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Objective We developed interim guidance for the care of patients with cognitive impairment in hospital during the COVID‐19 pandemic. Methods A Guidance Committee and Readers Group were recruited. The content was identified by the Committee and content‐specific subgroups, resulting in a draft document, which was sent to the Readers for review. People with dementia and care partners were involved in all aspects of the process. Results Infection control measures can lead to an escalation of distress. In an environment where visiting bans are applied to care partners/advocates, hospitals need to ensure care partners can continue to provide decision‐making support. Health‐care professionals can proactively engage care partners using videoconferencing technologies. Developing models of care that proactively support best practice can minimise the risk of delirium, mitigate escalating symptoms and guide the use of non‐pharmacological, pharmacological (start low, go slow) or physical restraint in managing behavioural and psychological symptoms.

The current PhD project aimed to carry out an investigation into the effect of green-exercise programmes on markers of health related to cardiovascular risk. These markers derived from three diverse areas; blood-borne markers of CV risk; vascular haemodynamics and arterial stiffness; and mental health. Exercise is a well-regarded treatment and preventive tool for markers of health related to these three areas and green-exercise has previously been seen to acutely improve markers of mental health and blood pressure, with access to green space being seen to correlate with better health and lower rates of morbidity and mortality. However, the specific impact upon health of regular participation in green-exercise had not before been investigated. A cross-sectional study was first performed to determine whether there was any effect of regular participation in aerobic exercise upon the measures of health and CV risk that were then to be employed in an intervention study. This study determined that regular participation was associated with reduced expression of the elastin-degrading enzyme, MMP-9, increased levels of HDL, and reduced diastolic blood pressures. With regards to mental health; self-esteem and cognitive function were improved in the regularly active participants compared to those who were sedentary. For the intervention study, previously sedentary participants in community-based green-exercise walking groups and workplace-based green-exercise walking challenges were recruited. Following the intervention, it was observed that approximately half of participants had not adhered to the green-exercise programme, and the cohort was therefore split in to a non-adherent group and an adherent group. The data suggest that regular attendance (an average of two 45-min sessions per week/8-weeks) of low/moderate-intensity green-exercise programmes is associated with significant reductions in MMP-9, and also increases in CD36 and ABCA1; two genes involved in reverse cholesterol transport. Central and peripheral SBP, DBP and MAP were also reduced, as was AIx (an indirect measure of arterial stiffness). Measures of anxiety, depression, self-esteem, stress and mood were also improved. Correlative associations were identified between AIx and MMP-9 expression, suggesting that exercise-associated MMP-9 down-regulation may be a mechanism contributing towards exercise-associated reductions in arterial stiffness, and hence CV risk. In conclusion, these findings suggest that CV risk may be combated using free and easily accessible green-exercise programmes.

Background Clostridium difficile infection (CDI) recurs after initial treatment in approximately one in four patients. A single-centre pilot study suggested that this could be reduced using ‘follow-on’ rifaximin treatment. We aimed to assess the efficacy of rifaximin treatment in preventing recurrence. Methods A multisite, parallel group, randomised, placebo controlled trial recruiting patients aged ≥18 years immediately after resolution of CDI through treatment with metronidazole or vancomycin. Participants received either rifaximin 400 mg three times a day for 2 weeks, reduced to 200 mg three times a day for a further 2 weeks or identical placebo. The primary endpoint was recurrence of CDI within 12 weeks of trial entry. Results Between December 2012 and March 2016, 151 participants were randomised to either rifaximin or placebo. Primary outcome data were available on 130. Mean age was 71.9 years (SD 15.3). Recurrence within 12 weeks was 29.5% (18/61) among participants allocated to placebo compared with 15.9% (11/69) among those allocated to rifaximin, a difference between groups of 13.7% (95% CI −28.1% to 0.7%, p=0.06). The risk ratio was 0.54 (95% CI 0.28 to 1.05, p=0.07). During 6-month safety follow-up, nine participants died in each group (12%). Adverse event rates were similar between groups. Conclusion While ‘follow-on’ rifaximin after CDI appeared to halve recurrence rate, we failed to reach our recruitment target in this group of frail elderly patients, so the estimated effect of rifaximin lacks precision. A meta-analysis including a previous trial suggests that rifaximin may be effective; however, further, larger confirmatory studies are needed.

Additional file 1:. Figure A: Description and timing of the elements of the intervention. Figure B: Practical design considerations for a quality improvement collaborative in dementia care in Australia. Figure C: Example of completed reporting checklist (example used for the occupational therapy recommendation. Other versions used for exercise and carer support).

Individuals with high aerobic fitness have lower systolic left ventricular strain, rotation and twist (‘left ventricular (LV) mechanics’) at rest, suggesting a beneficial reduction in LV myofibre stress and more efficient systolic function. However, the mechanisms responsible for this functional adaptation are not known and the influence of aerobic fitness on LV mechanics during dynamic exercise has never been studied. We assessed LV mechanics, LV wall thickness and dimensions, central augmentation index (AIx), aortic pulse wave velocity (aPWV), blood pressure and heart rate in 28 males (age: 21 ± 2 years SD) with a consistent physical activity level (no change >6 months). Individuals were examined at rest and during exercise (40% peak exercise capacity) and separated post hoc into a moderate and high aerobic fitness group (: 49 ± 5 and 63 ± 7 ml kg−1 min−1, respectively, P < 0.0001). At rest and during exercise, there were no significant differences in gross LV structure, AIx, blood pressure or heart rate (P > 0.05). However, for the same AIx, the high group had significantly lower LV apical rotation (P = 0.002) and LV twist (P = 0.003) while basal rotation and strain indices did not differ between groups (P > 0.05). We conclude that young males with high aerobic fitness have lower LV apical rotation at rest and during submaximal exercise that can occur without changes in gross LV structure, arterial haemodynamics or heart rate. The findings suggest a previously unknown type of physiological adaptation of the left ventricle that may have important implications for exercise training in older individuals and patient populations in which exercise training has previously failed to show clear benefits for LV function.

The eating and weight reducing behaviours of a group of male jockeys were investigated to determine a possible relationship to the disorder Anorexia Nervosa. Informal interviews and the Eating Attitudes Test were used to assess the degree of anorexic-like behaviour present and to determine the relative contributions of personal and socio-cultural factors in the development of their eating patterns. Somatotyping was used to define the general physical type of the jockey and to determine the extent to which physical factors contributed to the observed eating behaviours. These data indicate that the eating behaviours of the population simulate Anorexia Nervosa and that this is an adaptive response to cultural pressure to maintain a low body weight. Master of Arts (MA)