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Background: Adverse drug reactions (ADRs) and adverse drug events (ADEs) in older people contribute to a significant proportion of hospital admissions and are common following discharge. Effective interventions are therefore required to combat the growing burden of preventable ADRs. The Prediction of Hospitalisation due to Adverse Drug Reactions in Elderly Community Dwelling Patients (PADR-EC) score is a validated risk score developed to assess the risk of ADRs in people aged 65 years and older and has the potential to be utilised as part of an intervention to reduce ADRs.Objectives: This trial was designed to investigate the effectiveness of an intervention to reduce ADR incidence in older people and to obtain further information about ADRs and ADEs in the 12-24 months following hospital discharge.Methods: The study is an open-label randomised-controlled trial to be conducted at the Royal Hobart Hospital, a 500-bed public hospital in Tasmania, Australia. Community-dwelling patients aged 65 years and older with an unplanned overnight admission to a general medical ward will be recruited. Following admission, the PADR-EC ADR score will be calculated by a research pharmacist, with the risk communicated to clinicians and discussed with participants. Following discharge, nominated general practitioners and community pharmacists will receive the risk score and related medication management advice to guide their ongoing care of the patient. Follow-up with participants will occur at 3 and 12 and 18 and 24 months to identify ADRs and ADEs. The primary outcome is moderate-severe ADRs at 12 months post-discharge, and will be analysed using the cumulative incidence proportion, survival analysis and Poisson regression.Summary: It is hypothesised that the trial will reduce ADRs and ADEs in the intervention population. The study will also provide valuable data on post-discharge ADRs and ADEs up to 24 months post-discharge. [ABSTRACT FROM AUTHOR]

A study was conducted on stabilization plans which seek to lower inflation rates through the exchange rate, with emphasis on their interest rate aspects. A model was developed representing interest rate and portfolio determination when real currrency devaluation is imminent and considering account risk aversion among investors. Using monthly data from the period 1979-1980, it was found that the net monthly interest rate arbitrage return for Argentina was negatively associated with a 'safety factor' and the aggregate change in trade balance.

Purpose To pilot an evidence-based communication skills model (SAGE & THYME) with UK District Nurses (DNs) who visit patients with advanced cancer early in the dying trajectory. Evidence suggests that DNs lack confidence in communication skills and in assessing cancer patients' psycho-social needs; also that they lack time. SAGE & THYME is a highly structured model for teaching patient centred interactions. It addresses concerns about confidence and time. Method Mixed methods. 33 DNs were trained in SAGE & THYME in a three hour workshop and interviewed in focus groups on three occasions: pre-training, immediately post-training and two months post-training. Questionnaires measuring perceived outcomes of communication, confidence in communication and motivation to use SAGE & THYME were administered at the focus groups. Results SAGE & THYME provided a structure for conversations and facilitated opening and closing of interactions. The main principle of patient centeredness was reportedly used by all. Knowledge about communication behaviours helpful to patients improved and was sustained two months after training. Increased confidence in communication skills was also sustained. Motivation to use SAGE & THYME was high and remained so at two months, and some said the model saved them time. Challenges with using the model included controlling the home environment and a change in style of communication which was so marked some DNs preferred to use it with new patients. Conclusion Training DNs in SAGE & THYME in a three hour workshop appears to be a promising model for improving communication skills when working with cancer patients. [ABSTRACT FROM AUTHOR]

Summary: Background: Facilitating and supporting clinical learning for student nurses and midwives are essential within their practice environments. Clinical placements provide unique opportunities in preparation for future roles. Understanding the experiences of first year student nurses and midwives following clinical exposures and examining the clinical facilitators and barriers can assist in maintaining and developing clinical supports. Methods: The study used a structured group feedback approach with a convenience sample of 223 first year nursing and midwifery students in one Irish university in April 2011 to ascertain feedback on the clinical aspects of their degree programme. Results: Approximately 200 students participated in the process. Two key clinical issues were identified by students: facilitating clinical learning and learning experiences and needs. Positive learning environments, supportive staff and increased opportunities for reflection were important issues for first year students. Conclusions: The role of supportive mentoring staff in clinical practice is essential to enhance student learning. Students value reflection in practice and require more opportunities to engage during placements. More collaborative approaches are required to ensure evolving and adapting practice environments can accommodate student learning. [Copyright &y& Elsevier]

Abstract: The prebiotic potential of a konjac glucomannan hydrolysate (GMH) was investigated in vitro using batch cultures inoculated with human faeces. Bacterial enumeration was carried out using the culture independent technique, fluorescent in situ hybridisation (FISH), and short chain fatty acid (SCFA) production was monitored by gas chromatography. The populations of Bifidobacterium genus, Lactobacillus–Enterococcus group and the Atopobium group all significantly increased after GMH and inulin fermentation. The Bacteroides–Prevotella group had a lower end population after GMH fermentation while inulin gave an increase, although these differences were not significant. No significant differences in SCFA concentrations were observed between inulin and GMH. As with inulin, GMH produced selective stimulation of beneficial gut microbiota and a favourable SCFA profile. In order to confirm a beneficial effect of GMH further in vivo studies involving healthy human volunteers should be considered. [ABSTRACT FROM AUTHOR]

Objective: To develop a model for addressing the emotional concerns of patients or their caregivers; to teach the model in a three-hour workshop and to assess the impact of that training on a wide range of health and social care staff. Methods: A multi-specialty team, including a cancer patient, developed a model based on the evidence relating to emotional support and communication skills. The model (SAGE & THYME™) consists of nine steps (see Box 1). The purpose of the model is to enable staff of all grades and roles to fulfil the most important objectives of support: enabling patients to describe their concerns and emotions if they wish to do so, holding and respecting those concerns; identifying the patients’ support structures; exploring the patients’ own ideas and solutions before offering advice or information. Over 800 health and social care staff of all grades and students have participated in the three-hour SAGE & THYME™ training workshops. Results: Analysis from 412 participants suggests that the workshops had a significant positive effect on self-confidence (p <.0005), self-perception of competence (p <.0005) and willingness to explore the emotional concerns of patients (p <.0005). 95% felt that the workshop would be very likely to have an impact on their practice. Conclusions: The workshops have been successful in increasing the self-perceptions of confidence, competence and willingness to explore the emotional concerns of patients. The model ‘SAGE & THYME™’ has been welcomed by participants. Practice implications: Staff groups will require training for patients or their caregivers to have their concerns heard without interruption and to be allowed to explore their own resolutions. The three-hour SAGE & THYME™ training may go some way towards helping patients and staff form sound partnerships which assist patients to participate constructively in their own care. [Copyright &y& Elsevier]

Summary: Nursing students are increasingly undertaking paid term-time employment to finance their living expenses and studies. However the type and duration of this part-time work is unknown; furthermore there is a limited evidence on the extent to which this part-time employment is impacting on academic performance and the student’s experience of higher education. To address this shortfall this study undertook a cross-sectional survey of undergraduate nursing students to explore the incidence of student involvement in term-time employment and to develop an understanding of the relationship of employment on student’s academic and clinical achievement, and on their experience of higher education. The results found that the vast majority of the sample were working in part-time employment during term-time. The average number of hours worked per week was sixteen. The number of hours worked per week was found to be a predictor of course performance, the student’s experience of college and grades achieved. Students who worked greater hours reported negative outcomes in each of these three domains. The findings also support the contention that it is not working per se that has a detrimental effect on student outcomes but the numbers of hours’ students are actually working while attending college. Therefore policy makers, educationalists and health service providers need to be aware of the burden that nursing students may have to contend with in combining work with their academic studies. [Copyright &y& Elsevier]

To discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer. Literature regarding spirituality and life review of the author in cancer care provided the foundation for this article. Reliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer. Nurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being. [ABSTRACT FROM AUTHOR]

Discusses the effects of contraband on resource allocation and welfare using Paraguayan data. Trade taxes; Transhipment of goods from third countries through Paraguay to Brazil and Argentina; International Monetary Fund estimates of reported and unreported trade; Benefits and costs of smuggling; Welfare effects of illegal trade.

• We address the isenthalpic flash problem using a reduced variables formulation. • Our research extends the use of reduced variables beyond the isothermal phase-split. • The reduced formulation is insensitive to the presence of the trace concentrations. Thermal enhanced oil recovery (EOR) involves the complex interplay of mass and energy transport processes with phase behavior. Hydrocarbon and water components partition across multiple fluid phases as a function of composition, pressure and temperature. Thermal compositional simulation thus requires phase-equilibrium calculations for at least three fluid phases. Isenthalpic flash (phase-split) is needed for thermal compositional simulation when the molar variables are used in the solution of the global mass and energy balances. Isenthalpic flash solves for phase compositions and phase amounts, in addition to temperature. Isothermal flash algorithms have been consistently refined over the past four decades, whereas isenthalpic flash remains an outstanding challenge in the study of petroleum reservoir thermodynamics. Isenthalpic flash is more challenging than isothermal flash for a number of reasons. First, temperature is unknown a priori , resulting in uncertainty regarding the phase state. Second, narrow boiling point behavior results in extremely nonlinear behavior of enthalpy with respect to temperature. Finally, thermal EOR involves the injection of steam which results in hydrocarbon–water interactions at elevated temperatures. Water is the thermodynamically dominant component in this context, and cannot be excluded from phase equilibrium calculations in the simulation of thermal recovery processes. In this research we address the isenthalpic flash problem using a reduced variables formulation. For the first time, we extend the use of reduced variables beyond the isothermal-isobaric domain for phase-split calculations. We introduce a fully coupled Newton method, which exhibits rapid convergence even for narrow boiling point problems. Excellent performance of our novel formulation is demonstrated through comprehensive testing of characterized fluids from the literature. We expect the developments in this research to fortify the coupling of phase-equilibrium calculations with the mass and energy conservation laws in thermal compositional simulation. [ABSTRACT FROM AUTHOR]

Purpose: A single-center randomized clinical trial was performed to compare postinterventional primary patency rates achieved by cutting balloon angioplasty and high-pressure balloon angioplasty in the treatment of de novo stenoses within autogenous arteriovenous (AV) fistulae for hemodialysis.Materials and Methods: Forty-eight patients undergoing their first angioplasty were prospectively randomized to undergo angioplasty with a cutting balloon or high-pressure balloon 4-8 mm in diameter because cutting balloons larger than 8 mm are not available. Nine patients were excluded after angiography, with seven requiring balloons larger than 8 mm. In the remaining 39 patients, there were 42 stenoses in the following regions: juxtaanastomotic (38%), perianstomotic (38%), midcephalic (9%), and cephalic arch (14%). Patients in the cutting balloon group were younger (mean age difference, 9 y; P = .04), but other demographic variables were comparable (range, P = .08-.89). The mean follow-up period was 8.5 mo (range, 24 d to 32 mo). Kaplan-Meier analysis was used to compare duration of patency. Mann-Whitney rank-sum t test and χ2/Fisher exact tests were used to compare continuous and categoric variables, respectively.Results: Technical success was achieved in all 39 patients. At 3, 6, and 12 months, the postinterventional primary patency rates for the cutting balloon group were 61.1% (95% confidence interval [CI], 35.75%-82.70%), 27.7% (95% CI, 9.69%-53.48%), and 11.1% (95% CI, 1.38%-34.71%), respectively, compared with 70.0% (95% CI, 45.72%-88.11%), 42.1% (95% CI, 20.25%-66.50%), and 26.3% (95% CI, 9.15%-51.20%), respectively, for the high-pressure balloon group (P < .3 at each interval).Conclusions: Compared with high-pressure balloon angioplasty, cutting balloon angioplasty does not improve postinterventional primary patency of de novo stenotic lesions in autogenous arteriovenous fistulae. [ABSTRACT FROM AUTHOR]

Background & Aims: The cellular mediators of acute pancreatitis are incompletely understood. Dendritic cells (DCs) can promote or suppress inflammation, depending on their subtype and context. We investigated the roles of DC in development of acute pancreatitis. Methods: Acute pancreatitis was induced in CD11c.DTR mice using caerulein or L-arginine; DCs were depleted by administration of diphtheria toxin. Survival was analyzed using Kaplan–Meier method. Results: Numbers of major histocompatibility complex II+CD11c+ DCs increased 100-fold in pancreata of mice with acute pancreatitis to account for nearly 15% of intrapancreatic leukocytes. Intrapancreatic DCs acquired a distinct immune phenotype in mice with acute pancreatitis; they expressed higher levels of major histocompatibility complex II and CD86 and increased production of interleukin-6, membrane cofactor protein–1, and tumor necrosis factor–α. However, rather than inducing an organ-destructive inflammatory process, DCs were required for pancreatic viability; the exocrine pancreas died in mice that were depleted of DCs and challenged with caerulein or L-arginine. All mice with pancreatitis that were depleted of DCs died from acinar cell death within 4 days. Depletion of DCs from mice with pancreatitis resulted in neutrophil infiltration and increased levels of systemic markers of inflammation. However, the organ necrosis associated with depletion of DCs did not require infiltrating neutrophils, activation of nuclear factor–κB, or signaling by mitogen-activated protein kinase or tumor necrosis factor–α. Conclusions: DCs are required for pancreatic viability in mice with acute pancreatitis and might protect organs against cell stress. [ABSTRACT FROM AUTHOR]

Robust and efficient multiphase flash calculations are crucial in compositional and thermal simulations for complex fluid systems in which three or four phases may co-exist. Solution of the Rachford-Rice (RR) equations is an important operation in the multiphase flash. The Newton method generally does not converge during solution of the RR equations unless very good initial values are provided. In this paper, the solution of the RR equations is formulated as a minimization of a convex function problem. For the first time, we use a trust-region (TR) method to solve the RR equations through minimization of the convex function. The Hessian matrix of the convex function is always positive-definite, and the TR-based solver guarantees convergence. The key to successful implementation is to determine the relaxation parameter in the Newton update. We select this relaxation parameter to meet the boundary of the objective function and to ensure an adequate step length. We tested the RR solver for three and four phase RR problems in the construction of phase diagrams. The test cases are representative of complex fluid systems encountered in enhanced oil recovery, including injection of CO 2 into low temperature reservoirs and steam injection into heavy oil reservoirs at elevated temperatures. The test results reveal our RR solver to be robust, efficient, insensitive to initial values, and capable of handling negative phase amounts. We also evaluated the effect of the initial values on convergence and recommend methods to estimate the initial values in our RR solver. In summary, our RR solver greatly improves the multiphase flash calculations and strengthens the coupling of phase equilibrium calculations to the governing equations in multiphase compositional and thermal simulation. • Trust-region optimization method guarantees convergence in solving the Rachford-Rice equations. • New strategy to adjust the initial values and to select the relaxation parameter. • Examined the effect of the initial values and proposed new estimation. • Greatly improve the performance of multiphase flash computations in compositional and thermal reservoir simulation. [ABSTRACT FROM AUTHOR]

Established in 2006, the Irish Longitudinal Study on Ageing (TILDA) investigates the health, economic and social circumstances of a nationally-representative sample of people aged fifty years and older in a series of biennial data collection waves. Irish newspapers have been reporting the results of TILDA for over a decade and a half, and their texts represent reports of scientific research distilled through the pen of journalists. In their totality, their texts constitute a public discourse on ageing and health. Using critical discourse analysis, we examined the discourse within the texts of a purposive sample of two national daily newspapers. As sites of public discourse, newspapers reflect social life and are influential in forming and legitimating public attitudes. Like other sites of discourse, their language-in-use is contextually located, is rarely neutral and may employ strategies to discursively construct, sustain and privilege particular social identities, including ageing identities. Discursively constructed as 'ageing well', our analysis of newspaper texts revealed a discernible meta-discourse on ageing and health in which ageing was framed as a life course stage that may be cultivated, diligently self-nurtured and exploited for its positive aspects. When considered in light of literature on health and social inequalities, the consequences of this broadly positive ageing discourse can, somewhat perversely, frame older adults in unintended negative ways, including homogenising them and attributing to them capacities for ageing well that they may not possess. Discursively constructing older adults as a social and economic resource can also impose unrealistic expectations on them and may legitimise exploitation and demonstrate how normative ideologies of ageism and ableism are conveyed through legitimising language. Despite these potentially unintended consequences, the available media resources associated with TILDA may represent one of the most important contributions of the study, in terms of informing positive public attitudes towards ageing. • Media reports on ageing studies can inform positive public attitudes towards ageing. • Media discourse frames 'ageing well' as a life course stage to be self-nurtured. • Positive media discourse can frame older adults in unintended negative ways. • A discourse on healthy ageing can convey normative ideologies of ageism and ableism. [ABSTRACT FROM AUTHOR]

Advance care planning (ACP) is increasingly implemented in oncology and beyond, but a definition of ACP and recommendations concerning its use are lacking. We used a formal Delphi consensus process to help develop a definition of ACP and provide recommendations for its application. Of the 109 experts (82 from Europe, 16 from North America, and 11 from Australia) who rated the ACP definitions and its 41 recommendations, agreement for each definition or recommendation was between 68-100%. ACP was defined as the ability to enable individuals to define goals and preferences for future medical treatment and care, to discuss these goals and preferences with family and health-care providers, and to record and review these preferences if appropriate. Recommendations included the adaptation of ACP based on the readiness of the individual; targeting ACP content as the individual's health condition worsens; and, using trained non-physician facilitators to support the ACP process. We present a list of outcome measures to enable the pooling and comparison of results of ACP studies. We believe that our recommendations can provide guidance for clinical practice, ACP policy, and research. [ABSTRACT FROM AUTHOR]

Background The 80 h work week has raised concerns that complications may increase due to multiple sign-outs or poor communication. Trauma Surgery manages complex trauma and acute care surgical patients with rapidly changing physiology, clinical demands and a large volume of data that must be communicated to render safe, effective patient care. Trauma Morning Report format may offer the ideal situation to study and teach sign-outs and resident communication. Materials and methods Surgery Residents were assessed on a 1–5 scale for their ability to communicate to their fellow residents. This consisted of 10 critical points of the presentation, treatment and workup from the previous night’s trauma admissions. Scores were grouped into three areas. Each area was scored out of 15. Area 1 consisted of Initial patient presentation. Area 2 consisted of events in the trauma bay. Area 3 assessed clarity of language and ability to communicate to their fellow residents. The residents were assessed for inclusion of pertinent positive and negative findings, as well as overall clarity of communication. In phase 1, residents were unaware of the evaluation process. Phase 2 followed a series of resident education session about effective communication, sign-out techniques and delineation of evaluation criteria. Phase 3 was a resident-blinded phase which evaluated the sustainability of the improvements in resident communication. Results 50 patient presentations in phase 1, 200 in phase 2, and 50 presentations in phase 3 were evaluated. Comparisons were made between the Phase 1 and Phase 2 evaluations. Area 1 (initial events) improved from 6.18 to 12.4 out of 15 (p < 0.0001). Area 2 (events in the trauma bay) improved from 9.78 to 16.53 (p < 0.0077). Area 3 (communication and language) improved from 8.36 to 12.22 out of 15 (P < 0.001). Phase 2 to Phase 3 evaluations were similar, showing no deterioration of skills. Conclusions Trauma Surgery manages complex surgical patients, with rapidly changing physiologic and clinical demands. Trauma Morning Report, with diverse attendance including surgical attendings and residents in various training years, is the ideal venue for real-time teaching and evaluation of sign-outs and reinforcing good communication skills in residents. [ABSTRACT FROM AUTHOR]