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Increasing rates of Alzheimer disease and related dementia (ADRD) has resulted in greater reliance on adult day health centers (ADHCs) and their skilled workforce. Little is known about staffing in ADHCs that provide ADRD services compared with ADHCs that do not. This study examines whether there are differences in staffing between ADHCs that offer ADRD services versus those that do not, and whether the percentage of ADHC participants with ADRD is associated with staffing levels. It also examines whether staffing levels and provision of ADRD services are associated with participant outcomes. Cross-sectional analysis of secondary survey data. We used facility-level data from the 2014 National Post-acute and Long-term Care Study Adult Day Services Center module. This survey is completed by administrators of ADHCs, who provide information about their ADHC's organization, services, participants, sources of payment, staffing, and participant outcomes. Bivariate comparisons and multivariate regressions were used to compare scope of services, staffing, and participant outcomes for ADHCs that offered ADRD programs compared with those that did not. ADHCs with ADRD programs had similar average daily attendance, less revenue from Medicaid and self-payment, and greater proportions of Black and female participants. ADHCs with ADRD programs had similar staff hours per participant day for all staff categories; licensed nurse staffing increased and social worker staffing decreased with the proportion of participants with ADRD. Staffing had significant associations with participant outcomes. ADHCs that have more participants with ADRD have greater staffing of licensed nurses but fewer social workers. Participant outcomes are associated with staffing, but the results suggest that there are unmeasured dimensions of participant risk that confound the relationship. [ABSTRACT FROM AUTHOR]

• Medicare-Medicaid beneficiaries are at high risk of severe disease from influenza. • Community Based Adult Services (CBAS) centers can help with influenza vaccinations. • Survey results in LA County suggest CBAS centers are underutilized for vaccination. • Center size and staff training affect if centers assess for influenza vaccination. Medicare-Medicaid beneficiaries are at high risk of experiencing severe disease from influenza. Yet, immunization assessment followed by influenza vaccination (when needed) are not regularly performed at Community-Based Adult Services (CBAS) centers in/near medically underserved areas. To better understand this challenge, an organizational assessment was conducted in early 2020 to identify and examine modifiable factors that may impede or facilitate immunization assessment and influenza vaccination at CBAS centers in Los Angeles County (LAC), California. All 158 CBAS centers in LAC were asked to complete a 17-question survey. The survey asked about immunization assessment, gaps in communication with primary care providers, knowledge and use of the California Immunization Registry (CAIR), and institutional policies for influenza vaccination. In addition, the survey asked each center about its vaccination policy for staff and clients, including whether or not increasing vaccinations was an interest/priority for the center. Best subsets algorithms (regression models) were performed to identify factors that may influence CBAS centers' practices on immunization assessment and vaccination. Of the 158 centers, 101 (66 %) completed the survey. A majority did not conduct immunization assessments for influenza (n = 59; 58 %); nearly-two-thirds (n = 70; 71 %) reported it would be feasible to do so if the practice is integrated as part of the individualized/nursing plan of care. Best subsets algorithms showed the strongest factors influencing whether CBAS centers assess for influenza vaccination were: center size, staff training on CAIR, presence of barriers to vaccination, and the belief that it is the center's responsibility to conduct immunization assessments and vaccinations. Findings suggest that practice gaps in immunization assessment and influenza vaccination are common at LAC's CBAS centers. Closing these gaps may help LAC (and California) improve influenza vaccine uptake and other vaccinations (e.g., pneumococcal, COVID-19) among the most vulnerable of the state's aging populations, Medicare-Medicaid beneficiaries. [ABSTRACT FROM AUTHOR]

Assess educators' feeding practices and mealtime environments in family daycare services and examine the factors associated with educators' feeding practices and mealtime environments. Cross-sectional observational study of family daycare services (n = 33) in Australia. Best practices for mealtime environments and educator feeding practices were assessed during each mealtime using the Environment Policy Assessment and Observation instrument. Correlates assessed via survey included: socioeconomic status, main language spoken at home, early childhood career experience, and nutrition professional development. Descriptive statistics and independent t tests were calculated. Educators typically had higher scores, indicating better practices, for (the absence of) negative practices compared with positive practices. The only positive practice meeting best-practice standards was educators sitting with children during the meal. There were no significant correlations for educators' feeding practices or mealtime environment. Educators may benefit from professional development targeting positive feeding practices and supportive mealtime environments. [ABSTRACT FROM AUTHOR]

Background: Recently published guidelines and consensus statements have outlined recommended screening practices for monitoring of end-organ dysfunction in Fontan patients. We reviewed the current approach to end-organ screening in a local population of Fontan patients at the time of transition to adult care.Methods: Patient data from the Australia and New Zealand Fontan Registry and patient medical records were used to review investigations performed in Fontan patients transitioned from The Royal Children's Hospital Melbourne to an adult centre between 1 July 2015 and 30 June 2020.Results: A total of 32 patients were referred for transition to an adult centre between 1 July 2015 and 30 June 2020 at a mean age of 18.5±0.7 years (12.7±2.5 years post-Fontan). Liver function tests were performed in 22 patients (69%) within 5 years prior to transition and were abnormal in 15 patients (68%). Liver ultrasound was performed in 13 patients (41%) within 5 years prior to the date of transition, of whom 10 (77%) had abnormal findings (features suggestive of hepatic fibrosis in seven [54%], cirrhosis in two [15%], and portal hypertension in three [23%]). Fourteen (14) patients (44%) had no record of a liver ultrasound being performed between the date of the Fontan procedure and the time of transition to adult care. Hepatocellular carcinoma was diagnosed in one patient at 18 months following transition. A total of 24 patients (75%) had a serum creatinine measured within the 5 years prior to transition, and two (8%) had an estimated glomerular filtration rate (eGFR) less than 90 mL/min/1.73 m2. No patient had a urine protein-creatinine ratio measured between the date of the Fontan procedure and the time of transition to adult care.Conclusions: In this study we have identified that the majority of patients transitioned from a tertiary paediatric centre to an adult centre within the last 5 years did not undergo routine surveillance for end-organ dysfunction. Routine screening for end-organ complications of the Fontan circulation should be incorporated into clinical practice and is an important part of Fontan patient care both pre- and post-transition to adult services. [ABSTRACT FROM AUTHOR]

For more than 4 decades, adult day service centers (ADSCs) have provided long-term care services and socialization to hundreds of thousands of people in the United States. An important part of the long-term care continuum, ADSCs serve older adults and adults with disabilities, many of whom have low incomes and are racial and ethnic minorities. Yet, little is known about the quality of ADSCs. To better understand ADSC quality, we examined staffing levels, a key aspect of organizational structure. Staffing levels are an established quality measure associated with resident outcomes in nursing homes. Our study compares ADSC staffing levels between for-profit and nonprofit or government-operated ADSCs. Cross-sectional secondary data analysis using a nationally representative survey of ADSCs. Adult day service center (n = 573) directors completed a survey as part of the 2018 National Study of Long-Term Care Providers. Bivariate comparisons and multivariate linear regression were used to compare staffing, measured as hours per participant day in nonprofit and for-profit ADSCs. Approximately 60% of ADSCs in the sample were nonprofit or government-operated and the remainder were for-profit. For-profit ADSC staffing averaged 1.5 hours per participant day and nonprofit or government-operated ADSC staffing averaged 1.9 hours per participant day. For-profit ADSCs had 15.8% (P =.047) lower hours per participant day compared with nonprofit ADSCs after controlling for center characteristics, such as Medicaid use, participant acuity, and ADSC size. We found that for-profit ADSCs have lower staffing levels compared with nonprofit and government-operated ADSCs. Future research is needed to understand how staffing levels relates to the quality of care in for-profit and nonprofit ADSCs and how these relationships vary by participant characteristics, such as income, race/ethnicity, and acuity. [ABSTRACT FROM AUTHOR]

The demand for lower limb arthroplasty is projected to increase significantly over the next three decades, which poses a major challenge to healthcare services. Novel solutions in arthroplasty services are required to meet the growing volume of patients that require essential orthopaedic surgery. These solutions must be safe, efficient, and reproducible at scale. They must also be robust to the disruption felt with increasing frequency from the need to accommodate the growth of unscheduled inpatient care services. Day case total hip arthroplasty (THA) has become established in North America and is being used with increasing frequency in the UK and Europe. This approach been shown to be safe and effective in a wide variety of settings and is associated with good outcomes and high levels of patient satisfaction. Day case arthroplasty may improve the efficiency and productivity of planned essential surgery by reducing the burden on inpatient services, and consequently the demand for day case THA is likely to increase. It is therefore essential that the principles of day case THA are included in the continued professional development of clinicians in orthopaedic surgery, anaesthetics and perioperative care, and allied health professionals involved in the delivery of arthroplasty services. The first part of this article offers a narrative review of day case THA and considers the relative merits of this approach to lower limb arthroplasty services. The second part describes the experiences of successful units and provides a summary of the principles that are essential to deliver safe and effective care. [ABSTRACT FROM AUTHOR]

Oral exercise is a training method for swallowing dysfunction in older adults. The study investigated the effect of oral exercise on tongue pressure in older adults in Taiwanese community day care centers over a 3-month period. Participants over age 50 who were able to communicate and participating for the duration of the 12-week period were recruited from five community day care centers. A 15-min weekly group oral exercise activity was conducted. The tongue pressures were measured and multivariable linear regression models were used to assess the effect of oral exercise intervention on the participants' tongue pressures. A total of 66 older adult participants, among whom the mean age was 78.06 ± 10.74 years. Tongue pressure continued improving during the intervention period, and the mean tongue pressure at the end of the study was 20.63 ± 10.45 kPa, which was significantly higher than the baseline measurement (16.92 ± 10.62 kPa, p < 0.001). Participants exhibited significant improvement in tongue pressure regardless of their age groups. Moreover, participants with one to seven pairs of functional tooth units (FTUs) exhibited significantly more improvement in tongue pressure (16.00 kPa, 95% CI = 2.58–29.43) than those without FTUs (p = 0.021). Oral exercise over a 3-month period significantly improved tongue pressure among the study participants regardless of their gender or age group. Oral exercise should be integrated into comprehensive health promotion programs to assist in the improvement and maintenance of oral function among older adults. [ABSTRACT FROM AUTHOR]

COVID-19 has shone a harsh light on the inequities of health care in the United States, particularly in how we care for older people. We summarize some of the effects of lockdown orders on clients, family caregivers, and staff of adult day service programs throughout the United States, which may serve as a counterpoint to scientific evidence suggesting a lack of efficacy of these programs. Given the ramifications of state lockdown orders for users and staff of the long-term services and support system, we provide recommendations to better support community-based programs and those they serve. Specifically, (1) adult day programs should be classified as essential, (2) a focus on the value of adult day and similar programs is needed, and (3) an exploration of new ways to finance home and community-based services is warranted. Such advances in policy and science would help to integrate adult day services more effectively into the broader health care landscape. [ABSTRACT FROM AUTHOR]

There has been a recent recognized shift towards a whole-of-life or life-course approach to immunisation. However, coverage amongst at-risk adults for recommended vaccines continues to be suboptimal. This study examined the perceptions of middle and older aged Australian adults towards hospital-based immunization programs and their previous exposures to receiving vaccines via tertiary care. A cross-sectional survey was conducted with Australian adults 45 years and older in late 2019 to capture influenza and pneumococcal vaccine uptake, exposure to hospital-based immunization programs, missed opportunities to vaccinate and receptiveness towards the promotion and/or delivery of vaccines in the hospital setting. Only 13 respondents reported receiving a vaccine at hospital, yet 72.2% (931/1292) indicated that they were willing to be vaccinated in that setting. Amongst those who attended hospital during 2019 and were eligible for vaccination, 57.2% and 28.3% of respondents were not immunized for pneumococcal and influenza, respectively. Missed opportunities for both vaccines were significantly higher amongst those at low-risk for influenza (≤65 years (low-risk): 52.9%, ≤65 years (high-risk): 18.3%, >65 years: 15.1%; p < 0.001) and pneumococcal (≤65 years (low-risk): 79.1%, ≤65 years (high-risk): 52.4%, >65 years: 44%; p < 0.001). Among those with a missed opportunity for hospital-based vaccination, the most common reason for not getting immunized was a lack of recommendation. Most (86.4%) reported that their general practitioner was the person or group they trusted most to receive vaccine information from. The findings from this Australian study support international work that shows very low rates of opportunistic vaccination in hospitals despite national recommendations to vaccinate prior to discharge. Considering the need for high levels of uptake of the COVID-19 vaccine, hospitals may need to be considered to opportunistically capture those not accessing the vaccine in other settings. [ABSTRACT FROM AUTHOR]

La survenue d'incapacités physiques ou cognitives peut conduire une personne âgée à déléguer certaines tâches de la vie courante à un aidant. Si la mise en place d'aides permet le maintien à domicile et est fortement plébiscitée par les seniors, la perte d'autonomie constitue néanmoins un élément de rupture dans sa vie d'une personne. Notre objectif était d'explorer les processus d'installation d'un service de livraison de repas à domicile et les mécanismes d'appropriation de ce service par les bénéficiaires. Des entretiens semi-directifs ont été réalisés auprès de 30 bénéficiaires d'un service de livraison de repas (21 femmes ; 70–97 ans). L'analyse thématique des entretiens a montré que la mise en place de ce service faisait souvent suite à une perte de capacités fonctionnelles, limitant la capacité des personnes à faire leurs courses. Deux dynamiques principales ont été observées : pour certains, l'installation de ce service est une étape dans l'ajustement progressif des aides aux besoins de la personne, tandis que pour d'autres l'installation du service est soudaine, souvent à la suite d'une hospitalisation. Le contexte de vie de la personne âgée et la présence de proches influencent cette dynamique. De fait, l'implication effective de la personne dans l'installation de ce service varie beaucoup d'une personne à l'autre et peut influencer la perception des repas reçus. La revalorisation du portage de repas à domicile passe probablement par l'introduction d'espaces de liberté dans ce service (personnalisation des prestations), au regard des trajectoires de vie très variées des bénéficiaires. The onset of disabilities may lead older adults to delegate some daily activities to a caregiver. While a large majority of older people look forward to staying at home as long as possible, the loss of autonomy may constitute a disruptive element in a person's life. Objective. Our objective was to explore the setting-up and the appropriation processes of meals-on-wheels service among older adults. Method. Semi-directive interviews were conducted with 30 beneficiaries of meals-on-wheels service (21 women; 70-97 years old). Result. The thematic analysis of the interviews showed that the implementation of this service is often linked to a loss of functional capacity which limits older adults' ability to do their food shopping. Two main situations were observed: for some participants, the implementation of this service is one step among others within in the gradual implementation of various care services, while for others the implementation of a meals-on-wheels service is sudden, often following hospitalization. This dynamic is influenced by the life situation of the older person and the presence/absence of relatives. In fact, the personal involvement of an older individual in the implementation of this service varies greatly from one person to another and can influence the perception of this service. Conclusion. Meals-on-wheels service may be improved by introducing "freedom spaces" such as provision of choice or individualized delivery service, considering the life situation of each beneficiary. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the longitudinal relationship in insomnia symptoms over time with incident memory problems and dementia diagnoses among U.S. adults aged 65 years and older.Methods: Secondary analyses were performed on 9518 elderly participants (≥65 years) who completed the 2006 wave of the Health and Retirement Study (HRS) and were followed-up to determine if insomnia symptom scores (2006-2014) were associated with time-to-onset of [1] physician-diagnosed "memory-related disease", "Alzheimer's disease" and/or "dementia, senility or any other serious memory impairment" and [2] diagnosis of dementia based on HRS-specific criteria. Cox proportional hazards models were constructed adjusting for socio-demographic, lifestyle, and health characteristics.Results: In fully adjusted models, severe insomnia symptoms were associated with increased risk of physician-diagnosed memory problems. Individuals reporting any change (increase or decrease) in insomnia symptoms during the 2006-2010 period were more likely to be diagnosed with dementia based on HRS criteria. Finally, those who experienced an increase in the severity of insomnia symptoms over time exhibited 41-72% increased risks of physician-diagnosed memory problems and 45-58% increased risks of dementia diagnosis based on HRS criteria.Conclusions: When severe insomnia symptoms increased over time, physician-diagnosed memory problems and dementia diagnoses also increased among U.S. elderly people over a 10-year follow-up period. More studies are required to confirm these findings using large prospective cohort designs and validated tools. [ABSTRACT FROM AUTHOR]

This study presents the design of an integrated, proactive palliative care pathway covering the full care cycle and evaluates its effects using 3 types of outcomes: (1) physician-reported outcomes, (2) outcomes reported by family, and (3) (utilization of) health care outcomes. A clustered, partially controlled before-after study with a multidisciplinary integrated palliative care pathway as its main intervention. after assessment in hospital departments of oncology, and geriatrics, and in 13 primary care facilities, terminally ill patients were proactively included into the pathway. Patients' relatives and patients' general practitioners (GPs) participated in a before/after survey and in interviews and focus groups. A multidisciplinary, integrated palliative care pathway encompassing (among others) early identification of the palliative phase, multidisciplinary consultation and coordination, and continuous monitoring of outcomes. Measures included GP questionnaire: perceived quality of palliative care; questionnaires by family members: FAMCARE, QOD-LTC, EDIZ; and 3 types of health care outcomes: (1) utilization of primary care: consultations, intensive care, communication, palliative home visits, consultations and home visits during weekends and out-of-office-hours, ambulance, admission to hospital; (2) utilization of hospital care: outpatient ward consultations, day care, emergency room visits, inpatient care, (radio) diagnostics, surgical procedures, other therapeutic activities, intensive care unit activities; (3) pharmaceutical care utilization. GPs reported that palliative patients die more often at their preferred place of death, and that they now act more proactively toward palliative patients. Relatives of included, deceased patients reported clinically relevant improved quality of dying, and more timely palliative care. Patients in the pathway received more (intensive) primary care, less unexpected care during out-of-office hours, and more often received hospital care in the form of day care. An integrated palliative care pathway improves a variety of clinical outcomes important to patients, their families, physicians, and the health care system. The integration of palliative care into multidisciplinary, proactive palliative care pathways, is therefore a desirable future development. [ABSTRACT FROM AUTHOR]

Aims: To examine trends in survival from 2006 to 2018 and to assess whether the introduction of resuscitation guidelines was associated with a change in survival after adult in-hospital cardiac arrest.Methods: Using the Get With The Guidelines® - Resuscitation registry, we included adult patients with an in-hospital cardiac arrest between 2006 and 2018. The primary outcome was survival to hospital discharge. An interrupted time series analysis was used to compare survival before and after publication of the 2010 and 2015 resuscitation guidelines.Results: The analysis included 231,739 patients. Survival changed annually by 1.09% (95% CI, 0.74% to 1.43%; P < 0.001) from 2006 to 2010, 0.26% (95% CI, -0.11% to 0.64%; P = 0.17) from 2011 to 2015, and -0.43% (95% CI, -0.96% to 0.11%; P = 0.12) from 2016 to 2018. The survival trend was lower within the post-2010 compared to the pre-2010 period (risk difference, -0.82% per year; 95% CI, -1.35% to -0.30%; P = 0.002) and within the post-2015 compared to the pre-2015 period (risk difference, -0.69% per year; 95% CI, -1.33% to -0.04%; P = 0.04). There was no immediate change in survival after publication of the 2010 and 2015 guidelines.Conclusions: In-hospital cardiac arrest survival increased from 2006 to 2010, after which the trend plateaued. The annual survival trend was lower following publication of the 2010 and 2015 guidelines. Research targeting in-hospital cardiac arrest as a unique entity may be necessary to improve outcomes. [ABSTRACT FROM AUTHOR]

Background: Consumer escalation systems that allow patients and/or their family/carers to escalate concerns about clinical deterioration have been proposed as a way of enhancing patient safety. However, evidence to guide implementation or to support system effectiveness remains unclear.Aim: To critically evaluate the current evidence surrounding consumer escalation within the context of clinical deterioration to identify the strengths, weaknesses and gaps in existing knowledge, essential themes, and directions for further investigation.Method: Database searches were conducted within Cumulative Index of Nursing and Allied Health Literature, PubMed, and the Cochrane Library for articles directly relating to consumer escalation systems published, in English, within the previous 10 year-period. Titles and abstracts were screened and relevant full-text articles included. Content was examined to identify breadth of knowledge, essential themes, and the effectiveness of current systems.Results: 27 articles, containing a mixture of both quantitative and qualitative findings, were identified. Within the context of limitations in the overall depth and quality of current evidence, four key areas (relating to consumer understanding and awareness of clinical deterioration, confidence and ability to escalate concerns, education, and staff attitudes) were identified as potentially critical to the foundation, functioning, and success of consumer escalation systems. Consumer escalation processes may contribute positive effects beyond mortality rates; however, an agreed method of assessing effectiveness remains undetermined.Conclusions: The ability of consumer escalation processes to achieve their underlying goals is still to be adequately assessed. Further research is required to inform how to best implement, support and optimise consumer escalation systems. [ABSTRACT FROM AUTHOR]

Household-based caregivers serve an important role in protecting the health of cancer patients, who may be vulnerable to infectious diseases due to their cancer treatments. Caregiver preventive care should be prioritized to maintain continuity of care and to reduce potential for transmission of infectious diseases to cancer patients. Uptake of vaccines, such as influenza vaccine, is suboptimal in the United States in general, as well as among caregivers for cancer patients. Little is known about the types of information about vaccination and prevention of infectious diseases (e.g. influenza) presented to caregivers of cancer patients. A qualitative content review of NCI cancer center websites (N = 70), searching for vaccine-related information and the need for and availability of vaccines for caregivers, and comparison of the availability of this information to that for caregiver support groups and general preventative health information (e.g. diet, exercise) for caregivers or patients was conducted. While 53 of 70 (76%) cancer centers routinely presented general preventative health information for caregivers or patients, only eight (11%) cancer centers had any information about vaccinations for caregivers or patients. Of these eight cancer center websites, only one had information about vaccinations for caregivers or family contacts. As vaccinations confer both individual and community-level protection against infectious diseases, promotion of routine vaccination for caregivers should be considered as part of caregiver support resources provided by cancer centers. This can include changes such as including this information on cancer center websites or adding to caregiver support resource documents. [ABSTRACT FROM AUTHOR]

Hematopoietic cell transplantation (HCT) requires absence from work, with potential consequences of unemployment and early retirement. Risk factors for failure to return to work (RTW) following HCT have been reported, but there is little information about how transplant centers facilitate the RTW transition for their post-HCT patients. In the present study, we aimed to determine (1) whether transplant centers have guidelines for RTW post-HCT and the consistency of these guidelines and (2) whether centers have RTW programs for their patients, and the characteristics of these programs. We surveyed representatives from 150 adult transplant centers regarding their RTW guidelines and RTW programs. Centers were selected if they performed at least 50 HCTs (autologous [auto] and/or allogeneic [allo]) annually. The online survey contained 32 open-ended and closed-ended questions and 3 questions each eliciting respondents' demographic and transplant centers information. We received completed surveys from 45 centers (30% response rate). Forty-four percent of centers reported having RTW guidelines. All centers recommend RTW at 6 months or less after HCT for their auto-HCT recipients; recommendations for allo-HCT recipients ranged from 4 months to >1 year after HCT having jobs involving interactions with children, sick people, and animals was considered a reason to delay RTW by most centers. Although 87% of centers endorsed that RTW is a problem for post-HCT recipients, only 36% reported having an RTW program for their patients. The majority validated that RTW programs would be either somewhat helpful (36%) or very helpful (51%) for their patients. The majority of responding HCT centers believe that RTW is a problem for patients after HCT; however, consistent guidelines and RTW programs are lacking. With increasing numbers of HCT survivors, efforts to create standardized guidelines and to develop RTW programs are needed. [ABSTRACT FROM AUTHOR]

Objective: To understand if an electronic medical record embedded best practice alert decreased our hospital's Catheter-associated urinary tract infections (CAUTIs) and catheter utilization (CU) rates.Methods: Data from our inpatient prospective CAUTI database, spanning 2011 to 2016, were utilized for our analysis with the Best Practice Alert (BPA) starting in 2013. Using generalized linear models we compared the CU and CAUTI rates between pre- and post-BPA periods in different patient subpopulations.Results: We identified no decrease in the CU rate and no effect on the CAUTI rates as a result of the BPA. However, there was an increase in CAUTI rates in our adult intensive care unit (ICU) population from 0.2 to 1.8 CAUTIs per 1,000 catheter days (P <.01) despite a significant decrease in CU rate within this population after the BPA (pre-BPA odds ratio [OR] 0.93 vs post-BPA OR 0.89; P <0.01). In contrast, our non-ICU adult population had a decrease in CAUTI rate from 2.8 to 1.7 CAUTIs per 1,000 catheter days (P <.01) despite no significant decrease after the BPA (pre-BPA OR 0.90 vs post-BPA OR 0.95; P <.1).Conclusion: CAUTI rates are exceedingly low, with or without the use of a BPA. Such an alert appears to have limited success in lowering CU rates in populations where catheter use is already low and may not always lead to an improvement in CAUTI rates as there appears to be some populations that may be more prone to CAUTI development secondary to possible intrinsic or co-morbid conditions. [ABSTRACT FROM AUTHOR]

While survival after in-hospital cardiac arrest (IHCA) has improved in recent years, it remains unknown whether this trend primarily applies to younger IHCA victims. The aim of this study was to assess trends in survival to hospital discharge after adult IHCA across age groups from 2000 to 2016. This is an observational study of IHCA patients included in the Get With The Guidelines®-Resuscitation registry between 2000 and 2016. The primary outcome was survival to hospital discharge. Patients were stratified into five age groups: <50 years, 50–59 years, 60–69 years, 70–79 years, and ≥80 years. Generalized linear regression was used to obtain absolute survival rates over time. A total of 234,767 IHCA patients were included. The absolute increase in survival per calendar year was 0.8% (95% CI 0.7–1.0%, p < 0.001) for patients younger than 50 years, 0.6% (95% CI 0.4–0.7%, p < 0.001) for patients between 50 and 59 years, 0.5% (95% CI 0.4–0.6%, p < 0.001) for patients between 60 and 69 years, 0.5% (95% CI 0.4–0.6%, p < 0.001) for patients between 70 and 79 years, and 0.5% (95% CI 0.4–0.6%, p < 0.001) for patients older than 80 years. We observed a significant interaction between calendar year and age group (p < 0.001), indicating that the rate of improvement in survival over time was significantly different between age groups. For patients with IHCA, rates of survival to discharge have improved significantly from 2000 to 2016 across all age groups. [ABSTRACT FROM AUTHOR]

Background The WHO currently recommends a daily sodium intake of 2 g and has established the goal of a 30% reduction in mean salt intake by 2025. Objective We sought to estimate sodium intake in study participants according to the locations of where they consumed meals and their demographic and socioeconomic characteristics and practices related to salt consumption. Methods A population-based, cross-sectional study was conducted with a sample of 2574 individuals aged ≥10 y who answered the 2015 Campinas-Brazil Nutrition Survey. Mean sodium intake was estimated using a 24-h recall log and associations with the independent variables were tested using generalized regression analysis stratified by age group. Results Sodium intake was higher in male participants as well as adolescents and adults who reported eating ≥1 meal outside the home (6.07% and 7.06% increase, respectively). Per meal, sodium was consumed more outside the home at breakfast, during an afternoon snack, and at dinner among adolescents. No significant differences were found in the analysis by type of meal among the adults and seniors. Conclusions Sodium intake exceeded the WHO recommendation in all age groups analyzed. Having ≥1 meal outside the home was associated with greater sodium intake among adolescents and adults. Measures to regulate the food industry and dietary/nutritional education strategies targeting consumers are important to reducing the sodium intake of the population. [ABSTRACT FROM AUTHOR]

• There is a growing demand to include robust measures demonstrating the link between intervention outcomes and fidelity. • An implementation fidelity framework of teaching functions and training procedures was developed and assessed. • Authors can improve descriptions of procedures in caregiver-implemented research using precise and consistent terminology. The Bridging the Word Gap Research Network conducted a review of literature to identify effective interventions to facilitate the communication development of young children in hopes of identifying ways to reduce the well-documented word gap among children associated with socio-economic class. As part of this effort, we focused on the ways in which caregivers (teachers, parents, and others) were taught to implement evidence-based practices for facilitating language learning and use. Our goal was to characterize (a) the implementation fidelity, to describe the teaching functions and implementation procedures for teaching those language intervention strategies and (b) the intervention fidelity with which caregivers used strategies for facilitating their children's language development. Because training procedures are not well described in the implementation and professional development literature, a new framework was developed and its feasibility was assessed in an attempt to characterize the teaching functions and specific implementation procedures used across studies. Among the 270 intervention studies reviewed, there were 124 in which caregivers were taught to implement language intervention strategies. Teaching functions included a variety of implementation procedures, with 95% of studies sharing information, 80% incorporating modeling, 65% providing feedback, and only 18% using prompting/guiding/scaffolding. Seventy-two of these studies (58%) reported intervention fidelity, with an increasing proportion reporting fidelity in recent years. Of these 72 studies, 81% were rated as having a 'moderate to strong' description of fidelity measures, and 50% reported high levels of intervention fidelity (i.e., >70% fidelity). These analyses demonstrate the need for reporting more detailed and precise information on intervention fidelity and the teaching functions and procedures used to teach caregivers to implement language interventions. [ABSTRACT FROM AUTHOR]

Les données épidémiologiques françaises sur la nutrition entérale a domicile (NED) de l'adulte sont imprécises. Une première étude, à l'aide des données de l'Assurance maladie (forfaits d'installation et de suivi de la NED), avait déterminé l'incidence et la prévalence globales tout âge confondu. Cette seconde étude cible la population adulte pour obtenir des données plus précises notamment sur les pathologies associées à la NED. Il s'agit d'une étude observationnelle rétrospective couvrant l'année 2012 concernant la population adulte de plus de 15 ans, répartie en trois tranches d'âge : 15–39, 40–64 et plus de 65 ans. Les bases de données de l'Assurance maladie ont permis d'obtenir le nombre de patients ayant débuté une NED et ceux suivis en NED qui, rapportés à une population cible (population bénéficiaire de l'Assurance maladie), ont permis de calculer, respectivement, l'incidence et la prévalence. Ces données croisées avec le fichier des affections de longue durée ont permis de définir cinq catégories : cancérologie, neurologie, MICI, insuffisance d'organes et autres. Les données de 11 régions, soit 21,8 millions d'adultes, ont été obtenues. L'incidence et la prévalence moyennes de la NED étaient, respectivement, 29/100 000 hab/an et 67/100 000 hab/an. Les principales pathologies étaient la cancérologie et la neurologie, avec des variations selon les tranches d'âge. Il s'agit de la première étude fiable sur l'épidémiologie de la NED chez l'adulte en France. La projection à l'échelle nationale amène à une estimation de 39 000 adultes pris en charge par an, essentiellement pour des pathologies cancéreuses ou neurologiques. French epidemiological data regarding home enteral nutrition (HEN) are not well known and give rise to imprecise estimates. In a first study, and using health insurance data based on NED specific packages (installation package, follow-up packages), we were able to determine the overall incidence and prevalence of the global population (children and adults). This second study targets the adult population to obtain more accurate data especially by trying to determine the pathologies associated with the NED. A retrospective and observational study covering the year 2012 (from 01/01 to 31/12/2012) has been carried out, with the data of the adult population aged over 15 years, by defining three age groups: 15–39 years, 40–64 years, over 65 years. The databases of the health insurance allowed to obtain on the one hand, the number of patients who started a NED and on the other hand, the number of patients followed in NED. The target population (health insurance beneficiary population) being known, these data allowed to calculate incidence and prevalence, respectively. The data were also crossed with the thirty long-term diseases file of health national insurance (ALD 30), allowing patients to be classified into five categories: cancer, neurology, chronic intestinal inflammatory diseases, organ deficiency and others. Data from 11 regions, totaling 21.8 million adults, were obtained. The average incidence and prevalence of NED was estimated at 29/100,000 hab/yr and 67/100,000 hab/yr, respectively. The main pathologies were cancer and neurology, but with variations depending on age groups. Inflammatory bowel diseases were the second cause of NED in the age range 15–39 years. This is the first reliable study on the epidemiology of NED in adults in France. The projection of these figures to the entire French adult population leads to an estimate of around 39,000 patients per year benefiting from national health insurance for HEN, mainly for cancer and neurological diseases. [ABSTRACT FROM AUTHOR]

Highlights • Pan-EU study on the effect of 'dish-of-the-day' nudge strategy on older consumers. • Nudging by 'dish-of-the day' did not influence older people's plant-based dish choice. • Gender, country, sensory dimension, universalism and security influenced choice. • Improved dietary quality for older consumers requires combination of strategies. Abstract A quasi-experimental study was designed to promote novel plant-based dishes using the nudging strategy 'dish of the day' among older consumers in Denmark, France, Italy and the United Kingdom. Participants were presented with three dish options: veggie balls, meatballs and fish cakes. In the intervention situation, participants were informed that the 'dish of the day' was the novel plant-based 'veggie balls'. Thereafter, participants were asked to choose one of three dishes to intake and then fill a questionnaire. No statistically significant difference in dish choice was found between the control group and intervention group in the four countries. Males were less likely to choose the plant-based dish when compared with the females. Participants from the United Kingdom and Denmark were more likely to choose the plant-based dish when compared with participants from France. High scores of security dimension from the Human Value Scale was negatively associated with choice of plant-based dish, while high scores of the sensory dimension from Food Choice Questionnaire and high scores of the universalism dimension from Human Values Scale were positively related to the choice of the plant-based dish. The 'dish of the day' nudging approach did not influence older people's plant-based dish choice. Gender, country, and dimensions of sensory, universalism and security were critical factors influencing an older people's plant-based food choice. [ABSTRACT FROM AUTHOR]

• Rapid molecular testing for respiratory viruses in immunocompromised adults in a hospital emergency care setting is useful. • Implementation results in more targeted use of oseltamivir and a reduction in the use of in-hospital isolation facilities. • No effect was seen on antibiotic use, antibiotic duration, hospital admissions and length of hospital stay. Immunocompromised adults are more vulnerable to a complicated course of viral respiratory tract infections (RTI). Provide evidence on the effect of implementation of rapid molecular diagnostics for viruses on use of in-hospital isolation facilities, oseltamivir and antibiotic usage, and other clinical outcomes in immunocompromised patients. A before-after study during two consecutive respiratory viral seasons, including immunocompromised adult patients presenting at a tertiary care emergency department with clinical suspicion of RTI. During the first season (2016/2017), respiratory viruses were detected using inhouse real-time PCR. The second season (2017/2018), we implemented a diagnostic flowchart including a rapid molecular test for 15 respiratory viruses (FilmArray®). We assessed the effect of this implementation on need for isolation, antivirals and empirical antibiotics. We included 192 immunocompromised adult patients during the first and 378 during the second season. Respiratory viral testing was performed in 135 patients (70%) during the first and 284 (75%) during the second season (p = 0.218) of which 213 (75%) using the rapid test. After implementation, use of in-hospital isolation facilities was reduced (adjusted odds ratio 0.35, 95%CI 0.19-0.64). Furthermore, adequate use of oseltamivir improved, with fewer prescriptions in influenza negative patients (0.15, 95%CI 0.08-0.28) and more in influenza positive patients (11.13, 95%CI 1.75–70.86). No effect was observed on empirical antibiotic use, hospital admissions, length of hospital stay or safety outcomes. Implementation of rapid molecular testing for respiratory viruses in adult immunocompromised patients results in more adequate use of oseltamivir and in-hospital isolation facilities without compromising safety. [ABSTRACT FROM AUTHOR]

The demented elderly have physical, emotional and behavioral patterns that differ from those of the normal elderly, and those patterns differentiate their needs in terms of the indoor built environment (IBE). Therefore, it is essential to investigate the effects of the IBE on the quality of life (QoL) of the demented elderly. To ensure the study's reliability and validity, multiple research methods were applied, including qualitative methods (i.e., an interview) and quantitative ones (i.e., a questionnaire survey). In total, 96 demented elderly residents and 18 caregivers from eight care and attention (C&A) homes were involved in the current study. Based on the data collection, an IBE-QoL model was developed using a reliability test, correlation analysis and regression analysis. The model confirmed the following: 1) building services factors – lighting, temperature, lifts and water supply – predict demented elderly residents' physical health, psychological health, independence, activities of daily living and social relationships; and 2) supporting facilities factors – signage, finishes and furniture – also exert a positive impact on the residents' physical health, activities of daily living, social relationships and cognitive functioning. Practical recommendations are made, including that C&A homes provide access to a sky garden on each floor, label water taps with hot/cold signs, provide signage with iconic information at different strategic locations, employ color contrasting finishes in different rooms, use historical furniture, and so on. This study's results provide valuable insight into improving C&A homes' IBE in order to enhance the QoL of the demented elderly. • Six QoL domains and twelve indoor built environment (IBE) factors are identified. • The existing IBE in care and attention homes are generally unsatisfactory. • An IBE-QoL model for the demented elderly is built using multiple research methods. • Four building services factors positively predict their QoL of the demented elderly. • Three supporting facilities positively affect their QoL and cognitive functioning. [ABSTRACT FROM AUTHOR]

Background: Experimental and observational research suggests hyperoxia following resuscitation from cardiac arrest is associated with neurological injury and worse clinical outcomes. This paper describes the rationale and design of the EXACT trial. EXACT aims to determine whether reducing oxygen in the acute phase of post-resuscitation care for out-of-hospital cardiac arrest (OHCA) improves survival.Methods: EXACT is a multi-centre, randomised (1:1), single-blind, parallel trial. Presumed cardiac OHCA cases who achieve a return of spontaneous circulation will be eligible if they are comatose, with an advanced airway and have an oxygen saturation (SpO2) ≥95% on >10 L/min (or 100% oxygen). Paramedics will randomise 1416 eligible cases to receive oxygen therapy targeting an SpO2 of 90-94% (intervention) or 98-100% (control). Study treatment will continue until admission to an intensive care unit or hospital ward. The primary outcome is survival to hospital discharge. Secondary outcomes include 12-month survival and quality of life.Results: The study has commenced in the Australian states of Victoria and South Australia, and has enrolled 167 eligible cases to date (80 intervention and 87 control). Further sites are due to commence in 2019, recruitment is expected to take three years.Conclusion: This study will determine if early reduction of oxygen leads to improved outcomes in OHCA. Such a finding may potentially change clinical practice with implications on future OHCA survival outcomes.Trial Registration Number: NCT03138005. [ABSTRACT FROM AUTHOR]

Abstract Traumatic brain injury (TBI) often leads to immediate and chronic functional impairments that affect care partners, or those providing physical and/or emotional support to individuals with TBI. The many challenges associated with being a care partner often lead to caregiver burden and can compromise the well-being and quality of life of care partners and individuals with TBI under their care. Equipping care partners with problem-solving skills could facilitate and sustain their transition into this supportive role. Problem-solving training (PST) has demonstrated efficacy for providing such skills to care partners of individuals with TBI after discharge from inpatient rehabilitation. We propose that PST delivered to care partners during inpatient rehabilitation of individuals with TBI will provide care partners with the skills to manage their caregiving roles across the transition from hospital to home. Herein, we describe the methodology of a current randomized controlled trial that examines the feasibility and efficacy of PST plus TBI education compared to TBI education alone to improve care partner burden, emotional distress, and adaptive coping when delivered during the inpatient rehabilitation stay of individuals with moderate-severe TBI. [ABSTRACT FROM AUTHOR]

Background: Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared chest compression fraction (CCF) between patients receiving endotracheal intubation (ETI) versus bag mask ventilation (BMV).Methods: We studied adult OHCA enrolled from our center in the CAAM trial. Primary exposures were ETI or BMV. Primary outcome was whole intervention CCF, adjusted for Utstein confounders. Secondary outcomes were per cycle CCF, no flow time associated (NFT) with ventilation, rhythms checks and mechanical chest compression device placement.Results: Of 2040 OHCA enrolled in the CAAM trial we analyzed 112 cases recruited by our center. Unadjusted CCF was 0.89 for ETI and 0.88 for BMV (p = 0.19). Compared with BMV, ETI achieved lower NFT associated with ventilations (32 vs 127 s; p < 0.001). ETI cases experienced higher NFT associated with rhythm checks (69.5 vs 42.5 s p = 0.02) and with mechanical chest compression placement (29 vs 20 s; p = 0.04). CCF was higher during the first cycle in BMV than in ETI patients (0.81 vs 0.74; p = 0.02). After correction for confounders we observed no difference in global intervention CCF between the ETI and BMV (ΔCCF [ETI-BMV] 0.301; [95%CI: -1.9 to 2.51]; p = 0.79).Conclusion: In our substudy whole intervention CCF among OHCA was not modified by ETI compared to BMV. In the ETI group we observed lower NFT associated with ventilations and higher NFT associated with mechanical chest compression devices placement. CCF was lower in the ETI group during the first cycle. [ABSTRACT FROM AUTHOR]

Abstract Access to affordable daycare might improve population mental health. However, evidence is sparse and restricted to middle- and high-income country settings. We conducted a cluster-randomized controlled trial in one low-income setting, rural Rajasthan, India. Communities lacking daycare facilities were identified (n = 160) and randomly selected for assistance in setting up a community-based daycare program (n = 80) or not (n = 80). Women eligible for the daycare program living in these communities completed structured interviews before the intervention (participation rate = 89%) and approximately one year after rollout of the intervention (participation rate = 96%), resulting in a final analytic sample of 3041. Mental distress was measured with the Hindi version of the 12-item General Health Questionnaire (score range: 0–12). We modeled the relation between access to daycare and number of mental distress symptoms (GHQ-12 score) with negative binomial regression using an intention-to-treat approach, which groups women according to if they lived in communities randomized to affordable daycare. We also evaluated the effect of access to daycare on secondary outcomes that may be related to mental distress, including women's work burden, agency, and intimate partner violence (IPV). We found that access to daycare resulted in modest reductions in symptoms of mental distress (mean difference = 0.21, 95% CI: −0.43, 0.02). We found some evidence that daycare reduced IPV, but virtually no change in women's work burden or agency. Our results provide some indication that access to affordable daycare might be one policy lever to improve population mental health. Highlights • We assessed the effect of access to daycare using an intention-to-treat approach. • 41% of women living in communities randomized to daycare utilized services. • Access to daycare resulted in modest reductions in women's mental distress. • Access to daycare resulted in modest reductions in intimate partner violence. • Access to daycare did not lead to meaningful changes in agency or work amount. [ABSTRACT FROM AUTHOR]

Highlights • The psychometric properties of the FES-I were analysed with adult day care users. • The FES-I had excellent internal consistency and test-retest reliability. • Good concurrent validity and acceptable convergent validity were observed. • The FES-I is reliable and valid to measure concern about falling in day care settings. Abstract The majority of validation studies with the Falls Efficacy Scale-International (FES-I) are conducted with independent community-dwelling older people, which limits extrapolation to more vulnerable people, namely those receiving adult day care services. This study aimed to analyse the psychometric properties of the FES-I in terms of internal consistency, test-retest reliability, concurrent and convergent validity with users of adult day care centres. A cross-sectional study was conducted. Data collection included a socio-demographic questionnaire, the FES-I, the Activities-specific Balance Confidence Scale (ABC), the Hospital Anxiety and Depression Scale (HADS), the Timed Up and Go test (TUG) and the Five Times Sit to Stand Test (FTSST). Descriptive and inferential analyses were performed. A total of 100 users of adult day care centres (81.94 ± 6.43 years old; 77% female) have participated. The FES-I had excellent internal consistency (α = 0.970) and test-retest reliability (ICC 2,1 = 0.979). A significant negative correlation was found between the FES-I and the ABC (r s = −0.828; p < 0.001), suggesting good concurrent validity. FES-I scores were significantly higher among those who were female, had less educational levels and reported having fear of falling. Significant correlations were found between FES-I and age (r s = 0.217; p < 0.05), HADS-Anxiety (r s = 0.486; p < 0.001), HADS-Depression (r s = 0.658; p < 0.001), TUG (r s = 0.653; p < 0.001) and FTSST (r s = 0.635; p < 0.001), indicating acceptable convergent validity. The FES-I is a reliable and valid instrument to assess concern about falling among users of adult day care centres. The findings are highly comparable with those previously found for non-users. FES-I can be used to prevent risk of falls in this type of care settings. [ABSTRACT FROM AUTHOR]

Objectives To investigate the affective, social, behavioral, and physiological effects of the companion robot Paro for people with dementia in both a day care center and a home setting. Design A pilot block randomized controlled trial over 12 weeks. Participants were randomized to the intervention (Paro) or control condition (standard care). Setting Two dementia day care centers and participants’ homes in Auckland, New Zealand. Participants Thirty dyads (consisting of a care recipient with dementia and their caregiver) took part in this study. All care recipients attended dementia day care centers at Selwyn Foundation and had a formal diagnosis of dementia. Intervention Thirty-minute unstructured group sessions with Paro at the day care center were run 2 to 3 times a week for 6 weeks. Participants also had Paro at home for 6 weeks. Measurements At the day care centers, observations of the care recipients’ behavior, affect, and social responses were recorded using a time sampling method. Observations of interactions with Paro for participants in the intervention were also recorded. Blood pressure and salivary cortisol were collected from care recipients before and after sessions at day care. In the home setting, level of cognition, depressive symptoms, neuropsychiatric symptoms, behavioral agitation, and blood pressure were measured at baseline, 6 weeks, and 12 weeks. Hair cortisol measures were collected at baseline and at 6 weeks. Results Observations showed that Paro significantly improved facial expressions (affect) and communication with staff (social interaction) at the day care centers. Subanalyses showed that care recipients with less cognitive impairment responded significantly better to Paro. There were no significant differences in care recipient dementia symptoms, nor physiological measures between the intervention and control group. Conclusion Paro shows promise in enhancing affective and social outcomes for certain individuals with dementia in a community context. Larger randomized controlled trials in community settings, with longer time frames, are needed to further specify the contexts and characteristics for which Paro is most beneficial. [ABSTRACT FROM AUTHOR]

This study quantified the monetary cost of family caregiving for 51 patients with different severity of dementia. The mean annual informal cost of care was higher ( M = SG$44,530.55, SD = SG$31,354.82) compared to the mean annual formal cost of care ( M = SG$25,654.11, SD = SG$10,016.48). Costs were found to increase with severity of dementia (Severe: SG$47,251.30; Moderate: SG$38,607.84; Mild: SG$13,847.68). For each point increase in CMMSE scores, the informal cost lowered by SG$1,173.94. There was a significant negative correlation of cost and cognitive impairment but not functional impairment. The informal cost of care did not vary much with or without the use of day care centres, however the costs for those who did not have domestic helpers (DHs) was more than twice the costs for those with DHs. Results from this study show there were cost savings in care of people with dementia with DHs. [ABSTRACT FROM AUTHOR]

Background: The community-based Meeting Centres Support Programme for people with dementia and their carers has been proven more effective in influencing behaviour and mood problems of people with dementia and improving sense of competence of carers compared to nursing home-based day care centres for people with dementia. Six Dutch nursing home-based day care centres were transformed into Community-based day care centres with carer support, according to this Meeting Centres model. Objectives: To determine which factors facilitate or impede the transition to Community-based day care. Design: A process evaluation was conducted with a qualitative study design. Settings: Six nursing home-based day care centres transformed into Community-based day care centres for people with dementia and their carers. Study participants: Stakeholders (n = 40) that were involved during the transition. Methods: Factors that facilitated or impeded the transition were traced by means of (audiotaped and transcribed) interviews with stakeholders and document analysis. All data were coded by two independent researchers and analyzed using thematic analysis based on the Theoretical framework of adaptive implementation. Results: Six nursing home-based day care centres successfully made the transition to Community-based day care with carer support. Success factors for the start of the project were: the innovation being in line with the current trend towards more outpatient care and having motivated pioneers responsible for the execution of the transition. Barriers were difficulties reaching/recruiting the target group (people with dementia and carers), inflexible staff and little or no experience with collaboration with community-based care and welfare organizations. Facilitating factors during the implementation phase were: finding a suitable location in the community, positive changes in staff attitude and adoption of the new vision, and good cooperation with care and welfare organizations. Barriers were insufficient involvement of, and support from the managers of the responsible organizations, and communication problems with referrers of other organizations, including the GPs and case managers. Conclusions: The transition from nursing home-based psychogeriatric day care support to a community-based combined support programme for people with dementia and their informal carer is shown to be feasible. Successful implementation of this community-based combined support programme requires -- besides motivated pioneers, a change in staff attitude and working style, a suitable pleasant location and collaboration with other care and welfare organizations -- special attention for effective communication with the target user group and the referrers, and also how the management of the pioneer organizations can facilitate the staff during the transition process. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the psychometric properties of the Severe Dual Sensory Loss screening tool, a tool designed to help nurses and care assistants to identify hearing, visual and dual sensory impairment in older adults. Design: Construct validity of the Severe Dual Sensory Loss screening tool was evaluated using Crohnbach's alpha and factor analysis. Interrater reliability was calculated using Kappa statistics. To evaluate the predictive validity, sensitivity and specificity were calculated by comparison with the criterion standard assessment for hearing and vision. The criterion used for hearing impairment was a hearing loss of ≥40 decibel measured by pure-tone audiometry, and the criterion for visual impairment was a visual acuity of ≤ 0.3 diopter or a visual field of ≤0.3°. Feasibility was evaluated by the time needed to fill in the screening tool and the clarity of the instruction and items. Prevalence of dual sensory impairment was calculated. Results: A total of 56 older adults receiving aged care and 12 of their nurses and care assistants participated in the study. Crohnbach's alpha was 0.81 for the hearing subscale and 0.84 for the visual subscale. Factor analysis showed two constructs for hearing and two for vision. Kappa was 0.71 for the hearing subscale and 0.74 for the visual subscale. The predictive validity showed a sensitivity of 0.71 and a specificity of 0.72 for the hearing subscale; and a sensitivity of 0.69 and a specificity of 0.78 for the visual subscale. The optimum cut-off point for each subscale was score 1. The nurses and care assistants reported that the Severe Dual Sensory Loss screening tool was easy to use. The prevalence of hearing and vision impairment was 55% and 29%, respectively, and that of dual sensory impairment was 20%. Conclusions: The Severe Dual Sensory Loss screening tool was compared with the criterion standards for hearing and visual impairment and was found a valid and reliable tool, enabling nurses and care assistants to identify hearing, visual and dual sensory impairment among older adults. [ABSTRACT FROM AUTHOR]

Donor lungs may be transported to the recipient while maintaining perfusion and ventilation, mobile Ex Vivo Lung Perfusion (mEVLP), utilizing the Transmedics Organ Care System (OCS). Although safe and effective, the impact of its adoption on lung transplant program finances has not been studied. We reviewed adult lung transplants at our center between 2016 and 2020 for which the program received reimbursement. Transplants were dichotomized into those with use of standard cold preservation (STD) and those with use of mEVLP for preservation and transport. Baseline recipient characteristics, peri-operative data, outcomes and cost/reimbursement were collected and compared. Benefit-Cost Ratios (BCR) were calculated. We identified 17 STD transplants followed by 6 consecutive transplants with mEVLP reflecting a non-selective change in practice. LAS was significantly lower and use of intra-operative ECMO was more frequent in the mEVLP group. Post-operative ICU and hospital length of stay were comparable (median 5 and 26 days for STD, median 5 and 20 days for mEVLP). All patients survived to hospital discharge. Differences in direct costs and expected net revenue between STD and mEVLP were not statistically significant for all patients. BCR among Medicare patients was 2.32. Mobile EVLP for allograft preservation was adopted in all lung transplants without a negative impact on program finances in this single center experience. The BCR for Medicare patients suggests that mEVLP may be cost-effective relative to standard preservation and warrants further study. [ABSTRACT FROM AUTHOR]

• Caregivers shared how they chose their child's schooling during the COVID-19 crisis. • Caregivers provided both quantitative and qualitative feedback. • For many, children's social and emotional development was the most important factor. • Caregivers also weighed child, caregiver, and systemic factors. • The schooling decision caused significant stress and low confidence for caregivers. In March 2020, U.S. schools and daycares largely shut down to manage the novel COVID-19 pandemic. As the country made efforts to reopen the economy, American parents faced difficult decisions regarding returning to work and securing schooling and care for their young children. During the summer and fall of 2020, caregivers (N = 1655) of children (N = 2408; ages 0 – 12 years) completed questionnaires assessing their decision-making process regarding their children's daycare or schooling situation. A mixed method approach (i.e., qualitative, quantitative assessments) was utilized. Outcomes indicated three main themes that impacted caregivers' choices: child factors, caregiver factors, and systemic factors. Caregivers experienced high levels of stress while worrying about their child's and family's health, job responsibilities, and risk of COVID-19 infection rates in their areas. Continued assessment of families and children during this time is warranted. [ABSTRACT FROM AUTHOR]

Abstract: We examine the effects of Head Start participation on parenting and child maltreatment in a large and diverse sample of low-income families in large U.S. cities (N=2807), using rich data from the Fragile Families and Child Wellbeing Study (FFCWS). To address the issue of selection bias, we employ several analytic approaches, including logistic regressions with a rich set of pretreatment controls as well as propensity score matching models, comparing the effects of Head Start to any other arrangements as well as specific types of other arrangements. We find that compared to children who did not attend Head Start, children who did attend Head Start are less likely to have low access to learning materials and less likely to experience spanking by their parents at age five. Moreover, we find that the effects of Head Start vary depending on the specific types of other child care arrangements to which they are compared, with the most consistently beneficial protective effects seen when Head Start is compared to being home in exclusively parental care. [Copyright &y& Elsevier]

Abstract: Whether rehabilitation outcome can be maintained after discharged from GDH has not been thoroughly investigated. This study was conducted to examine the rehabilitation outcome and its predictors 6 months after discharged from GDH. We studied 418 patients attended a GDH in Hong Kong. All of them had post-6-month assessment. Cognitive status was assessed with Cantonese version of mini-mental state examination (C-MMSE). Functional independence measure (FIM) upon GDH admission (FIM-adm), discharge (FIM-dis) and 6 months after discharge (FIM-p6m) were measured. FIM gain was FIM-dis−FIM-adm while FIM efficiency was FIM gain divided by number of GDH visits. Of the study pool, 164 (39.2%) showed a drop of FIM-p6m. There was a significant drop of FIM-p6m as compared with FIM-dis (p <0.001). However, the FIM-p6m remained significantly higher than FIM-adm (p <0.001). Multivariate analysis revealed that FIM-dis was a negative predictor (p <0.001) while Parkinsonism was a positive predictor for drop of FIM-p6m (p =0.008). A proportion of functional gain can still be maintained 6 months after discharged from GDH. More studies are needed to look for strategies in maintaining functional gain in GDH discharged patients, especially those with Parkinsonism. [Copyright &y& Elsevier]

Abstract: Objectives: The purpose of this review was to determine the nature of support that mental health nurses could deliver to carers of people diagnosed with schizophrenia. The aim was to identify approaches that could be delivered within community practice to reduce burden and increase knowledge, mental health and coping. Questions addressed: What effect did support have on carer burden and other needs? What were the key elements of effective support? What effective supports could mental health nurses deliver within practice? Design: This review covers the international scientific literature published between 1980 and 2008. Data sources: Searches were made of electronic databases relevant to nursing. All papers, published in English, were assessed. Hand searches of review papers and references were also carried out. Sixty-eight studies were included. Study appraisal and synthesis: Only comparative studies providing a quantitative assessment of carer outcomes were included. Findings were synthesised in narrative format and grouped by intervention type. Results: Of the 68 emerging studies, 12 (18%) directly included nurses in delivering the intervention and 16 (24%) included nurses as part of a multidisciplinary team. There is fairly robust evidence that education improves carer knowledge of schizophrenia. There is, however, little evidence that it addresses more substantive areas such as burden, coping or mental health. Supportive family education moves beyond information giving by developing coping. As might be expected these approaches can reduce burden. More intensive programmes such as behavioural family therapy aim to address stressful relationships which commonly occur in families of people diagnosed with schizophrenia. These programmes are particularly effective in reducing burden and can also improve mental health. Community support such as intensive outreach is also effective in reducing burden. Finally, there is some evidence that mutual support groups reduce burden and improve coping. Conclusions: Research on effective support for carers of people diagnosed with schizophrenia is emerging. Although findings were mixed, there was some evidence supporting a range of approaches that mental health nurses could offer to carers. There is, however, still a need for pragmatic studies to determine the extent that these approaches can be delivered within nursing practice. [Copyright &y& Elsevier]

Foucault's medical gaze has only been minimally applied to palliative care through the analysis of key policy documents. This paper develops the conceptualisation of Foucault's medical gaze using empirical data gathered from a group ethnography of a hospice daycare centre. Using Foucault's medical gaze as a theoretical aporia we conceptualise the "hospice gaze". We argue the hospice gaze is the antithesis of the Foucauldian medical gaze, suggesting it operates reflexively so that professionals adapt to patients, rather than patients to professionals; that it is directed towards enabling patients and their loved ones to narrate severe illness and death in ways that develop more patient-centred narratives; and, structures the processes of care in direct resistance to the neoliberalisation of healthcare by engaging in slow practices of care with patient's bodies and minds. Finally, key to all of this is how the hospice gaze manages the spaces of care to ensure that it always and already appears slow to the patients. Therefore, the hospice gaze ensures a (re)distribution of power and knowledge that minimises the corrosive qualities of busyness and maximises the ethical potentials of slowness. We conclude by arguing that the operation of the hospice gaze should be examined in other settings where palliative care is practiced such as in-patient and home care services. • Ethnographic research develops Foucault's medical gaze in contemporary settings. • A Foucauldian inspired hospice gaze provides ethical approaches to palliative care. • The hospice gaze offers patients more agency than the medical gaze. • The hospice gaze slows care, and adapts the environment to patients. • The hospice gaze attunes staff to patients and helps expression of patient needs. [ABSTRACT FROM AUTHOR]

• Frequent ADCC attendance and involvement in its social activities were associated with low loneliness scores. • Frequent contact with family members was negatively associated with loneliness. • Frequent ADCC attendance reduces feelings of loneliness at low and average levels of contact frequency with family, but not with high-level contact frequency. • Formal support may substitutes the efforts of informal support in reducing feelings of loneliness in later life. To examine the link between intensity of use of formal support and loneliness among older adults, controlling for family support and covariates; and examine the moderating effect of contact frequency with family on this relationship. Cross-sectional data were collected from September 2016 - April 2017 through structured interviews with 360 older adults attending adult day care centers (ADCCs) and representing three different ethnic groups in Israel. Loneliness was assessed by the UCLA Loneliness Scale. Hierarchical regression was applied to the study variables with loneliness scores as dependent variable, and bootstrapping with resampling strategies tested a moderating effect. Loneliness was linked negatively with contact frequency with the family network, frequency of ADCC attendance, and greater involvement in social activities at the ADCC. Significant negative correlation between ADCC attendance frequency and loneliness occurred only when family contact was at low-to-average frequency, but not in cases of high-contact frequency. Frequent use of ADCCs emerged as a significant contributor beyond the contribution of family support for reducing loneliness in older age, particularly for those with insufficient family contact. Service providers should improve the accessibility and availability of formal community services for the older population. [ABSTRACT FROM AUTHOR]

The period of transition from pediatric to adult care is a risk to the health of a heart transplant recipient. Best practice resources are available for transplant centers yet pose an additional time-consuming task. This study overviews one center's approach to improving their transition program utilizing current literature, continuous quality improvement and individualization for optimal outcomes. A gap assessment was completed reviewing the current transition program against the literature's best practice standard. Surveys of stakeholders were performed to identify areas of strength and weakness. Four focus areas for improvement were selected: 1) Development of high-quality transition care harnessing limited clinician time and budget resources utilizing American Society of Transplantation Pediatric Transition action plans and readiness assessments. To simplify clinician workload, all patients in the transition program were divided into groups by transition phase and age. Content from each phase was divided into focus sections that repeat with increasing complexity. 2) Normalize the transition process using patient-peer support groups along with goal mastery. A group learning session for each transition group was implemented every 6 months where new transition topics were introduced, and individual goals were set. These goals were discussed at each clinic visit to individualize care. 3) Improving transition of primary medical responsibility from caregiver to the young adult patient. Caregivers were made an essential part of each child's goals with annual "caregiver only" transition learning and support sessions. 4) Incorporating surveys of patient, caregiver and adult transplant center teams to guide a continuous quality improvement process. Using PDSA (Plan-Do-Study-Act) cycles has led to high satisfaction and preparation of the transition patients. Our transition program was initiated in 2011 and educated a total of 38 patients. Since modifying our transition program in 2017: 51 patients have been part of the revised format, 5 patients have successfully transitioned and 100% of patients and caregivers reporting feeling well prepared for transition. Utilizing industry standards, existing resources and addressing identified center specific needs can result in an effective, streamlined and successful transplant transition program. [ABSTRACT FROM AUTHOR]

With rapidly increasing demand at academic medical centers, inpatient resource allocation is a critical focus. Patients receiving autologous stem cell transplant (ASCT) often face complicated discharges, requiring lengthy day of discharge teaching sessions from nurses and dietitians that may cause delays in discharge time. We queried if streamlining the complex discharge process by scheduling teaching appointments in advance would reduce unnecessary delays in discharge. An interdisciplinary committee reviewed existing workflows with relevant stakeholders. Process improvement methodologies, including value-stream mapping, were utilized to reduce variation and delays. New teaching workflows ("discharge pilot") were implemented using a model line approach to iteratively test operations on 1 inpatient pod and were later rolled out on 4 (of 10) pods. After IRB review, patients were allocated to receive the discharge pilot based upon admission to one of these pods. Discharge time was compiled to assess impact. Typically, discharge teaching was completed on the day of discharge as clinicians waited for caregivers to arrive, contributing to delays; teaching took 2 hours. Information given in teach sessions varied greatly between clinicians. Beyond poor utilization of staff, patients and caregivers reported they could not retain critical information as they were prepared for discharge. Teach content delivery was standardized using templated guidelines for home and medication preparation. A provider checklist (Fig 1) was created specifying when to complete discharge readiness tasks. Specialized posters were hung in patient rooms for provider documentation and to engage patients and caregivers on their care journey (Fig 2). Nurses distributed caregiver requirements prior to the teaching appointment and caregivers were notified of required attendance. Teaching appointments were scheduled 2-3 days prior to discharge. Between Jan. – Sep. 2019, 58.8% of patients receiving pilot (advance) discharge teachings (n = 68) discharged before 2pm (range 10:27a – 7:01p). During this same time, only 39.7% of patients receiving no discharge intervention (n = 68) discharged before 2pm (range 11:29a – 11:30p) (p = 0.0257) (Fig 3). Scheduling discharge teaching for patients and their caregivers in advance increased discharges from the hospital before 2pm, significant for operational improvement. This optimized staff resource utilization and allowed for more efficient bed turnover. Other factors like central line removal and transfusion timing should be examined. We are now examining satisfaction and anxiety during discharge when advance teaching is performed. Further research should assess precaution adherence for this intervention. [ABSTRACT FROM AUTHOR]

To characterize and study the impact of moderate-to-severe atopic dermatitis (AD) on the adult treated population in Portugal. A self-administered questionnaire was used to collected data on patients' demographics, medical care, level of embarrassment and absenteeism related to AD. [Extracted from the article]

DRG-based payment system was implemented in Russia in 2013 and is used presently by vast majority of subjects of Russian Federation. Data on the medical care payment (inpatient medical care and some kinds of day care payed by DRG in Russia) for 2016-2018 was analyzed. Both in inpatient and day medical care payed by DRG the LoS is reduced, which corresponds to the global trends and tasks of DRG system implementation. [Extracted from the article]

Caregivers of individuals with Alzheimer's disease and related dementias (ADRD) often experience debilitating caregiver burden and emotional distress. To address these negative emotional consequences of caregiving , we will test and refine a strategy training intervention – Problem-Solving Training (PST) – that promotes self-efficacy and reduces caregiver burden and depressive symptoms. Previous research supports efficacy of PST; however, we do not know exactly how many PST sessions are needed or if post-training "boosters" are required to maintain PST benefits. Additionally, we translated and culturally-adapted PST into "Descubriendo Soluciones Juntos" (DSJ), our novel intervention for Spanish-speaking caregivers. In this 2 × 2 factorial design randomized controlled trial, we will test remotely-delivered PST/DSJ sessions for both English- and Spanish-speaking caregivers of persons with ADRD to determine the optimal number of PST/DSJ sessions and ongoing "booster" sessions needed to best help caregivers navigate their current and future needs. 1) Compare the efficacy of three vs. six PST/DSJ sessions each with and without booster sessions for decreasing caregiver burden and depression and enhancing caregiver problem-solving; 2) Identify key factors associated with efficacy of PST/DSJ, including age, gender, primary language, relationship to care recipient, and uptake of the PST/DSJ strategy. These results will establish guidelines needed for an evidence-based, culturally-adapted, and implementable problem-solving intervention to reduce caregiver stress and burden and improve caregiver health and well-being. This work promotes inclusion of diverse and underserved populations and advances therapeutic behavioral interventions that improve the lives of caregivers of individuals with chronic conditions. [ABSTRACT FROM AUTHOR]

The study was conducted to compare four different culture containers [cage, recycled oil container, tray (control), and tube] in the nursery and grow-out culture of the abalone Haliotis asinina on a reef flat. For nursery culture, early juvenile abalone with mean shell length (SL) of 1.30 ± 0.006 cm and mean body weight (BW) of 0.45 ± 0.007 g were stocked in the containers at 100 ind m−2 and reared until they attained the 3 cm SL size required for grow-out culture in three of the four culture containers. For grow-out culture, juvenile abalone harvested from nursery culture with mean SL of 3.23 ± 0.018 cm and mean BW of 7.33 ± 0.131 g were stocked in the containers at 50 ind m−2 and reared until they were harvestable at 5 cm SL cocktail size in three of the four culture containers. The 3 cm SL grow-out size was attained at 90 days of culture (DOC) in recycled containers, trays, and tubes, while the 5 cm SL cocktail size at 180 DOC in the same containers. Abalone reared in tubes had the highest mean SL after 90 DOC in nursery culture (3.21 cm), while those in trays after 180 DOC in grow-out culture (5.30 cm). However, at the end of the nursery and grow-out culture, there were no significant differences in mean SL among the abalone reared in these three culture containers. In both culture phases, abalone reared in cages had the lowest mean SL, 2.88 and 4.44 cm, respectively. Survival was highest in trays (98.64%) during nursery culture and in tubes (96.57%) during grow-out culture. With comparable results in recycled containers, trays, and tubes for both growth and survival at the nursery and grow-out phases, tubes are recommended for use when culture is to be done on reef flats. Tubes are the most stable and durable among the four culture containers tested. They can withstand strong winds and waves and may be reused for several culture runs. • Cage, recycled oil container, tray, and tube were compared as culture containers of abalone in nursery and grow-out culture. • Nursery: at 90 DOC, abalone attained the desired ≥3 cm shell length (SL) for grow-out culture in three of the four containers. • Grow-out: at 180 DOC, abalone attained ≥5 cm SL cocktail size in three of the four containers and were ready for harvest. • Abalone reared in cages had the least growth and survival; those reared in other culture containers had comparable results. • Of the four containers, tube is recommended for use in large-scale culture on reef flats. [ABSTRACT FROM AUTHOR]

[Display omitted] • Development of two benchmark models for post-world war II residential buildings. • Average energy use intensity per household (archetypes A and B) were 166 and 155 kWh/m2/year. • Models validated with four-year monitoring data on energy consumption. • Households are dominated by senior adults and their occupancy profiles are presented. • Findings on energy needs and use intensity are useful in temperate and continental climates. In the context of the European carbon neutrality targets, building benchmarks are a key issue for the renovation of existing buildings. Although there are various benchmark methods for energy efficiency characterization, their application to the residential sector is still limited. This paper developed two building simulation models for post-world war II houses in Belgium based on data from post-occupancy measurements and field survey campaigns. The study reports the energy characteristics and occupancy profiled of detached single-family houses. An analysis of energy consumption (electricity and natural gas) and a walkthrough survey were conducted between 2016 and 2019. The benchmark model's validity has been further checked against public statistics and verified through model calibration and monthly energy bill comparison. Two reference models representing 633.702 post-WWII single-family houses in Belgium were created and validated. The first archetype has an average energy use intensity of 166 kWh/m2/year and represents detached single-family houses built between 1945 and 1969. The second archetype has an average energy use intensity of 155 kWh/m2/year and represents detached single-family houses built between 1970 and 1990. The paper provides a timely opportunity to evaluate the real performance of post-world war II most common archetypes concerning design assumptions and how building professionals can turn the energy performance gap challenge to their advantage. The findings on energy needs and intensity are useful for creating future renovation scenarios for similar archetypes in Western European countries. [ABSTRACT FROM AUTHOR]

With expected increases in the number of older adults worldwide, the delivery of stepped psychological care for depression and anxiety in older populations may improve both treatment and allocative efficiency for individual patients and the health system. A multisite pragmatic randomised controlled trial evaluating the clinical and cost-effectiveness of a stepped care model of care for treating depression and anxiety among older adults compared to treatment as usual (TAU) will be conducted. Eligible participants (n = 666) with clinically interfering anxiety and/or depression symptoms will be recruited from and treated within six Australian mental health services. The intervention group will complete a low intensity cognitive behavioural therapy (CBT) program: Internet-delivered or using a work-at-home book with brief therapist calls (STEP 1). Following STEP 1 a higher intensity face-to-face CBT (STEP 2) will then be offered if needed. Intention-to-treat analyses will be used to examine changes in primary outcomes (e.g. clinician-rated symptom severity changes) and secondary outcomes (e.g. self-reported symptoms severity, health related quality of life and service utilisation costs). An economic evaluation will be conducted using a cost-utility analysis to derive the incremental cost-effectiveness ratio for the stepped care intervention. This study will demonstrate the relative clinical and economic benefits of stepped care model of psychological care for older adults experiencing anxiety and/or depression compared to TAU. The evaluation of the intervention within existing mental health services means that results will have significant implications for the translation of evidence-based interventions in older adult services across urban and rural settings. Prospectively registered on anzctr.org.au (ACTRN12619000219189) and isrctn.com (ISRCTN37503850). [ABSTRACT FROM AUTHOR]