Search

Background: screening for cognitive impairment in Emergency Department (ED) requires short, reliable tools. Objective: to validate the 4AT and 6-Item Cognitive Impairment Test (6-CIT) for ED dementia and delirium screening. Design: diagnostic accuracy study. Setting/subjects: attendees aged ≥70 years in a tertiary care hospital's ED. Methods: trained researchers assessed participants using the Standardised Mini Mental State Examination, Delirium Rating Scale-Revised 98 and Informant Questionnaire on Cognitive Decline in the Elderly, informing ultimate expert diagnosis using Diagnostic and Statistical Manual of Mental Disorders (DSM-V) criteria for dementia and delirium (reference standards). Another researcher blindly screened each participant, within 3 h, using index tests 4AT and 6-CIT. Result: of 419 participants (median age 77 years), 15.2% had delirium and 21.5% had dementia. For delirium detection, 4AT had positive predictive value (PPV) 0.68 (95% confidence intervals: 0.58-0.79) and negative predictive value (NPV) 0.99 (0.97-1.00). At a pre-specified 9/10 cut-off (9 is normal), 6-CIT had PPV 0.35 (0.27-0.44) and NPV 0.98 (0.95-0.99). Importantly, 52% of participants had no family present. A novel algorithm for scoring 4AT item 4 where collateral history is unavailable (score 4 if items 2-3 score ≥1; score 0 if items 1-3 score is 0) proved reliable; PPV 0.65 (0.54-0.76) and NPV 0.99 (0.97--1.00). For dementia detection, 4AT had PPV 0.39 (0.32-0.46) and NPV 0.94 (0.89-0.96); 6-CIT had PPV 0.46 (0.37-0.55) and NPV 0.94 (0.90--0.97). Conclusion: 6-CIT and 4AT accurately exclude delirium and dementia in older ED attendees. 6-CIT does not require collateral history but has lower PPV for delirium. [ABSTRACT FROM AUTHOR]

Successful integration of volunteers in hospital settings is dependent on many factors and volunteer roles should be clearly defined to prevent tension between staff and volunteers. The objective of this article is to explore staff, patient, and family member's perceptions of volunteers to work with and advocate for older adults with a cognitive impairment in the acute hospital setting. This research uses a qualitative descriptive design using semi-structured interviews in a medium sized acute teaching hospital in Ireland. The sample consisted of staff (n 25: nurses, porters, care assistants, and relevant line managers), patients aged sixty-five years or older (n 15), and family members of older patients (n 15) from medical, surgical, and geriatric wards and the emergency department. All groups consistently identified psychosocial support as an area that could well be supplemented by volunteers, followed by practical assistance. Concerns regarding confidentiality and the character of volunteers emerged as a strong theme among all groups. A potential advocacy role for patients was found to be a contentious issue among staff and was poorly understood by patients and family members. We conclude that volunteers to work with older adult patients are broadly welcomed by relevant acute hospital stakeholders especially for psychosocial support. Robust selection and monitoring of volunteers is necessary to reassure all involved. A combined support and advocacy role needs further patient/relative explanation and staff education prior to initiation. [ABSTRACT FROM AUTHOR]

Aim. To measure fatigue and physical functioning in patients with end stage renal disease (ESRD) receiving haemodialysis and to investigate the relationships between fatigue and physical functioning. Background. Fatigue and reduced physical functioning are among the most bothersome symptoms experienced by individuals receiving haemodialysis for ESRD. Research has shown that increasing activity levels has resulted in decreased fatigue levels and improved physical functioning in individuals with cancer. Establishing whether or not a relationship exists between both concepts in haemodialysis patients is a preliminary step in identifying potential fatigue reducing strategies necessary for improved wellbeing. Method. A quantitative exploratory correlational design was used with 46 individuals completing the Multi-dimensional Fatigue Inventory, the Medical Outcomes Study Short-Form 36-item questionnaire and a Demographic Questionnaire. Results. Results indicated fatigue was prevalent with highest scores achieved for physical fatigue; reduced activity and general fatigue. Substantial limitations in physical functioning were found. A significant moderate negative relationship between general fatigue and physical functioning indicated that, as physical functioning levels increased, fatigue levels decreased. A significant difference was also found between general fatigue scores for males and females. Significant relationships were found between overall physical functioning, older age and employment status. Conclusion. The research indicates the prevalence of fatigue and limitations in physical functioning in individuals with ESRD. However, as physical functioning increased fatigue decreased; a finding relevant to clinical nursing. Relevance to clinical practice. Understanding the levels of fatigue and the value of exercise is of relevance to clinical practice thus assessment of fatigue and physical functioning ability in the clinical setting is necessary. [ABSTRACT FROM AUTHOR]

Introduction: (comprising context and the problem statement) The Integrated care Programme in Ireland aims to integrate prevention and management of chronic disease into clinical practice. It will require changes in service delivery to make every clinical consultation count to: Routinely assess patients for their lifestyle risk factors for chronic disease Support patients in changing their lifestyle related health behavior Encourage self-management for patients with existing chronic disease. Changing this culture and practice to Make Every Contact Count will require upskilling of our existing healthcare staff and teaching the skills and knowledge required in undergraduate training programmes for all health professionals as outlined in the National Implementation plan for Healthy Ireland in the Health Services (2015-2017). Short description of practice change implemented: All new staff in the Irish health service will "Make Every Contact Count" by routinely assessing patients risk factors for chronic disease and carrying out a lifestyle behavior change intervention as part of all clinical interactions. Aim and theory of change: In 2015, the Health and Wellbeing Division, HSE established a collaborative between the Higher Education Institutions in Ireland to develop a competency based national standard undergraduate curriculum for medical, nursing and allied health professionals to support the integration of chronic disease prevention into clinical practice by Making Every Contact Count through brief interventions. Targeted population and stakeholders: Targeted population: All undergraduate students on health professional degree programmes. Key stakeholders are: HSE, HEI's, all service users including those at risk of chronic disease and who have chronic diseases. Timeline: The curriculum will be delivered in relevant courses in HEI's in Ireland from September 2017. Highlights: (Innovation, Impact and outcomes) This is the first time that a collaborative standard competency based national curriculum for healthcare professionals has been developed in Ireland. Collaborative health service and education initiative Shifts the emphasis towards chronic disease prevention in training healthcare professionals Evidence informed curriculum: The curriculum includes lifestyle choices and personal wellness, communicating with patients for chronic disease prevention and health behaviour change interventions to Make Every Contact Count. Comments on sustainability: Supports sustainable change in the routine delivery of lifestyle behaviour change interventions as part of all clinical consultations. Comments on transferability: Internationally transferable into other undergraduate training programmes for healthcare professionals. Conclusions: (comprising main findings) A nationally directed, collaborative approach was useful in: Creating leadership and commitment to the curriculum across all HEI's Providing a multidisciplinary approach to its development Supporting the collective exchange of knowledge and resources. Supporting the implementation across all HEI's in Ireland. [ABSTRACT FROM AUTHOR]