Search

The COVID-19 pandemic has disproportionately affected people with diabetes, who are at increased risk of severe COVID-19.* Increases in the number of type 1 diabetes diagnoses (1,2) and increased frequency and severity of diabetic ketoacidosis (DKA) at the time of diabetes diagnosis (3) have been reported in European pediatric populations during the COVID-19 pandemic. In adults, diabetes might be a long-term consequence of SARS-CoV-2 infection (4-7). To evaluate the risk for any new diabetes diagnosis (type 1, type 2, or other diabetes)30 days

Background Numerous tools exist to screen for frailty in clinical settings but a single international standard has not yet been adopted. Recent research indicates that more than one tool is often deployed by clinicians to diagnose frailty. This study aimed to compare the use of two screening tools in the emergency department and assess the predictive ability of keywords in triage notes to detect frailty. Methods Frailty screening was carried out on 198 individuals (100 female / 98 male) attending the emergency department of a large urban teaching hospital, using the Rockwood Clinical Frailty Scale and the Variable Indicative of Placement Risk (VIP) scale. Average screening time for Rockwood was 43.1 ± 21.7s, whilst average screening time for VIP was 11.8 ± 8.5s. Results were dichotomised to frail, corresponding to Rockwood scores of ≥4 or VIP scores of ≥1, or non-frail (Rockwood=1-3 or VIP=0) for comparisons. Triage notes were reviewed to find keywords associated with frail patients. Results Among 198 individuals screened, 149 (75.3%) were frail according to Rockwood, and 143 (72.2%) according to VIP. 25 (12.6%) of the 198 individuals were categorised as frail according to Rockwood but were non-frail according to VIP. Among these, 8 were female (8% of all female patients; 6 were 75+ years of age, and 2 were under 75) and 17 were male (17.3% of all male patients; 11 were 75+ years of age and 6 were under 75). Keywords associated with frailty were identified from triage notes, across the following categories: Falls/ mobility/ balance; Cognition; Living circumstances; Nutrition; Other frailty-associated conditions; and General deterioration. Conclusion Comparison of the two scales suggests that frailty could be missed if relying on a single index. This effect may be more frequent in men than women. Screening triage notes to identify frailty-associated keywords may be a helpful adjunct to existing tools.

Over the last few decades, teaching the skills required for providing culturally competent practice has become the mainstay across many disciplines. This means that for those responsible for teaching these skills, critical reflection on our own competencies is paramount. Critical reflection asks us to think about our teaching practice and the ideas we have about it. It then challenges us to take a step back and consider our thinking through a series of questions related to the reflective act. This means not only looking at the past and the present, but considering the future and acting accordingly. The complexities of this are increased when teaching outside of a culture that is not our own. In this chapter, we critically reflect on our own positions as non-Indigenous women teaching Indigenous content to students from a variety of disciplines. We also consider what this means from our own perspectives of becoming culturally competent and maintaining culturally competent practice.

This chapter describes the way that collaboration with local Elders led to revision of a first-year psychology subject. We outline the changes that were made to several critical areas including teaching students about critical reflection and how to work effectively. The Wiradyuri way of living and pedagogical framework were foundational to the revision. This new approach led us to reflect on, and change the nature and types of assessment. In this chapter we illustrate the way that authentic Aboriginal knowledge and pedagogy became an integral part of an existing subject. It demonstrates that the process of decolonising curriculum can occur through partnership under the guidance of local Elders. We anticipate that this will lead to greater cultural safety and better learning for Aboriginal and non-aboriginal students and teachers.

Background Although not an inevitable part of ageing, frailty is an increasingly common condition in older people. Frail older patients are particularly vulnerable to the adverse effects of hospitalisation, including deconditioning, immobility and loss of independence (Chong et al, J Am Med Dir Assoc 18:638.e7–638.e11, 2017). The ‘Systematic Approach to improving care for Frail older patients’ (SAFE) study co-designed, with public and patient representatives, quality improvement initiatives aimed at enhancing the delivery of care to frail older patients within an acute hospital setting. This paper describes quality improvement initiatives which resulted from a co-design process aiming to improve service delivery in the acute setting for frail older people. These improvement initiatives were aligned to five priority areas identified by patients and public representatives. Methods The co-design work was supported by four pillars of effective and meaningful public and patient representative (PPR) involvement in health research (Bombard et al, Implement Sci 13:98, 2018; Black et al, J Health Serv Res Policy 23:158–67, 2018). These pillars were: research environment and receptive contexts; expectations and role clarity; support for participation and inclusive representation and; commitment to the value of co-learning involving institutional leadership. Results Five priority areas were identified by the co-design team for targeted quality improvement initiatives: Collaboration along the integrated care continuum; continence care; improved mobility; access to food and hydration and improved patient information. These priority areas and the responding quality improvement initiatives are discussed in relation to patient-centred outcomes for enhanced care delivery for frail older people in an acute hospital setting. Conclusions The co-design approach to quality improvement places patient-centred outcomes such as dignity, identity, respectful communication as well as independence as key drivers for implementation. Enhanced inter-personal communication was consistently emphasised by the co-design team and much of the quality improvement initiatives target more effective, respectful and clear communication between healthcare personnel and patients. Measurement and evaluation of these patient-centred outcomes, while challenging, should be prioritised in the implementation of quality improvement initiatives. Adequate resourcing and administrative commitment pose the greatest challenges to the sustainability of the interventions developed along the SAFE pathways. The inclusion of organisational leadership in the co-design and implementation teams is a critical factor in the success of interventions targeting service delivery and quality improvement.

Hahn's New Pseudoisochromatic Colour Vision Test contains provision for screening red-green and blue-yellow colour vision deficiencies, a qualitative diagnosis as protan and deutan, and a quantitative diagnosis of red-green deficiencies. In this study 58 colour vision deficient and 68 colour vision normal subjects were examined using a battery of colour vision tests. The screening and classification ability of the Hahn test was compared with Ishihara's Test and the Standard Pseudoisochromatic Plates (SPP). The quantitative diagnosis ability was assessed by comparison with the Farnsworth—Munsell D-15 Test, the Farnsworth Lantern, and the Anomaloscope range. The Hahn proved to have a colour vision screening performance comparable with the two other PIC tests. Its classification ability was poor compared with the other PIC tests, one design in the SPP plates was markedly superior. The Hahn's quantitative diagnosis plates did not produce a useful classification; more than 50% of subjects made the full six errors and only 3 of 58 colour vision deficient subjects made less than 3 errors out of the 6 plates. The colorimetric measurements are used to illustrate the design features and are consistent with these performances. © 1998 John Wiley & Sons, Inc. Col Res Appl, 23, 69–77 1998