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Introduction: long-term care (LTC) residents have higher hospitalisation rates than non-LTC residents. Rapid decline may follow hospitalisations, hence the importance of preventing unnecessary hospitalisations. Literature describes diagnosis-specific interventions (for cardiac failure, ischaemic heart disease, chronic obstructive pulmonary disease, stroke, pneumonia--termed 'big five' diagnoses), impacting on hospitalisations of older community-dwellers, but few RCTs show reductions in acute admissions from LTC. Methods: LTC facilities with higher than expected hospitalisations were recruited for a cluster-randomised controlled trial (RCT) of facility-based complex, non-disease-specific, 9-month intervention comprising gerontology nurse specialist (GNS)-led staff education, facility benchmarking, GNS resident review and multidisciplinary discussion of residents selected using standard criteria. In this post hoc exploratory analysis, the outcome was acute hospitalisations for 'big five' diagnoses. Re-randomisation analyses were used for end points during months 1-14. For end points during months 4-14, proportional hazards models are adjusted for within-facility clustering. Results: we recruited 36 facilities with 1,998 residents (1,408 female; mean age 82.9 years); 1,924 were alive at 3 months. The intervention did not impact overall rates of acute hospitalisations or mortality (previously published), but resulted in fewer 'big five' admissions (RR = 0.73, 95% CI = 0.54-0.99; P = 0.043) with no significant difference in the rate of other acute admissions. When considering events occurring after 3 months (only), the intervention group were 34.7% (HR = 0.65; 95% CI = 0.49-0.88; P=0.005) less likely to have a 'big five' acute admission than controls, with no differences in likelihood of acute admissions for other diagnoses (P = 0.96). Conclusions: this generic intervention may reduce admissions for common conditions which the literature shows are impacted by disease-specific admission reduction strategies. [ABSTRACT FROM AUTHOR]

Behavioural phenotypes are invariably plastic to some degree and are among the most labile of phenotypes. Some are acquired over the course of development in a particular environment (developmental plasticity), but most are elicited by an environmental trigger and are expressed only briefly, but often repeatedly, in the life of an organism (activational plasticity). Thus, individuals can possess the ability to perform a behaviour, but in the absence of the appropriate environmental stimulus, can fail to do so over the course of a lifetime. Rarely is the evolution of behavioural phenotypes explored in the larger context of the evolution of phenotypically plastic traits. Here I argue that the evolution of behavioural phenotypes, regardless of the nature of the plasticity expressed, can be examined in the same way as the evolution of other plastic traits. I first provide a conceptual review of the factors that can influence the evolution of plastic phenotypes and of the ways in which behavioural plasticity can influence the evolution of other aspects of phenotype. Many of the most compelling questions involve contrasting ancestral patterns of plasticity with those in derived populations or species, a particularly challenging problem in the case of phenotypic plasticity. I therefore provide an overview of the ways in which the influence of plasticity upon evolution can be addressed and then provide a review of examples from the literature that offer initial insights into the role of behavioural plasticity in evolution. The questions are exciting, the data limited, and, as I argue in closing, we need creative insights into the ways in which behavioural plasticity has evolved and has in turn influenced the evolution of other aspects of phenotype. [ABSTRACT FROM AUTHOR]

Aims: Allied health professionals (AHPs) have a key role in the delivery of palliative care through rehabilitation. However, evidence suggests that rehabilitation remains an area of neglect in palliative care. This study explores the views of allied health professionals in delivering rehabilitation in palliative care to people with Parkinson's disease. Methods: Twelve allied health professionals, from both generalist and specialist settings, who had experience of working with people with advanced Parkinson's disease and/or palliative care took part in interviews and/or focus groups. Findings: Participants viewed palliative care as holistic care, however, the rehabilitation care they provided was impeded by a number of personal and organisational barriers, and negative perceptions. Misconceptions as to the value of rehabilitation in the palliative stage and a lack of training resulted in uncertainty as to when and how it could be introduced. While the importance of early referral to AHP rehabilitation services was highlighted, organisational and administrative barriers prevented many people from accessing such care. Conclusions: Many health professionals have a role in palliative rehabilitation, but barriers prevent early referral and ongoing access to such services. There is a need to educate professionals in the principles of palliative rehabilitation, combined with providing targeted resources to promote shared care and responsibility. [ABSTRACT FROM AUTHOR]