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The American Academy of Ophthalmology evaluated the practice of routine screening for intraocular infection from Candida septicemia. In the United States, ophthalmologists are consulted in the hospital to screen for intraocular infection routinely for patients with Candida bloodstream infections. This practice was established in the era before the use of systemic antifungal medication and the establishment of definitions of ocular disease with candidemia. A recent systematic review found a rate of less than 1% of routinely screened patients with endophthalmitis from Candida septicemia. Other studies found higher rates of endophthalmitis but had limitations in terms of inaccuracies in ocular disease classification, lack of vitreous biopsies, selection biases, and lack of longer-term visual outcomes. Some studies attributed ocular findings to Candida infections, rather than other comorbidities. Studies also have not demonstrated differences in medical management that are modified for eye disease treatment; therefore, therapy should be dictated by the underlying Candida infection, rather than be tailored on the basis of ocular findings. In summary, the Academy does not recommend a routine ophthalmologic consultation after laboratory findings of systemic Candida septicemia, which appears to be a low-value practice. An ophthalmologic consultation is a reasonable practice for a patient with signs or symptoms suggestive of ocular infection regardless of Candida septicemia.

Mental health issues can have a profound impact on school performance, with anxiety creating significant challenges in the classroom setting. As teachers work to address barriers to learning, schools must develop a system to fully address the growing needs of students with anxiety. The purpose of this study was to examine the relationship between metacognition and its use as a mental health support strategy for students suffering from anxiety. Results of the study showed a statistically significant relationship between the use of metacognition, self-regulation as a component of metacognition, and teacher confidence level in supporting students with anxiety. This study works to further advance the growing body of knowledge regarding the teacher’s role in the support of mental health needs of students.

This study presented a secondary analysis of the National Assessment of Educational Progress (NAEP) dataset. The paper explored the differences between fourth grade reading scores by examining (1) how often the fourth graders discuss their school work at home with family and (2) how often the fourth graders discuss what they were reading with friends. The results by NAEP Data Explorer indicate that the average scale score (M=214, SD=36) of students who report “never or hardly ever” talking about studies at home was significantly (p

The Infectious Diseases Society of America recommends ophthalmologic examinations for everyone with positive Candida blood culture results (candidemia) to screen for endophthalmitis, a practice that remains controversial because of multiple concerns for its limited usefulness and potential for harm.To determine guideline efficacy by reconciling discrepancies in the incidence of endophthalmitis and evaluating outcomes of studies assessing ophthalmologic screening for candidemia.PubMed literature searches, including the search terms candidemia, fungemia, chorioretinitis, and endophthalmitis, identified longitudinal studies prior to 2018 of patients who underwent ophthalmologic evaluations in the setting of positive fungal blood culture results regardless of symptoms or clinical status. Additional studies not captured by these queries were found by manually scanning references within the articles captured by the queries. Ambiguous studies of patients with concomitant bacterial or viral infections were excluded.Thirty-eight applicable studies of 7472 patients who underwent ophthalmologic screening for candidemia or fungemia were identified. Criteria were compared with the conventional definition of endophthalmitis based on present (concordant) or absent (discordant) frank vitreous involvement. Concordant (59 of 6693 [0.9%]) and discordant (114 of 779 [14.6%]) endophthalmitis incidence rates differed by 13.8% (95% CI, 11.4%-16.4%; P .001). Visual acuity for each case was recorded verbatim as subjective report provided by each study, when available. None of the concordant endophthalmitis cases reported direct, intraocular, microscopic evidence of Candida or other fungal organisms. Outcomes were available for 19 patients with concordant endophthalmitis; 6 died within 4 weeks of screening. The rate of substantial vision loss was associated (φ = 0.58; 95% CI, 0.01-0.86; P = .046) with additional invasive intervention (3 of 6 [50.0%]) compared with medical management alone (0 of 6).In this systematic review without meta-analysis, inconsistent definitions of endophthalmitis accounted for discrepancies of its incidence and overreporting among patients with candidemia, contributing to bias and resulting in the construction of guidelines. As few as 3 of 7472 patients had potential improvement, while routine examination overall could lead to additional interventions and harm in this population. These findings suggest that indiscriminate screening based on candidemia alone does not appear to be supported by the literature and should be reevaluated for inclusion as a recommendation from the Infectious Diseases Society of America.

Communicating with students is one of the most important responsibilities for faculty in an online course. It can also be a puzzling process. Having a “communication plan” and understanding effective email strategies, along with proper timing and frequency of communicating with students, are all important pieces of this puzzle. We propose using “touchpoints” in designing a communication plan. This article provides a blueprint of touchpoints as well as best practices for more effective emails for connecting with online students. The blueprint identifies key student touchpoints and provides actionable communication interactions for each touchpoint. These improved strategies can increase instructor-student engagement, student learning, and student satisfaction.

Formative assessment is widely implemented in the classroom to provide both teachers and students timely feedback about learning. A growing body of applications of formative practice has emerged over the last few decades that is based upon research. This is a highly successful approach that has the potential to serve school leaders and enhance school climate and culture. In this manuscript how school leaders can apply formative assessment concepts and strategies to assess and improve working relationships is examined. Specific strategies that principals, teacher leaders, and superintendents can use are reviewed. Discussed are the reflective practice that is facilitated by use of such strategies and how this experience is received by the constituencies a leader serves.

The purpose of this experimental study was to investigate the effects of metacognitive reflective assessment instruction on student achievement in mathematics. The study compared the performance of 141 students who practiced reflective assessment strategies with students who did not. A posttest-only control group design was employed, and results were analyzed by conducting one-way analysis of variance (ANOVA) and nonparametric procedures. On both a posttest and a retention test, students who practiced reflective strategies performed significantly higher than students who did not use the strategies. A within-subjects ANOVA was also conducted six weeks following the intervention to assess how the factor of time affected retention levels. No significant difference was found between the posttest and retention test results for the experimental groups or the control group.

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home’s control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home’s control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families’ expectations regarding residents’ care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.

Formative assessment involves feedback to teachers for informing instruction and also feedback to students for directing their own learning. Early research on formative assessment showed independence from any particular theoretical foundation. Self-regulated learning theory provides a helpful construct for organizing formative assessment through familiar classroom practices, including provision of feedback, strategy use, and metacognition. One way to integrate reflective activities is with reflective assessment, which emphasizes gathering feedback through questioning, writing, and discussing. Ten studies were analyzed using best-evidence methodology to show the effects of reflective assessment on student performance of posttest and retention tests. Weighted mean effect sizes ranged from .28 to .37. Results suggest additional investigations into the use of reflection for improving student learning and other outcomes.

Nursing homes are increasingly becoming the place of care and site of death for growing numbers of frail older people dying of chronic progressive illnesses. Despite this increase, empirical evidence suggests that providing palliative care in nursing homes is replete with challenges. In a previous publication, the authors examined challenges external to the nursing home that influence the provision of palliative care, and which may be beyond the nursing home's control (Wowchuk et al, 2006). This paper reviews the primary internal factors identified in the literature that affect the provision of palliative care and are, to some extent, under the nursing home's control. The internal factors include: i) lack of care provider knowledge about the principles and practices of palliative care; ii) care provider attitudes and beliefs about death and dying; iii) staffing levels and lack of available time for dying residents; iv) lack of physician support; v) lack of privacy for residents and families; vi) families' expectations regarding residents' care; vii) hospitalisation of dying residents. Suggestions for practice, education and research are provided.

Relationships between bereavement following the death of a grandparent and adolescent death anxiety levels were examined using Hogan's Inventory of Bereavement and the revised Death Anxiety Scale within private schools. Of the 226 adolescent respondents (aged 11–18) who completed questionnaires, 124 had experienced the death of a grandparent. The regression model indicated that grief due to bereavement was found to be significantly associated with death anxiety. The factors of personal growth, gender, time since death, and numbers of deaths experienced were not found to be significant predictors within the model. The findings encourage further exploration into the nature of the grandparent–adolescent relationship as well as the impact of type of death experienced.

Advance directives (ADs) are documents that allow competent individuals to set forth their medical treatment wishes and/or to name a proxy in the event that they lose the capacity to communicate these decisions in the future. Despite the benefits of and support for such documents, very few people have completed an AD. This posttest-only experimental study examined whether an individualized intervention given to half of the older adults who attended an educational session increased the discussion and/or completion of ADs. Of the 74 participants, 25.7% (n = 19) completed an AD. There were no significant differences between control and intervention groups on the discussion and/or completion of ADs. Multivariate analysis indicated that perceived barriers were significantly associated with the discussion and completion of ADs. Content analysis revealed that major barriers to discussion and completion include procrastination and a reluctance to think about deteriorating health status and/or death.

Elder abuse research reports little consensus regarding gender and age. This project examined 99 incidents of elder abuse by an adult child and 86 incidents of elder abuse by a spouse, and compared the groups using the variables: gender, age, and incidents. The results are discussed from a feminist and age perspective. Differences between the groups were found, namely that elder abuse by an adult child is most likely to be financial abuse. Traditional ideas about women and men, as well as ideas about the nature of the old were found to be factors in elder abusive relationships.

G. Winokur (1987, Family (genetic) studies in neurotic depression. Journal of Psychiatric Research, 21, 357–363) suggested that in an alcoholic family, alcohol abuse and depression among adult children of alcoholics (AGOAs) may be two ways of expressing the same propensity. It was hypothesised that Winokur's “propensity” could be characterised as a construct of personality variables, specifically low self-esteem, high neuroticism, and high psychoticism. This study examined Winokur's hypothesis using 982 male and female participants (18–64 yr of age) of a general population survey in an attempt to identify the commonalities connecting alcoholic and depressed ACOAs. ACOAs were found to have significantly different personality scores than adults from non-alcoholic families (non-ACOAs), and alcoholic ACOAs shared similar scores with depressed ACOAs on all three personality variables. No differences were seen between alcoholic and depressed participants across family history groups. It would appear from these data that ACOAs can be differentiated from non-ACOAs at least by their low self-esteem, high neuroticism, and high psychoticism, and that alcoholism and depression are two ways that ACOAs can manifest these traits.

RÉSUMÉUn sondage sur l'abus et les mauvais traitements faits aux personnes âgées a été posté à 174 professionnels canadiens et américains susceptibles de compter parmi leur clientèle des victimes d'abus. La négligence représentait la forme la plus courante de mauvais traitements, suivi par l'abus sur le plan financier et les mauvais traitements sur le plan psychologique. La violence physique constituait le plus petit nombre de cas signalés. Même si diverses relations de famille ont été décrites, les fils d'âge moyen représentaient la plus large proportion de personnes responsables d'un comportement abusif, alors que les mères âgées représentaient les victimes les plus fréquentes. Peu importe les lois établies, les répondants ont déclaré que celles-ci étaient généralement efficaces. Le manque de fonds pour administrer les lois et offrir des services aux personnes âgées victimes d'abus représentait la question qui préoccupait le plus les répondants.

RÉSUMÉL'aide de variables découlant de la théorie de l'attachement, cette étude examine les différences entre les sexes dans les types de soins donnés aux parents par les enfants d'âge adulte en fonction de plusieurs facteurs reposant sur la motivation et la structure. Cette étude analyse des données tirées du «Winnipeg Parent Support Project» (Projet de soutien auprès des parents de Winnipeg), qui portait sur l'aide informelle donnée par les fils et les filles âgés de 30 à 64 ans (n = 179). Soutenant les résultats d'études antérieures, l'analyse a démontré que les filles prodiguent davantage de soins que les fils. Les variables structurelles sur le plan de l'emploi, du mariage et de la présence des enfants n'ont donné aucun indicateur prévisionnel significatif sur la quantité de soins donnés par les fils et les filles. La théorie de l'attachement s'est révélée un facteur important. La dépendance perçue des parents, suivie par la fréquence des visites représentaient les plus importants facteurs d'incitation à la prestation de soins chez les fils et les filles. L'aptitude perçue des parents constituait également une variable chez les filles, mais non chez les fils. Les résultats n'ont pas soutenu la théorie d'échange: le facteur de réciprocité n'a pu permettre de prévoir le degré de participation à la prestation de soins. Les auteurs discutent de l'importance de comprendre le comportement des fils et des filles d'âge adulte qui prêtent main-forte.

This article reports the results of a pilot study on the financial abuse of mentally incompetent seniors. The objectives of the study were to: (1) establish the incidence of suspected financial abuse among the clientele of the Office of Public Trustee, Province of Manitoba, (2) identify the characteristics of mentally incompetent older adults most at risk, and (3) identify indicators of financial abuse. Approximately 20% of the cases opened in a one year period were under suspicion of abuse. Findings were consistent with those of other research projects on elder abuse, in general, showing an over-representation of women over the age of eighty as victims of financial abuse. Unpaid personal care home bills when money should have been available was the most common indicator. In addition to providing a list of indicators of financial abuse that are of potential use to professionals, devising prevention programs, practical implications for service providers are presented.

RÉSUMÉCe livre présente une série d'articles, principalement publiés au Canada et aux États-Unis, ayant pour thème la situation des personnes âgées vivant en milieu rural. Le premier chapitre analyse des définitions, des approches et des concepts relatifs à la « ruralité ». Dans le dernier chapitre, les auteurs font des suggestions concernant la recherche, les politiques et la mise sur pied de programmes pour les aânés qui habitent en milieu rural. Les quatre autres chapitres examinent le travail, la retraite et les loisirs; l'autonomie, le réseau familial et social ainsi que la santé. Tout en résumant de nombreuses études, Keating souligne aussi les problèmes qui existent dans plusieurs secteurs. Très peu d'études ont été menées sur la vie des personnes âgées qui vivent en milieu rural et qui n'exploitent pas de ferme, ainsi que sur la retraite dans les villages où sévissent le chômage saisonnier ou le chômage chronique. Les facteurs subjectifs et objectifs doivent être pris en conséderation lorsque l'on examine les services de soutien pour les personnes auto-nomes; les problèmes des autochtones et des services en région éloignée doivent également étre étudiées. Des facteurs subjectifs doivent être explorées en relation avec l'efficacité du soutien familial, et les questions entourant la santé doivent être dégagées de l'optique de la « maladie » et refléter davantage une approche plus subjective et holistique qui est aussi celle des mesures des politiques actuelles.

Possible relationships between bereavement and religiosity to death anxiety levels of adolescents were investigated. Scales measuring religiosity, bereavement, and death anxiety were incorporated into one questionnaire. Two hundred and twenty-six adolescents between the ages of 11 and 18 participated in the study based in urban and rural private schools within Manitoba. Females exhibited significantly higher death anxiety levels than did males; differences between the death anxiety levels of adolescents having a no-previous-death-experience death and those who had experienced a familial death were not significant; while religiosity levels were significantly higher for students attending religion-based schools, the relationships between measurements of religiosity and death anxiety were weak. Grief due to bereavement was the major factor in determining death anxiety for the adolescent.

In this article, the authors explore the home care experience as described by older physically impaired individuals and their caregiving spouses. Separate face-to-face semistructured interviews were carried out with each spouse from nine couples. Analysis of the interview data revealed four themes. For care receivers the themes were Independence and Developing a Trusting Relationship With Home Care Workers. Relief and Continuity were voiced by the caregiving spouses. The authors show how these themes relate to the participants' sense of security, which emerged as a key underlying concept in the home care experience. This study adds to the home care and caregiving literature as it expands our understanding of the relationship between formal and informal caregiving, highlights issues and concerns older couples face as they receive home-based care, and includes both older spouse caregivers and their direct-care recipients.

Although parents experience the death of adult children diagnosed with cancer, most of the literature on adult child death has examined the issues of violent death or suicide. Where death from cancer has been studied, the focus has been mainly on psychological outcomes. Little is known about parents' experiences with this phenomenon.To understand parents' experience of having an adult child die from cancer.Descriptive-exploratory study utilizing semistructured interviews with parents of 10 adult children who had died of cancer.Parents who had lost a child to cancer were interviewed in their own home or in the interviewer's office.Interviews were recorded, transcribed, and analyzed. Latent content analysis and constant comparison techniques were used to develop coding labels, which were then classified into categories and subcategories.Parents experienced a tension between their strong desire to "parent" their child, and their recognition that their child was an autonomous adult, sometimes with a spouse and family who took precedence over them. Parents of a dying child felt helpless, and sometimes were excluded/unacknowledged by health care professionals. To cope, they reconfigured their parent role using various strategies. After the death of their child further reconfiguring takes place, including preserving memories of the child, and talking about him/her. Continuing family and social relationships influence this stage.The conflict of wishing to "parent" a dying adult child while recognizing the child's autonomy creates uncertainty for parents at an already stressful time. Facilitating parent-child communication during the illness is important. After the death of the adult child parents may continue to face difficulty with their perceived role in society (parent and/or bereaved person), and sometimes within their family. Health care professionals should make greater efforts to include the parents of the dying adult in the circle of care. The bereavement experience of these parents is intense and long-lasting. Further research is needed regarding the ways in which health care providers can best assist parents to successfully integrate this profound loss.

Aim To examine the perspectives of family members, registered nurses and healthcare aides regarding the last 72 hours of Canadian nursing home residents' lives. Study design Exploratory, descriptive design using semistructured interviews. Sample Consisted of 14 registered nurses and eight healthcare aides who had provided care within the last 72 hours before a resident's death and four family members who had visited within the same time frame. Setting A 220-bed nursing home located within a larger long-term care facility in Canada. Methods Thematic analysis was conducted independently and through consensus identified themes and subthemes emerging from the interviews. Findings Dyspnea was a more common end-of-life (EoL) symptom for nursing home residents in this sample than was pain. Caring behaviours of staff were central to the resident's dying process and involved assessment, coordination of care, physical care, family education and nurturance. Family members' ambivalence about the resident's death and fear of the resident dying alone were frequently noted. Conclusions Appropriate and timely symptom management and a range of caring behaviours of staff are critical elements in the dying experience of nursing home residents. Additional education and support for personnel involved with caring for this group will enhance end-of-life care.

Intergenerational interaction between matched pairs of older parents and their middle-aged offspring were explored in this research, comparing Mennonites and non-Mennonites. Middle-aged respondents replied to a mailed questionnaire, and their parents were interviewed. Five dimensions of family solidarity were compared between the generations, with the result that middle-aged offspring typically report less family solidarity than do their parents. These results are explained in terms of the concept of the “developmental stake.”