Associations of potentially inappropriate medication use with four year survival of an inception cohort of nursing home residents

BackgroundSurvival in older adults has a high variability. The possible association of length of survival with potentially inappropriate medication (PIM) use remains unclear.AimTo examine the four-year survival rate, the prevalence of polypharmacy and PIM use at admission, and the association between the two, in an inception cohort of newly admitted nursing home residentsMethodsData were used from ageing@NH, a prospective observational cohort study in nursing homes. Residents (n = 613) were followed for four years after admission or until death. PIM use was measured at admission, using STOPPFrail. The Kaplan-Meier method was used to estimate survival, using log-rank tests for subgroup analyses. Cox regression analyses was used to explore associations with PIM use and polypharmacy, corrected for covariatesResultsMean age was 84, 65% were females. After one, two, three and four years the survival rates were respectively 79%, 60.5%, 47% and 36%. At admission, 47% had polypharmacy and 40% excessive polypharmacy, 11% did not use any PIMs, and respectively 28%, 29%, and 32% used one, two and three or more PIMs. No difference in survival was found between polypharmacy and no polypharmacy, and PIM use and no PIM use at admission. Neither polypharmacy nor PIM use at admission were associated with mortality.ConclusionResidents survived a relatively short time after NH admission. Polypharmacy and PIM use at admission were relatively high in this cohort, although neither was associated with mortality.     

Exercise and Lifestyle Education program for Brazilians living with prediabetes and diabetes: A pilot randomized trial

AimsTo test the Diabetes College Brazil Study feasibility, the acceptability of study interventions and their preliminary effectiveness, and describe the study protocol modifications due to the COVID-19 pandemic.MethodsSingle-center, double-blinded pilot randomized trial with two parallel groups, Exercise and Lifestyle Education (ExLE; 12-week exercise and educational interventions) and Exercise (Ex; 12-week exercise intervention only) involving patients with prediabetes or diabetes. Feasibility (eligibility, recruitment, retention, completeness of variables measures and participation rates), acceptability (satisfaction), and preliminary effectiveness of interventions (variables: functional capacity, physical activity (PA), exercise self-efficacy, diabetes knowledge, health literacy, adherence to Mediterranean food pattern, glycated hemoglobin (HbA1c), anthropometric measures, cardiac autonomic control, depression, and quality of life (QofL)).ResultsEligibility, recruitment, retention, participation in exercise sessions, and education classes rates were 17%, 93%,82%, 76%, and 71%, respectively. Missing data in the post-intervention assessment (PA, HbA1c, cardiac autonomic control, anthropometric measures, depression, and QofL) were mainly related to research procedure modifications. The interventions were highly acceptable, and most variables improved farther in the ExLE, with moderate effect sizes for PA, diabetes knowledge, health literacy, cardiac autonomic control, and QofL.ConclusionsThe Diabetes College Brazil Study is feasible, and the ExLE may benefit Brazilians living with prediabetes and diabetes.     

Developing an Educational Framework for Urological Nursing: Using a World Café approach to gain an emerging international understanding of issues,challenges and responses

A series of three World Café events centred on the topic of developing an Educational Framework for Urological Nursing [EFUN] were held by the British Association of Urological Nurses [BAUN], the European Association of Urology Nurses [EAUN] and the Australian and New Zealand Urological Nursing Society [ANZUNS] between 2017 and 2019. About 376 urology nurses participated in these “conversations that matter” and generated 1047 individual response items that were grouped into themes to assist the three associations to take the creation of an EFUN to the next level. Areas explored centred on four aspects: what any agreed educational framework for urology nursing should contain; the academic level at which education should be provided; who should be recruited as collaborators on writing an educational framework and, lastly, just how any emergent framework should be used. Analysis of the conversational data indicate that there exists within the urological nursing community a collective wisdom regarding their educational needs and how these needs should be met.     

Development and validation of the incontinence associated dermatitis knowledge,attitude and practice questionnaire

AimThis study aimed to develop and test the validity and reliability of the Knowledge, Attitudes and Practices of Incontinence-associated Dermatitis Questionnaire (KAP-IAD-Q) for Nurses.MethodsA psychometric validation design was employed. Phase I of the study entailed the development of items through an extensive literature review and a double Delphi procedure with 11 experts specialised in wound, ostomy and continence to examine content validity of the KAP-IAD-Q. Phase II involved administering the KAP-IAD-Q to a convenience sample of 263 Registered Nurses from a public hospital in Singapore to evaluate its construct validity, internal consistency and test-retest reliability.ResultsThe instrument showed acceptable content validity (S-CVI = 0.85). Exploratory factor analysis showed all 22 items demonstrated strong factor loadings >0.4 and the four factors KAP-IAD-Q explained 58.1% of total variance. The four factors were☹1) knowledge om IAD aetiology and identification, (2) knowledge on IAD risk factors; (3) attitudes, and (4) practices. The overall internal consistency was excellent (Cronbach's α = 0.913). The KAP-IAD-Q showed good overall test-retest reliability as well (ICC = 0.89 (95% CI 0.69–0.96, p < 0.001).ConclusionThe KAP-IAD-Q demonstrated good psychometric properties and is effective in measuring levels of IAD-related KAP among nurses. Further confirmation of the proposed factor structure is recommended. Future research should explore determinants of nurses’ KAP and associations between IAD knowledge, attitudes and practices.     

Sex and gender differences in Alzheimer’s disease: current challenges and implications for clinical practice

Alzheimer’s disease (AD) is characterized by high heterogeneity in disease manifestation, progression and risk factors. High phenotypic variability is currently regarded as one of the largest hurdles in early diagnosis and in the design of clinical trials; there is therefore great interest in identifying factors driving variability that can be used for patient stratification. In addition to genetic and lifestyle factors, the individual’s sex and gender are emerging as crucial drivers of phenotypic variability. Evidence exists on sex and gender differences in the rate of cognitive deterioration and brain atrophy, and in the effect of risk factors as well as in the patterns of diagnostic biomarkers. Such evidence might be of high relevance and requires attention in clinical practice and clinical trials. However, sex and gender differences are currently seldom appreciated; importantly, consideration of sex and gender differences is not currently a focus in the design and analysis of clinical trials for AD. The objective of this position paper is (i) to provide an overview of known sex and gender differences that might have implications for clinical practice, (ii) to identify the most important knowledge gaps in the field (with a special regard to clinical trials) and (iii) to provide conclusions for future studies. This scientific statement is endorsed by the European Academy of Neurology.     

师承教育在医教协同创新中医人才培养中的作用

中医师承教育是当今社会中医传承的主要方式,其培养了大量的中医优秀人才,促进中医药文化和中医学术思想传播,是现代中医药发展不可缺少的组成部分。但近代以来,人们脑海中逐渐形成了以西方医学为体系的思维模式时,中医学教育该如何的发展与传承。针对这一现象,我们分析了现代院校教育与师承教育的特点,阐述师承教育在现代中医人才培养中的作用,以期探讨高等中医药院校教育改革的模式。     

《医用有机化学》课程中进行德育渗透

教学与德育有机融会贯通,是当前教育领域的共识。医学本科生秉承"以德载医"的精神,肩负"治病救人"的重任,因此德育教育在整个医学教学中占有重要的地位。《医用有机化学》教材中含有丰富的德育内容,高校教师传授专业知识的同时,在教学过程中巧妙的穿插辩证唯物主义、爱国主义和社会责任感的思政教育,可以帮助学生们树立正确的世界观和人生观。文章以医用有机化学课程为例,主要从教师的自身道德素养、德育在教学过程中的具体实践和德育实施过程中需要注意的问题三方面进行阐述,充分将新时代新理念融入大纲、教案和课堂中,化"知识"为"智慧",变"文化"为"品格",充分发挥医用有机化学课程的德育功能。     

Effects of a summer school-readiness programme on measures of literacy and behaviour growth: a pilot study

Young children enter kindergarten with varying levels of readiness and abilities to learn. One factor that contributes to lower levels of school readiness is poverty. One timely, cost-effective, and feasible strategy to boost school readiness, regardless of exposure to high-quality preschool is to leverage the summer months prior to kindergarten entry and provide comprehensive, evidence-based programming immediately before the school year begins. The current study implemented a community-based summer programme targeted at improving school readiness for 25 four- and five-year-old children in a low-income community. Across the 9-week study, children participated in two types of early literacy activities and the Incredible Years social/emotional learning curriculum. Results indicate that participants demonstrated significant growth across three early literacy skills and were rated as overall stable regarding their behaviour across the summer. These results are discussed along with implications and future directions in this line of research.     

以临床胜任力为导向的CBL在急危重症护理本科教学中的实践

目的　探讨临床胜任力为导向的病例教学（case-based learning，CBL）在急危重症护理学本科教学中的可行性和有效性。方法　将急危重症护理本科生120人随机分为CBL教学组和传统教学组。根据每次实习学生人数，CBL教学组分为数个小组，每小组固定一个带教教师，并以小组为单位进行临床教学实践；传统教学组采用既往的临床实习教学方式，即一个学生固定跟随一个带教教师。采用理论考试、技能考试以及问卷调查等多种考核方式评价两组的教学效果，采用SPSS 21.0软件行t检验和卡方检验。结果　与传统教学组相比，CBL教学组在理论考试[（92.5±3.0） vs. （85.3±3.3）]和技能考试[（93.1±4.5） vs. （88.1±3.4）]方面均更好，且差异有统计学意义（P<0.05）；在对教学满意度调查方面，CBL教学组优于传统教学组。结论　以临床胜任力为导向的CBL教学应用于急危重症护理本科教学是可行的，能有效培养学生的临床思维和提高实际的临床胜任力。