Drug Burden Index associated with function in community-dwelling older people in Finland: A cross-sectional study

Abstract

Background. This cross-sectional study aimed to investigate the relationship between exposure to anticholinergic and sedative medications, measured with the Drug Burden Index (DBI), and functional outcomes in community-dwelling older people living in Finland.

Methods. The study population consisted of community-dwelling older people (n = 700) enrolled in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study. Outcomes included walking speed, chair stands test, grip strength, timed up and go (TUG) test, instrumental activities of daily living (IADL), and Barthel Index.

Results. Exposure to DBI drugs was identified in 37% of participants: 24% had a DBI range between >0 <1, and 13% DBI ≥1. After adjusting for confounders, exposure to DBI drugs was associated with slower walking speed (P < 0.0001), poorer performance on chair stands (P = 0.0001) and TUG (P < 0.0001), difficulties in IADL (P < 0.0001), and Barthel Index (P < 0.0001). The mean adjusted walking speed, time to complete chair stands and TUG, IADL, and Barthel scores were significantly poorer among participants with higher DBI ranges.

Conclusion. In older adults living in Finland, DBI was associated with impaired function on previously tested and new outcomes. This finding supports the use of the DBI as tool, in combination with other assessments, to identify older people at risk of functional impairment. The findings highlight the need for revision of current guidelines to improve the quality of drug use in older people.     

Experience with NORPLANT® in Egypt

Experience with the contraceptive NORPLANT in Egypt dates back to early 1980 when the first multicentre trial was initiated. To date, more than 3000 women have received this contraceptive at the Assiut University Family Clinic alone. Analysis of the overall experience in this clinic has indicated a 5-year cumulative continuation rate of 51 and a pregnancy rate of 1.8 per 100 women.

Clinical pharmacology studies pertaining to the safety of NORPLANT in our community have indicated no deleterious effect on the lipid profile, liver functions and blood coagulation system. Two studies conducted in Egypt have indicated that the initiation of NORPLANT use shortly after delivery does not have any unfavourable effect on lactational performance, or on physical or psychomotor development of the breast-fed infants. This is particularly important in Arab and Moslem cultures where prolonged breast-feeding is emphasized.

A study utilizing focus-group discussion to assess users' attitudes to NORPLANT has indicated the need to improve the informational/educational package given in the service by emphasizing certain cultural considerations.

On the whole, this first implant method has proven to be safe and acceptable in Egypt, where there is a special need for long-term methods for contraception, particularly as sterilization is not socially acceptable.     

The relationship between the levels of nurses’ competence and the length of their clinical experience: a tentative model for nursing competence development

Aims and objectives. To explore the relationship between the levels of nurses’ competence and the length of their clinical experience, in order to provide a tentative model of the continuing competence of nurses. Background. The professional development of employees has attracted great interest. This interest has led to the development of various models that illustrate how employees develop their competence throughout their careers. However, little is known of how nurses maintain and develop their competence throughout their career pathways. Design. A cross‐sectional design was used. Methods. Using a survey method, five dimensions of self‐assessed nursing competence and the length of the nurses’ clinical practice were measured (n = 325). Each dimension of competence was plotted against the length of their clinical experience using locally weighted scatterplot smoothing. Then, the shapes of the plots were analysed by fractional polynomial regression analysis. Results. Overall, the relationships between the levels of nursing competence and the length of clinical experience were illustrated by curves with a rapid increase in competence levels at the early stage of the nursing career and a slower increase later. These curves were modelled by either a logarithmic, square‐root function or its reciprocal. The results supported the learning curve model. Conclusions. The competence development of nurses may be characterised by two distinctive periods: a rapid growth period followed by stable periods. However, the modality of the growth may be different depending on which dimension of nursing competence is in focus. Relevance to clinical practice. The level of nursing competence directly affects the quality of care provided to patients. The findings of the study enable healthcare organisations to take proactive approaches to enhance nurses’ competence by identifying when and how to assist nurses.     

A randomised trial of nursing interventions supporting recovery of the postmastectomy patient

Aims and objectives. This ABC to recovery study evaluated the combined and separate components of preoperative education and the effectiveness of wearing the Papilla Gown. Background. Surgical removal of the breast may lead to activity limitation, self‐image issues, discomfort and later complication of lymphoedema. Design. This study used experimental and longitudinal design. Methods. One hundred and forty‐five women undergoing mastectomies for stages two and three breast cancer were randomised into four groups: education and Papilla Gown, education only, gown only and control. The outcomes of activity (A), body image (B), comfort (C), knowledge and lymphoedema were assessed at baseline and/or 1 week and 6 months using three measures. All 145 participants completed the study questionnaires at first two measures, and forty‐six of these participants completed the questionnaires at 6 months postoperatively. The setting for the study included two clinics and hospitals. To examine statistical significance at each time point after surgery, 2‐way anova s were performed on ABC, knowledge and tape measurement to see whether there were any statistically significant differences between the four groups. All reported p‐values are two sided. All statistical analyses were performed using sas 9.2 for Windows. Results. The mean age of the sample was 55 years. The study revealed that women who received the combined intervention demonstrated greater activity. Women who wore the gown only had a greater comfort level and decreased lymphoedema. Women that received preoperative education experienced increased knowledge. Conclusions. Outcomes suggest that the combined intervention (ABCs to recovery) can improve recovery following mastectomy. Relevance to clinical practice. The results will be used to further modify the intervention and to increase awareness of nurse practitioners and other healthcare professionals of the specific needs of postmastectomy patients.     

Comparison of the kinetic characteristics of standing and sitting Tai Chi forms

Purpose. To compare the kinetic characteristics of Tai Chi forms performed in standing and seated positions.

Methods. An experienced Tai Chi master was invited to perform the Tai Chi Qi Qong 18-form while standing and seated. Two force platforms were used to track the centre of pressure (COP) during the Tai Chi movements. Centre of mass (COM) displacement was measured using a video motion analysis system.

Results. In standing, the maximum COP displacements in the anteroposterior and mediolateral directions ranged from 2.6% to 9.5%, and 0.3% to 29.6% of the subject's height, respectively. The maximum COP displacements in sitting were smaller, with mean displacements of 0.7% and 0.1% of height in the anteroposterior and ML directions, respectively. The subject's COM moved in the vertical direction in slow, coordinated and smooth patterns.

Conclusions. The kinetic data on each of the 18 Tai Chi forms studied can guide the choice of suitable Tai Chi forms for balance training. Sitting Tai Chi is recommended for rehabilitating the balance of frail older adults who have difficulty standing. Because of the minimal demands of sitting Tai Chi for balance control, progressing to practice in standing as quickly as possible is recommended.