and reliable assessment of peripheral vestibular function. Many studies tested its accuracy in clinical settings for differential diagnosis and quantification of the vestibulo-oculomotor reflex (VOR) in various disorders. However, the results of its application after lesions of the CNS are discordant and have never been studied in rehabilitation. This study aims to assess the VOR performance in a sample of stroke survivors.
METHODS
This is a cross-sectional study on 36 subacute and chronic stroke survivors; only persons with first-ever stroke and able to walk independently, even with supervision, were included. We performed VOR assessments for each semicircular canal by vHIT and balance assessments by the Berg Balance Scale and the MiniBESTest scale.
RESULTS
Two hundred and sixteen semicircular canals were assessed using the Head Impulse paradigm (in both the vertical and horizontal planes), while 72 semicircular canals were assessed using the Suppressed Head Impulse paradigm (horizontal plane). There was a high prevalence of participants with dysfunctional canals, particularly for the left anterior and right posterior canals, which were each prevalent in more than one-third of our sample. Furthermore, 16 persons showed an isolated canal dysfunction. The mean VOR gain for the vertical canals had confidence intervals out of the normal values (0.74-0.91 right anterior; 0.74-0.82 right posterior; 0.73-0.87 left anterior).
CONCLUSION
Our findings suggest that peripheral vestibular function may be impaired in people with stroke; a systematic assessment in a rehabilitation setting could allow a more personalized and patient-centred approach.
PubMed: 38758244
DOI: 10.1007/s00405-024-08721-x -
The Journal of Head Trauma... May 2024Identification of biomarkers of cognitive recovery after traumatic brain injury (TBI) will inform care and improve outcomes. This study assessed the utility of...
Temporal Profile of Serum Neurofilament Light (NF-L) and Heavy (pNF-H) Level Associations With 6-Month Cognitive Performance in Patients With Moderate-Severe Traumatic Brain Injury.
OBJECTIVE
Identification of biomarkers of cognitive recovery after traumatic brain injury (TBI) will inform care and improve outcomes. This study assessed the utility of neurofilament (NF-L and pNF-H), a marker of neuronal injury, informing cognitive performance following moderate-to-severe TBI (msTBI).
SETTING
Level 1 trauma center and outpatient via postdischarge follow-up.
PARTICIPANTS
N = 94. Inclusion criteria: Glasgow Coma Scale score less than 13 or 13-15 with clinical evidence of moderate-to-severe injury traumatic brain injury on clinical imaging. Exclusion criteria: neurodegenerative condition, brain death within 3 days after injury.
DESIGN
Prospective observational study. Blood samples were collected at several time points post-injury. Cognitive testing was completed at 6 months post-injury.
MAIN MEASURES
Serum NF-L (Human Neurology 4-Plex B) pNF-H (SR-X) as measured by SIMOA Quanterix assay. Divided into 3 categorical time points at days post-injury (DPI): 0-15 DPI, 16-90 DPI, and >90 DPI. Cognitive composite comprised executive functioning measures derived from 3 standardized neuropsychological tests (eg, Delis-Kaplan Executive Function System: Verbal Fluency, California Verbal Learning Test, Second Edition, Wechsler Adult Intelligence Scale, Third Edition).
RESULTS
pNF-H at 16-90 DPI was associated with cognitive outcomes including a cognitive-executive composite score at 6 months (β = -.430, t34 = -3.190, P = .003).
CONCLUSIONS
Results suggest that "subacute" elevation of serum pNF-H levels may be associated with protracted/poor cognitive recovery from msTBI and may be a target for intervention. Interpretation is limited by small sample size and including only those who were able to complete cognitive testing.
PubMed: 38758056
DOI: 10.1097/HTR.0000000000000932 -
Journal of the American Medical... Jul 2024The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of...
OBJECTIVES
The epidemiology of medication discrepancies during transitions from post-acute care (PAC) to home is poorly described. We sought to describe the frequency and types of medication discrepancies among hospitalized older adults transitioning from PAC to home.
DESIGN
A nested cohort analysis.
SETTING AND PARTICIPANTS
Included participants enrolled in a patient-centered deprescribing trial, for patients (aged ≥50 years and taking at least 5 medications) transitioning from one of 22 PACs to home.
METHODS
We assessed demographic and medication measures at the initial hospitalization. The primary outcome measure was medication discrepancies, with the PAC discharge list serving as reference for comparison to the participant's self-reported medication list at 7 days following PAC discharge. Discrepancies were categorized as additions, omissions, and dose discrepancies and were organized by common medication classes and risk of harm (eg, 2015 Beers Criteria). Ordinal logistic regression assessed for patient risk factors for PAC discharge discrepancy count.
RESULTS
A total of 184 participants had 7-day PAC discharge medication data. Participants were predominately female (67%) and Caucasian (83%) with a median of 16 prehospital medications [interquartile range (IQR) 11, 20]. At the 7-day follow-up, 98% of participants had at least 1 medication discrepancy, with a median number of 7 medication discrepancies (IQR 4, 10) per person, 4 (IQR 2, 6) of which were potentially inappropriate medications as defined by the Beers Criteria. Higher medication discrepancies at index hospital admission and receipt of caregiver assistance with medications were 2 key predictors of medication discrepancies in the week after PAC discharge to home.
CONCLUSIONS AND IMPLICATIONS
Older patients transitioning home from a PAC facility are at high risk for medication discrepancies. This study underscores the need for interventions targeted at this overlooked transition period, especially as patients resume responsibility for managing their own medications after both a hospital and PAC stay.
Topics: Humans; Female; Male; Aged; Patient Discharge; Subacute Care; Middle Aged; Aged, 80 and over; Medication Reconciliation; Cohort Studies; Medication Errors; Home Care Services; Hospitalization
PubMed: 38754476
DOI: 10.1016/j.jamda.2024.105017 -
Journal of Rehabilitation Medicine May 2024To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury.
OBJECTIVES
To explore current hospital practice in relation to the assessment of vision problems in patients with acquired brain injury.
DESIGN
A survey study.
SUBJECTS
A total of 143 respondents from hospital settings, with background in occupational therapy and physical therapy, participated in the survey.
METHODS
The survey questionnaire, developed collaboratively by Danish and Norwegian research groups, encompassed 22 items categorically covering "Background information", "Clinical experience and current practice", "Vision assessment tools and protocols", and "Assessment barriers". It was sent out online, to 29 different hospital departments and 18 separate units for occupational therapists and physiotherapists treating patients with acquired brain injury.
RESULTS
Most respondents worked in acute or subacute hospital settings. Few departments had an interdisciplinary vision team, and very few therapists had formal education in visual problems after acquired brain injury. Visual assessment practices varied, and there was limited use of standardized tests. Barriers to identifying visual problems included patient-related challenges, knowledge gaps, and resource limitations.
CONCLUSION
The study emphasized the need for enhanced interdisciplinary collaboration, formal education, and standardized assessments to address visual problems after acquired brain injury. Overcoming these challenges may improve identification and management, ultimately contributing to better patient care and outcomes in the future.
Topics: Humans; Denmark; Vision Disorders; Brain Injuries; Surveys and Questionnaires; Occupational Therapy; Hospitals
PubMed: 38742932
DOI: 10.2340/jrm.v56.28793 -
Disability and Rehabilitation May 2024To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health...
Prevention of sickness absence through early identification and rehabilitation of at-risk patients with musculoskeletal disorders (PREVSAM): short term effects of a randomised controlled trial in primary care.
PURPOSE
To evaluate short-term effects of the PREVention of Sickness Absence for Musculoskeletal disorders (PREVSAM) model on sickness absence and patient-reported health outcomes.
METHODS
Patients with musculoskeletal disorders were randomised to rehabilitation according to PREVSAM or treatment as usual (TAU) in primary care. Sickness absence and patient-reported health outcomes were evaluated after three months in 254 participants.
RESULTS
The proportion of participants remaining in full- or part-time work were 86% in PREVSAM vs 78% in TAU ( = 0.097). The PREVSAM group had approximately four fewer sickness benefit days during three months from baseline ( range 0.078-0.126). No statistically significant difference was found in self-reported sickness absence days (PREVSAM 12.4 vs TAU 14.5; = 0.634), nor were statistically significant differences between groups found in patient-reported health outcomes. Both groups showed significant improvements from baseline to three months, except for self-efficacy, and only the PREVSAM group showed significantly reduced depression symptoms.
CONCLUSIONS
The findings suggest that for sickness absence, the PREVSAM model may have an advantage over TAU, although the difference did not reach statistical significance at the < 0.05 level, and similar positive effects on patient-reported health outcomes were found in both groups. Long-term effects must be evaluated before firm conclusions can be drawn.
PubMed: 38738694
DOI: 10.1080/09638288.2024.2343424 -
Australian Occupational Therapy Journal May 2024Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation....
INTRODUCTION
Forensic mental health services balance recovery-focussed therapy with risk management, which may limit opportunities for participation in meaningful occupation. Previous research describes forensic patients in secure settings participating mainly in passive leisure and sleep. This study aimed to use quantitative and qualitative evidence to investigate how patients in the sub-acute and rehabilitation units of an Australian forensic hospital perceive and use their time and to discuss how the findings compare with the previous study within the organisation, published in 2004.
METHOD
An explanatory sequential mixed methods design was used with convenience sampling of patients and purposive sampling of staff. Patients completed time use diaries followed by semi-structured interviews. Staff perceptions were obtained via survey.
RESULTS
Seven male patients with a diagnosis of schizophrenia and five staff members (three occupational therapists and two nurses) participated. Time use diaries indicated patients spent most time in personal care, passive recreation, and leisure activities. Qualitative data illustrated patient time use was influenced by the individualised meaningfulness of activities. Patients drew meaning from past roles, personal interests/needs, and their goals for recovery. While patients had some choice over how time is spent and with whom they chose to engage, external factors such as staff/program availability prevented their having full control. Staff provided additional perspectives on the links between time use and recovery, identifying enablers and barriers to meaningful time use.
CONCLUSION
Patient time use has not changed significantly when compared to past research, although perceptions of time use are more future and recovery-focussed. The amount of time recorded in activities typically associated with recovery does not necessarily capture the quality and benefit of that time use. Patient participation continues to be influenced by broader systems.
PubMed: 38733208
DOI: 10.1111/1440-1630.12961 -
Minerva Medica Jun 2024The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF).
BACKGROUND
The aim of this study was to evaluate the impact of educational status (ES) on the clinical course of Asian patients with atrial fibrillation (AF).
METHODS
We used data from the prospective APHRS-AF Registry. ES was classified as follows: low (primary school), medium (secondary), and high (University). The primary outcome was a composite of all-cause death, thromboembolic events, acute coronary syndrome, and heart failure. Secondary outcomes were each component of the primary outcome, cardiovascular death, and major bleeding. The one-year risk of primary and secondary outcomes was assessed through Cox-regressions. Adherence to the Atrial fibrillation Better Care (ABC) pathway was assessed.
RESULTS
Among 2697 AF patients (69±12 years, 34.8% females), 34.6% had low ES; 37.3% had medium ES; and 28.1% had high ES. Compared to patients with medium-high ES, patients with low ES were older, more often females, with a higher prevalence of cardiovascular risk factors, and a lower ABC pathway adherence (30.4% vs. 40.2%, P<0.001). On multivariable analysis, low ES was associated with a higher risk for the primary outcome (HR 1.52,95%CI 1.11-2.06) and all-cause death (HR 1.76,95%CI 1.10-2.83) than medium-high ES. A significant interaction was found for the risk of composite outcome among the different age strata, with the higher risk in the elderly (P for int=0.008), whereas the beneficial effect of the ABC pathway was irrespective of ES (P for int=0.691).
CONCLUSIONS
In Asian AF patients, low ES is associated with high mortality. Efforts to improve education and include ES evaluation in the integrated care approach for AF are necessary to reduce the cardiovascular burden in these patients.
Topics: Humans; Atrial Fibrillation; Female; Male; Aged; Registries; Prospective Studies; Educational Status; Middle Aged; Asian People; Thromboembolism; Heart Failure; Hemorrhage; Acute Coronary Syndrome; Aged, 80 and over; Risk Factors; Cause of Death
PubMed: 38727706
DOI: 10.23736/S0026-4806.24.09159-6