Are we improving the quality of nursing home care: the case of pressure ulcers

BACKGROUND: There are widespread concerns regarding the quality of nursing home care and whether care is improving. We evaluated a large provider of nursing home care to determine whether risk-adjusted rates of pressure ulcer development have changed. METHODS: We used the Minimum Data Set to study National HealthCare Corporation nursing homes from 1991 through 1995. Rates of pressure ulcer development were calculated for successive 6-month periods by determining the proportion of residents initially ulcer-free having a stage 2 or larger pressure ulcer on subsequent assessments. Rates were risk-adjusted for patient characteristics. The proportion of new ulcers that were deep (stages 3 or 4) were also calculated. RESULTS: We examined risk-adjusted rates of pressure ulcer development based on 144,379 observations of 30,510 residents at 107 nursing homes. The number of observations per 6-month period ranged from 11,041 to 15,805. Between 1991 and 1995, there was a significant (P<.05) rate decline of more than 25%. Additionally, the proportion of new ulcers that were stages 3 or 4 declined from 30 to 22% (P<.01). CONCLUSIONS: Nursing homes showed significant improvement in the quality of pressure ulcer preventive care from 1991 to 1995.     

What matters to users of services? An explorative study to promote shared decision making in health care

Background Involving service users and carers in decisions about their health care is a key feature of health‐care practice. Professional health and social care students need to develop skills and attributes to best enable this to happen. Aims The aims were to explore service user and carer perceptions of behaviours, attributes and context required to enable shared decision making; to compare these perceptions to those of students and academic staff with a view to utilizing the findings to inform the development of student assessment tools. Methods A mixed methods approach was used including action learning groups (ALG) and an iterative process alongside a modified Delphi survey. Participants The ALGs were from an existing service user and carer network. The survey was sent to sixty students, sixty academics and 30 service users from 16 different professional disciplines, spanning four Universities in England. Results The collaborative enquiry process and survey identified general agreement that being open and honest, listening, showing respect, giving time and being up to date were important. The qualitative findings identified that individual interpretation was a key factor. An unexpected result was an insight into possible insecurities of students. Conclusions The findings indicate that distilling rich qualitative information into a format for student assessment tools could be problematic as the individual context could be lost, it is therefore proposed that the information could be better used as a learning rather than assessment tool. Several of those involved identified how they valued the process and found it beneficial.     

Media and scientific communication about the COVID-19 pandemic and the repercussions on the population's mental health: A protocol for a systematic review and meta-analysis

Background:Good communication strategies are essential in times of crisis, such as the coronavirus pandemic. The dissemination of inaccurate information and the need for social isolation to control coronavirus disease 2019 (COVID-19) have shown a negative impact on the population, causing damage to mental health, with the appearance or worsening of symptoms of stress, fear, anxiety, and depression. Thus, the systematic review study is intended to gather evidence on the impact of information about COVID-19 on the mental health of the population.Methods:This systematic review protocol is conducted using the guidelines of the preferred reporting items for systematic reviews and meta-analyses protocols and the Cochrane Handbook for Systematic Reviews of Interventions. The review aims to include published studies that address the exposure of the general population to information about COVID-19, through observational and experimental studies, which consider the following outcomes: fear, stress, anxiety, and depression. Thus, a comprehensive research strategy will be conducted in the following databases: PubMed / Medline, Scopus, Web of Science, EMBASE, Science Direct, CINAHL, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). Two independent reviewers will perform all procedures, such as study selection, data collection, and methodological evaluation. Disagreements will be forwarded to a third reviewer. RevMan 5.3 software will be used for data analysis.Results:This systematic review will provide evidence of the influence of access to and consumption of media and scientific information about COVID-19 on the mental health of the population. It will consider information about the characterization of the study and the population studied, clinical and epidemiological information on mental health, and data on access to and consumption of media and scientific information.Discussion:The results should inform about the consequences of communication about the new coronavirus on the emergence or worsening of psychological and psychiatric symptoms, allowing to develop strategies to achieve effective communication of information to promote the mental health of the population.Systematic review registration number:PROSPERO CRD42020182918     

Proximal Optimization Technique and Kissing Balloon Inflations With the Bioresorbable Vascular Scaffold for Coronary Bifurcation Percutaneous Coronary Intervention

Proximal optimization technique and final kissing balloon inflations with noncompliant balloons facilitate success with coronary bifurcation intervention. The use of bioresorbable vascular scaffolds has been postulated to reduce the risk of in-stent restenosis, a particular problem with bifurcation intervention. We present a case of bifurcation intervention in a 49-year-old woman, using for the first time, proximal optimization and kissing balloon inflation within bioresorbable vascular scaffolds, using optical coherence tomography guidance.     

Pr3+ doping at the A-site of La0.67Ba0.33MnO3 nanocrystalline material: assessment of the relationship between structural and physical properties and Bean–Rodbell model simulation of disorder effects

Bulk nanocrystalline samples of (La_1−xPr_x)_0.67Ba_0.33MnO₃ (0.075 ≤ x ≤ 0.30) manganites with a fixed carrier concentration are prepared by the sol–gel based Pechini method. Rietveld refinement of the X-ray diffraction patterns, shows the formation of single-phase compositions with rhombohedral symmetry. Upon Pr³⁺ doping at the A-site, the unit cell volume and the B–O–B bond angles are reduced. FTIR spectra present a prominent absorption peak of the in-phase stretching mode (B_2g mode) rising from the vibration of the Mn–O bond. Raman spectra at room temperature reveal a gradual shift toward lower frequencies in (E_g) phonon mode with increasing Pr³⁺ concentration. The M(T) measurements shows a clear ferromagnetic (FM)–paramagnetic (PM) phase transition with increasing temperature. An increase in resistivity and activation energy and a decrease in the metal–semiconductor transition (T_M–SC) and Curie temperatures (T_C) was observed as a consequence of Pr³⁺ doping. The results are discussed according to the change of A-site-disorder effect caused by the systematic variations of the A-site average ionic radius 〈r_A〉 and A-site-cation mismatch σ², resulting in the narrowing of the bandwidth and the decrease of the mobility of e_g electrons. The magneto-transport behavior in the whole measured temperature and a magnetic field can be described by a percolation model, which is in agreement with the limited experimental data of the samples for x = 0.075, 0.15 and 0.30. The experimental results confirm that A-site substitution with Pr³⁺ destroys the Mn³⁺–O²⁻–Mn⁴⁺ bridges and weakens the double exchange (DE) interaction between the Mn³⁺ (t³_2ge¹_g, S = 2) and Mn⁴⁺ (t³_2ge⁰_g, S = 3/2) ions. On the other hand, the Bean and Rodbell model has been successfully used to simulate the magnetization data of the samples with x = 0.15 and x = 0.22. The random replacement of La³⁺ by Pr³⁺ is shown to induce more disorder in the system, which is reflected in the increase of the fitted disorder parameter and spin value fluctuation. At a temperature close to room temperature, the maximum magnetic entropy change (ΔS_Max) and the relative cooling power (RCP) of La_0.52Pr_0.15Ba_0.33MnO_2.98 are found to be, respectively, 1.34 J kg⁻¹ K⁻¹ and 71 J kg⁻¹ for a 1.5 T field change.

Bulk nanocrystalline samples of (La_1−xPr_x)_0.67Ba_0.33MnO₃ (0.075 ≤ x ≤ 0.30) manganites with a fixed carrier concentration are prepared by the sol–gel based Pechini method.     

Analysis of Metal Contamination and Bioindicator Potential of Predatory Fish Species Along Contas River Basin in Northeastern Brazil

Samples of two carnivore fish species (Hoplias malabaricus and Serrasalmus brandtii) were collected along Contas River, northeastern Brazil, to determine the levels of Co, Cr, Cu, Fe, Mn, Ni and Pb in edible and non-edible tissues of these important local fisheries resources. Lead could not be quantified in most of the samples, while the other metals were detected in both species. In edible parts, Cr levels were above Brazilian threshold limits in all specimens and Ni was at high concentration in S. brandtii individuals from one collection site. In non-edible parts (viscera), besides Cr, Cu concentration was higher than that recommended by Brazilian laws. Both fish species proved to be sensitive to environmental contamination. Despite the different ecological characteristics, such as vagility and feeding strategy, these fish showed that aquatic predators are efficient bioindicators of water quality and biomagnification.     

Participation of adolescents in the Family Health Strategy from the theoretical-methodological structure of an enabler to participation

Objective

to evaluate the participation of adolescents in the Family Health Strategy, from the theoretical-methodological structure of an enabler to participation.

Method

a quantitative study, conducted from December of 2010 to March of 2011, with 213 professionals in the FHS in the region of Cariri-Ceará-Brazil. Data were collected through a questionnaire and organized in SPSS 18.0.

Results

the level of normative participation becomes manifest beginning with the adolescent search for health services, motivated by disease (77.9%). Normative participation + independence appear when they seek prenatal care and family planning. Emancipatory participation was identified by the frequency of adolescents in group activities, in the schools, and a move in the direction of the level of transformative participation was observed.

Conclusion

in this context, it is understood that there exists a need to stimulate the participatory process of the adolescents for a change in health promotion in this group.     

Histopathology and immunohistochemistry of tissues outside central nervous system in bovine rabies

We performed a histopathological and immunohistochemical study of tissues outside the central nervous system in 48 cases of bovine rabies confirmed by direct immunofluorescence and/or immunohistochemistry (IHC) of the central nervous system. In the bovines of this study, mononuclear inflammation in all ganglia (trigeminal, spinal, stellate, and celiac) and adrenal medulla was observed. This injury also occurred in 85 % of neuro-pituitaries in 55 % of pars intermediate and 15 % of the pars distalis of pituitary evaluated. IHC was positive in 92.31 % of lumbar spinal ganglia, 90.9 % of trigeminal ganglia, stellate ganglia of 41.67 and 16.67 % of the celiac ganglia. One of the evaluated adrenal (1/17) showed strong immunohistochemical labeling in the cytoplasm of pheochromocytes. The pituitary IHC was positive in one case in the neurohypophysis (1/20) and in one case in the pars intermedia of the adenohypophysis (1/20). Data from this study indicate that in suspected cases of rabies, besides the complex pituitary rete mirabile and trigeminal ganglion, the evaluation of other ganglia, particularly the lumbar spinal, and adrenal may also contribute to the diagnosis and understanding of the clinical presentation and pathogenesis of the disease in bovines.     

The contribution of primary care practitioners to interventions reducing loneliness and social isolation in older people—An integrative review

Background

Social connection is a fundamental human need. Its absence can lead to loneliness and social isolation, adversely impacting health and well-being. Given their regular contact and trusted relationships with older people, practitioners delivering community-based primary care are well-positioned to address this issue. However, their contribution to addressing loneliness and social isolation is unclear.

Aim

This integrative review explores the contribution of the primary care workforce to interventions aimed at reducing loneliness and social isolation in community-dwelling older people.

Method

Using an integrative review method, Scopus, Web of Science, CINAHL and PubMed were searched for original research published between 2000 and 2022. Fourteen papers reporting 13 primary studies were appraised for methodological quality and included in the review. Data were extracted into a summary table and analysed using thematic analysis.

Results

Included studies came from over six countries. Internationally, primary care services have diverse structures, funding and workforces influencing their response to loneliness and social isolation. All but one intervention was multi-component, with ten studies including a group-based activity and three providing primarily individual-level activities. Only six studies reported reductions in loneliness following the intervention. Three themes were identified: characteristics of interventions; implementation context, barriers and facilitators; and differing contributions of primary care practitioners in addressing loneliness and social isolation of older people.

Conclusion

There is increasing demand and scope for primary care practitioners to assist lonely and socially isolated older people. It is important to understand how to equip and incentivise these practitioners to routinely identify, assess and respond to lonely and socially isolated older people despite varying implementation contexts. There is a need for further research that explores how the primary care team can be better utilised to deliver effective interventions that reduce the health impacts of loneliness and social isolation.