Interprofessional collaboration in a community virtual ward: A focus group study

Background

The problem of a lack of nurses is expected to worsen in the future. With an ever-increasing number of elderly patients with multimorbidity and a shortage of healthcare professionals, primary care must innovatively organise their services to offer more sustainable healthcare services. Organising healthcare services in a community virtual ward has been found to improve the quality of life for vulnerable elderly populations.

Aim

The aim of the study was to explore healthcare professionals' experiences of interprofessional collaboration in care for patients with multimorbidity in a community virtual ward in the Norwegian context.

Methods

Focus group interviews were conducted in this qualitative exploratory study. A purposive sample of 17 healthcare professionals working in a community virtual ward in Norway was interviewed. Data were analysed using thematic analysis.

Results

The study results show that healthcare professionals recognise a need for patient involvement in the community virtual ward to offer more sustainable healthcare services at home. Furthermore, the results show how healthcare professionals experience the use of assessment tools and whiteboard meetings as useful tools for facilitating interprofessional collaboration. The study results also describe how interprofessional and holistic follow-up with patients with multimorbidity contributes to increased focus on health promotion in the community virtual ward.

Conclusion

We found that interprofessional collaboration in community virtual wards may be a sustainable way of organising healthcare services for patients with multimorbidity living at home. Interprofessional collaboration with a patient-centred and health promotion approach, seems to increase the quality of the follow-up for patients with multimorbidity living at home. Additionally, mutual interprofessional trust and respect seems to be essential for making use of the unique expertise of different professions in the follow-up for patients with multimorbidity. In the future, both the patient's voice and opinion of their next of kin should be considered in the development of more sustainable homecare services.     

Locking plates and their effects on healing conditions and stress distribution: A femoral neck fracture study in cadavers

Background

Implants are used to stabilize femoral neck fractures to achieve successful fracture healing, but there is still a high rate of fracture non-unions. We compared micromotions in femurs with fractured femoral necks stabilized with three screws with or without a locking plate. We also investigated whether osteoporosis was associated with micromotion magnitudes, and explored the influence of implants on load distribution in the upper femur.

Methods

Twelve pairs of human cadaver femurs with femoral neck fractures (AO/OTA 31-B1) were allocated to fracture fixation by three locked screws or three individual screws. All femurs underwent dual energy X-ray absorptiometry. Physiological subject-specific axial load and torque was applied for 10,000 cycles. Micromotion of the head fragment was measured every 100 cycles with high-resolution optical motion detection. Load distribution was measured with strain-gauge rosettes attached to the lateral and medial proximal diaphysis.

Findings

The locking plate group showed reduced micromotion about the femoral neck axis (P = 0.035, effect size = 0.62). No differences were found in valgus–varus or antegrade–retrograde rotations, or in the three translations. Micromotion magnitudes were not associated with osteoporosis. The overall micromotions of the upper femur and the load distribution in the proximal diaphysis were not influenced by fixation type.

Interpretation

The locking plate group showed increased resistance to shear forces compared with the screw group. This effect was not associated with a diagnosis of osteoporosis. The locking plate did not affect the load distribution in the proximal femur.     

Association of wall thickness of the brachial artery measured with high-resolution ultrasound with risk factors and coronary artery disease

Intima-media thickness of the carotid and femoral arteries has been associated with coronary atherosclerosis and its clinical sequelae. The brachial artery (BA) is widely used for the assessment of flow-mediated vasodilation. The aim of this study was to examine whether BA wall thickness (WT) is associated with coronary artery disease (CAD) and risk factors. High-resolution ultrasound (13 MHz) examination of the BA was performed in 179 patients undergoing coronary angiography for the evaluation of chest pain. CAD (> or =30% diameter stenosis in > or =1 major branch) was found in 132 patients, whereas 47 patients had smooth coronary arteries. WT of the posterior BA wall (0.4 +/- 0.05 vs 0.35 +/- 0.06 mm, p <0.001) and wall index (WI) (WT/vessel diameter x 100; 16.1 +/- 0.0 vs 13.8 +/- 0.8, p <0.001) were greater in patients with than without CAD. On univariate analysis, WT and WI correlated with age, presence of CAD, systemic hypertension, maximum coronary diameter stenosis, and baseline diameter. On logistic regression analyses adjusting for age, cholesterol levels, systemic hypertension, smoking, and positive family history, WT (p <0.01) and WI (p = 0.02) remained significantly correlated with the presence of CAD. Thus, BA-WT is independently correlated with the presence of CAD. WT may provide a novel noninvasive marker of atherosclerosis that can be assessed together with flow-mediated vasodilation to yield functional and morphologic information in the same vessel.     

Four gonadotropin releasing hormone receptor genes in Atlantic cod are differentially expressed in the brain and pituitary during puberty

Gonadotropin releasing hormones (GnRH) are an important part of the brain-pituitary-gonad axis in vertebrates. GnRH binding to its receptors (GnRH-R) stimulates synthesis and release of gonadotropins in the pituitary. GnRH-Rs also mediate other processes in the central nervous system such as reproductive behavior and neuromodulation. As many as five GnRH-R genes have been identified in two teleost fish species, but the function and phylogenetic relationship of these receptors is not fully understood. To gain a better understanding of the functional relationship between multiple GnRH-Rs in an important aquaculture species, the Atlantic cod (Gadus morhua), we identified four GnRH-Rs (gmGnRH-R) by RT-PCR, followed by full-length cloning and sequencing. The deduced amino acid sequences were used for phylogenetic analysis to identify conserved functional motifs and to clarify the relationship of gmGnRH-Rs with other vertebrate GnRH-Rs. The function of GnRH-R variants was investigated by quantitative PCR gene expression analysis in the brain and pituitary of female cod during a full reproductive cycle and in various peripheral tissues in sexually mature fish. Phylogenetic analysis revealed two types of teleost GnRH-Rs: Type I including gmGnRH-R1b and Type II including gmGnRH-R2a, gmGnRH-R2b and gmGnRH-R2c. All four gmGnRH-Rs are expressed in the brain, and gmGnRH-R1b, gmGnRH-R2a and gmGnRH-R2c are expressed in the pituitary. The only GnRH-R differentially expressed in the pituitary during the reproductive cycle is gmGnRH-R2a such that its expression is significantly increased during spawning. These data suggest that gmGnRH-R2a is the most likely candidate to mediate the hypophysiotropic function of GnRH in Atlantic cod.     

Long-term Changes in Depressive Symptoms and Estimated Cardiorespiratory Fitness and Risk of All-Cause Mortality: The Nord-Trøndelag Health Study

Objective

To assess the independent and combined associations of long-term changes in depressive symptoms (DSs) and estimated cardiorespiratory fitness (eCRF) with all-cause mortality.

Wheat challenge in self-reported gluten sensitivity: a comparison of scoring methods

Background: The condition non-coeliac gluten sensitivity (NCGS) is clinically similar to coeliac disease, but lack objective diagnostic criteria. Symptom relief on gluten-free diet followed by gluten containing food challenge may confirm the condition in clinical settings.

Aim: To describe the results of an open bread challenge in patients with suspected NCGS, and to compare the results with recently suggested cut-offs for symptom change.

Material and methods: Fifty-six patients (12 males) self-instituted on gluten-free diet with negative coeliac disease diagnostics were examined for NCGS by an open bread challenge. Symptoms were reported by Gastrointestinal Symptom Rating Scale, IBS-version (GSRS-IBS) and visual analogue scale (VAS). Results were retrospectively compared to the Salerno and Monash cut-offs for symptom change.

Results: Forty-seven patients were diagnosed with NCGS. Total GSRS-IBS score and overall symptoms by VAS increased significantly in NCGS (p?<?.001), but not in non-NCGS patients (p?<?.12 and p?=?.08, respectively). Total GSRS-IBS challenge score and overall symptoms by VAS were significantly higher in NCGS than in non-NCGS patients (53 vs. 37, p?=?.004 and 76 vs. 39?mm, p?=?.02, respectively). Applying the Salerno and Monash cut-offs, 63 and 75% would be classified with NCGS, respectively. According to total GSRS–IBS absolute agreement was lowest between clinician’s diagnosis and Salerno cut-off (63%) and highest between Salerno and Monash cut-offs (88%).

Conclusion: Clinician diagnosed 85% with NCGS. The proportion of NCGS was lower according to the Salerno and Monash cut-offs. The Salerno cut-off should be the starting point for a common definition of symptom change.     

Are QALYs based on time trade‐off comparable? – A systematic review of TTO methodologies

A wide range of methods is used to elicit quality‐of‐life weights of different health states to generate ‘Quality‐adjusted life years’ (QALYs). The comparability between different types of health outcomes at a numerical level is the main advantage of using a ‘common currency for health’ such as the QALY. It has been warned that results of different methods and perspectives should not be directly compared in QALY league tables. But do we know that QALYs are comparable if they are based on the same method and perspective? The Time trade‐off (TTO) consists in a hypothetical trade‐off between living shorter and living healthier. We performed a literature review of the TTO methodology used to elicit quality‐of‐life weights for own, current health. Fifty‐six journal articles, with quality‐of‐life weights assigned to 102 diagnostic groups were included. We found extensive differences in how the TTO question was asked. The time frame varied from 1 month to 30 years, and was not reported for one‐fourth of the weights. The samples in which the quality‐of‐life weights were elicited were generally small with a median size of 53 respondents. Comprehensive inclusion criteria were given for half the diagnostic groups. Co‐morbidity was described in less than one‐tenth of the groups of respondents. For two‐thirds of the quality‐of‐life weights, there was no discussion of the influence of other factors, such as age, sex, employment and children. The different methodological approaches did not influence the TTO weights in a predictable or clear pattern. Whether or not it is possible to standardise the TTO method and the sampling procedure, and whether or not the TTO will then give valid quality‐of‐life weights, remains an open question. This review of the TTO elicited on own behalf, shows that limiting cost–utility analysis to include only quality life weights from one method and one perspective is not enough to ensure that QALYs are comparable. Copyright © 2004 John Wiley & Sons, Ltd.