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AIMS: To determine the prevalence of potentially inappropriate medication (PIM) use at hospital admission and discharge, and the contribution to hospital admission among residential aged care facility (RACF) residents with and without dementia. METHODS: We conducted a secondary analysis using data from a multi‐hospital prospective cohort study involving consecutively admitted older adults, aged 75 years or older, who were taking five or more medications prior to hospital admission and discharged to a RACF in South Australia. PIM use was identified using the 2015 Screening Tool for Older Persons’ Prescription (STOPP) and 2019 Beers Criteria. An expert panel of clinicians with geriatric medicine expertise evaluated the contribution of PIM to hospital admission. RESULTS: In total, 181 participants were included, the median age was 87.5 years and 54.7% were female. Ninety‐one (50.3%) had a diagnosis of dementia. Participants with dementia had less PIMs, according to at least one of the two screening criteria, than those without dementia, at admission (dementia: 76 (83.5%) vs no dementia: 84 (93.3%), p=0.04) and discharge (78 (85.7%) vs 83(92.2%), p=0.16). PIM use was causal or contributory to the admission in 28.1% of study participants (n=45) who were taking at least one PIM at admission. CONCLUSIONS: Over 80% of acutely admitted older adults took PIMs at hospital admission and discharge and for over a quarter of these people the admissions were attributable to PIM use. Hospitalisation presents an opportunity for comprehensive medication reviews, and targeted interventions that enhance such a process could reduce PIM use and related harm. Refereed/Peer-reviewed

Missed nursing care is a concern on inpatient hospital units but has not been adequately explored in the perioperative setting. This cross-sectional study used results from a survey of 1,693 AORN members to investigate the amount and type of missed perioperative nursing care and evaluate associations between reported missed care and facility and nurse characteristics. The survey asked OR nurses how frequently specific care items were missed by themselves or others. Overall, nurses' perceptions of the frequency of missed care was 0.84 on a scale of 0 to 4 (0 = never, 4 = always). The survey items were categorized into five subscales: legal requirement, preparation, safety, communication, and closing routine. Nurses reported most missed care in the communication and preparation categories. The number of ORs at a facility, nurse education and job title, and perceptions of staffing adequacy were significantly associated with the perceived amount of missed perioperative nursing care.

Objective: To determine the prevalence of medication- related hospitalisations pre-ceded by potentially suboptimal processes of care in aged care residents Method: We conducted a retrospective analysis of administrative claims data from the Australian Government Department of Veterans’ Affairs (DVA). We identified all hospital admissions for aged care residents between 1 July 2014 and 30 June 2019. The proportion of hospital admissions preceded by potentially suboptimal medication- related processes of care was determined Results: A total of 18874 hospitalisations were included, and 46% were preceded by potentially suboptimal medication- related care. One- quarter of fracture admissions occurred in residents at risk of fracture who were not using a medicine to prevent fracture, and 87% occurred in residents using falls- risk medicines. Thirty per cent of heart failure admissions occurred in patients who were not using an angiotensin- converting enzyme inhibitor or angiotensin receptor blocker Conclusion: Nearly half of hospital admissions were preceded by potentially sub-optimal medication- related processes of care. Interventions to improve use of medi-cines for aged care residents in these areas are warranted. Refereed/Peer-reviewed

We conducted simulations with a 4-km resolution for Hurricane Joaquin in 2015 using the weather research and forecast (WRF) model. The model data are used to study stratospheric gravity waves (GWs) generated by the hurricane and how they correlate with hurricane intensity. The simulation results show spiral GWs propagating upward and anticlockwise away from the hurricane center. GWs with vertical wavelengths up to 14 km are generated. We find that GW activity is more frequent and intense during hurricane intensification than during weakening, particularly for the most intense GW activity. There are significant correlations between the change of stratospheric GW intensity and hurricane intensity. Therefore, the emergence of intensive stratospheric GW activity may be considered a useful proxy for identifying hurricane intensification.

Objective: To identify demographic and medication-related predictors of unplanned hospitalisation and combine them into a hospitalisation risk score.Methods: Patients aged ≥65 years from an outpatient multimorbidity clinic were included. Hospitalisation predictors within a year of clinic discharge were identified using logistic regression. A risk score was developed. The area under the curve(AUC) was used to assess its predictive ability, compared to that of the medicines count (definition of polypharmacy). Results: A total of 598 patients were included (median age of 80.0 years). 58.0%(n = 347) were hospitalised within a year of clinic discharge. The AUC for the risk score incorporating age, medicines count, heart failure (HF), atherosclerotic disease and systemic steroids was 0.67 [95% CI 0.62-0.71], compared to 0.62 [95% CI 0.58-0.67] for the medicines count. Conclusion: A hospitalisation risk score incorporating demographics, medicines,namely steroids, and diseases such as HF had increased predictive ability compared to the medicines count, providing guidance for developing future polypharmacy tools. Refereed/Peer-reviewed

Aims and objectives The purpose of this study was to examine the extent to which staffing adequacy predicts nursing teamwork, controlling for demographic and background variables. Background Findings from former studies indicate that hospital, unit and staff characteristics may be related to nursing teamwork, such as type of hospital and unit, role, gender, age, work experience, type of shift worked, shift length, number of working hours per week, overtime and staffing adequacy. Teamwork as well as staffing is identified as significant contributors to patient and staff safety in hospitals. However, the contribution of staffing to the quality of nursing teamwork is scarcely studied. Design This was a quantitative descriptive cross-sectional study using the paper-and-pencil questionnaire Nursing Teamwork Survey-Icelandic. Methods The study was conducted in 27 inpatient units in eight hospitals in Iceland with a sample of 925 nursing staff members. Participants were 567 registered nurses, practical nurses, unit secretaries and nurse unit managers. The Strengthening the Reporting of Observational Studies in Epidemiology checklist was used for this paper. Results When controlling for unit type, role, experience on current unit and intent to leave, perceived adequacy of staffing alone explains up to 10% of overall teamwork. Unit type, role, years of experience on current unit and perceived staffing adequacy correlated significantly with overall teamwork. Conclusions The findings of this study indicate that unit and staff characteristics, including perceived adequacy of staffing, are associated with and explain the variability in nursing teamwork on inpatient hospital units. The findings of this study provide important information for clinical nurses, nurse managers, policymakers and instructors in health care. Relevance to clinical practice The findings underline the importance of adequate staffing for nursing teamwork in inpatient hospital units.

We conduct a mesoscale simulation with a 4-km resolution for Hurricane Joaquin in 2015 using the Weather Research and Forecast (WRF) model. The model data are used to study stratospheric gravity wa...

Background: Delirium is a serious condition in which medications are just one of a number of potential predisposing or precipitating factors. Adequate knowledge of delirium among all healthcare professionals, including pharmacists, may assist in effective prevention and management. However, little is known about the knowledge of pharmacists regarding delirium. Aim: To assess Australian hospital pharmacists’ knowledge of risk factors, symptoms, prevention and treatment of delirium in elderly patients. Method: A cross-sectional survey was conducted via a web-based questionnaire to collect information on participants’ demographics, knowledge of delirium risk factors, symptoms, prevention and treatment. A link to the survey was included in the newsletters of The Society of Hospital Pharmacists of Australia, Australasian Delirium Association and New South Wales Therapeutic Advisory Group and distributed to hospital pharmacists in Australia via email. Results: One-hundred and six responses from hospital pharmacists were available for analysis. Nine of 11 questions assessing basic knowledge were correctly answered by more than half of respondents. Seven of the eight questions related to delirium prevention strategies were correctly answered by more than half of pharmacists. However, only three of the eight questions about risk factors for delirium were answered correctly by more than half of pharmacists. Conclusion: Pharmacists’ basic knowledge about delirium and prevention strategies was good; however, their knowledge of risk factors and symptoms of delirium needs to be improved. Delirium-specific educational programs for pharmacists should be considered for improving their knowledge and understanding regarding delirium. Refereed/Peer-reviewed

Objectives: To examine the risk of dementia associated with posttraumatic stress disorder (PTSD) and the contribution of antipsychotic use to this risk. Design: Retrospective cohort study Setting: Australia. Administrative claims data from the Australian Government Department of Veterans' Affairs were used. Participants: Male Vietnam veterans aged 55 to 65 at baseline (2001-02) with no preexisting dementia diagnosis (N = 15,612). Measurements: The association between PTSD and dementia was assessed over 12 years of follow-up. Dementia was identified as a hospital diagnosis, dementia record in service disability data, or dispensing of medicines for dementia. Cox-proportional hazards models were used, with age as the time-scale. Results were stratified according to baseline antipsychotic use. Results: No greater risk of dementia was observed with PTSD. In veterans who received antipsychotics, dementia risk was significantly higher than in those who did not (hazard ratio (HR) = 2.1, 95% confidence interval (CI) = 1.4-3.3). Dementia risk was significantly greater in veterans hospitalized for PTSD who received antipsychotics (HR = 2.2, 95% CI = 1.1-4.6) and veterans without PTSD who received antipsychotics (HR = 4.3, 95% CI = 2.1-8.6) than in those without PTSD with no antipsychotic use. Conclusion: Antipsychotic use may be a contributor to dementia risk. These findings should be interpreted with caution because the study design was observational. Further research using prospective study designs in settings where diagnostic data, cognitive function, and disease severity are available are required. Refereed/Peer-reviewed

Using social media to collect patient perspectives on quality of life : A feasibility study

BACKGROUND Missed nursing care is an error of omission defined as standard, required nursing care that is not completed or is seriously delayed. Study findings from around the world show that missed nursing care is a global concern. PURPOSE The purpose of this study was to compare reports of missed nursing care by two types of nurses - registered nurses and practical nurses - in acute care hospitals in Iceland. Former studies in the USA indicate a variance in reports of missed nursing care by staff with different roles. METHODS This was a cross-sectional descriptive study using the MISSCARE Survey-Icelandic questionnaire for data collection. The questionnaire asks about the amount of missed nursing care on the unit for 24 nursing elements (Part A) and 17 reasons of care being missed (Part B). Participants were nursing staff from medical, surgical and intensive care units in all hospitals in Iceland. FINDINGS A t-test for independent groups showed a significant difference for the overall missed nursing care score (Part A) between registered nurses (M = 2.09, SD = 0.51) and practical nurses (M = 1.82, SD = 0.59) [t(541) = 5.703, p < 0.001]. A comparison of the overall mean score for reasons of missed nursing care (Part B) between registered nurses (M = 2.32, SD = 0.38) and practical nurses (M = 2.21, SD = 0.62) indicated a significant difference in their reporting [t(299) = 2.210, p = 0.028]. In spite of the overall significant difference in ratings of the elements and reasons for missed nursing care by registered nurses and practical nurses, a pattern is evident in the ranking of the elements of nursing care being missed and reasons. CONCLUSIONS The findings of this study point to the need to acknowledge certain aspects of missed nursing care and the different roles within nursing. They indicate a need to improve open, sincere and structured communication and mutual respect and trust within healthcare teams in Icelandic hospitals.

Aims and objectives To identify the contribution of hospital, unit, staff characteristics, staffing adequacy and teamwork to missed nursing care in Iceland hospitals. Background A recently identified quality indicator for nursing care and patient safety is missed nursing care defined as any standard, required nursing care omitted or significantly delayed, indicating an error of omission. Former studies point to contributing factors to missed nursing care regarding hospital, unit and staff characteristics, perceptions of staffing adequacy as well as nursing teamwork, displayed in the Missed Nursing Care Model. Design This was a quantitative cross-sectional survey study. Methods The samples were all registered nurses and practical nurses (n = 864) working on 27 medical, surgical and intensive care inpatient units in eight hospitals throughout Iceland. Response rate was 69·3%. Data were collected in March–April 2012 using the combined MISSCARE Survey-Icelandic and the Nursing Teamwork Survey-Icelandic. Descriptive, correlational and regression statistics were used for data analysis. Results Missed nursing care was significantly related to hospital and unit type, participants’ age and role and their perception of adequate staffing and level of teamwork. The multiple regression testing of Model 1 indicated unit type, role, age and staffing adequacy to predict 16% of the variance in missed nursing care. Controlling for unit type, role, age and perceptions of staffing adequacy, the multiple regression testing of Model 2 showed that nursing teamwork predicted an additional 14% of the variance in missed nursing care. Conclusions The results shed light on the correlates and predictors of missed nursing care in hospitals. This study gives direction as to the development of strategies for decreasing missed nursing care, including ensuring appropriate staffing levels and enhanced teamwork. Relevance to clinical practice By identifying contributing factors to missed nursing care, appropriate interventions can be developed and tested.

The importance of histone acetylation for certain types of memory is now well established. However, the specific contributions of the various histone acetyltransferases to distinct memory functions remain to be determined; therefore, we employed selective histone acetyltransferase protein inhibitors and short-interference RNAs to evaluate the roles of CREB-binding protein (CBP), E1A-binding protein (p300) and p300/CBP-associated factor (PCAF) in hippocampus and perirhinal cortex (PRh)-mediated object memory. Rats were tested for short- (STM) and long-term memory (LTM) in the object-in-place task, which relies on the hippocampus and PRh for spatial memory and object identity processing, respectively. Selective inhibition of these histone acetyltransferases by small-interfering RNA and pharmacological inhibitors targeting the HAT domain produced dissociable effects. In the hippocampus, CBP or p300 inhibition impaired long-term but not short-term object memory, while inhibition of PCAF impaired memory at both delays. In PRh, HAT inhibition did not impair STM, and only CBP and PCAF inhibition disrupted LTM; p300 inhibition had no effects. Messenger RNA analyses revealed findings consistent with the pattern of behavioral effects, as all three enzymes were upregulated in the hippocampus (dentate gyrus) following learning, whereas only CBP and PCAF were upregulated in PRh. These results demonstrate, for the first time, the necessity of histone acetyltransferase activity for PRh-mediated object memory and indicate that the specific mnemonic roles of distinctive histone acetyltransferases can be dissociated according to specific brain regions and memory timeframe.

The purpose of this study was to test the psychometric properties of the Nursing Teamwork Survey-Icelandic (NTS-Icelandic), which was translated from US English to Icelandic. The Nursing Teamwork Survey, with 33 items, measures overall teamwork and five factors of teamwork: trust, team orientation, backup, shared mental models, and team leadership. The psychometric testing of the NTS-Icelandic was carried out on data from a pilot study and a national study. The sample for a pilot study included 123 nursing staff from five units, and the sample for a national study included 925 nursing staff from 27 inpatient units. The overall test-retest intraclass correlation coefficient in the pilot study was 0.693 (lower bound = 0.498, upper bound = 0.821) (p