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Depressive symptoms and cognitive function in older adults: A cross-lagged network analysis
No full textBackground: Depressive symptoms commonly co-occur with cognitive decline in older adults. However, prospective interrelation-ships between different cognitive function domains and depressive symptoms are not well understood. This study evaluated prospective interrelationships between depressive symptoms and cognitive functioning components among individuals aged50 years or older from a perspective of network analysis.
Method: Longitudinal data from the English Longitudinal Study of Aging were analyzed. Depressive symptoms were measured with the eight-item Center for Epidemiologic Studies Short–Depression Scale. Cognitive functions assessed included memory, orientation, and executive function. Contemporaneous network analyses were conducted using mixed graphical model, while atemporal network model was assessed using cross-lagged panel network model. To identify important predictors and outcomes, centrality indices, including expected influence, out-expected influence, and in-expected influence, were calculated.
Results: A total of 6,433 older adults were included in the network analysis. Baseline “Not enjoy life” (CESD-6) was negativelyassociated with executive function at the follow-up assessment. Moreover, improvements in “Everything was an effort” (CESD-2)and “Loneliness” (CESD-5) were related to less future decline of executive function and memory ability. Furthermore, analyses suggested targeting “Lack of happiness” (CESD-4) could be useful in reducing the co-occurrence of depression and cognitive decline among older adults..
Conclusions: This network analysis study highlighted dynamic interrelationships between depressive symptoms and cognitive decline in older adults. Findings suggest that interventions targeting specific depressive symptoms may have the potential toalleviate declines in executive function and memory for this population
Exercise as a non-pharmacological intervention for the management of sleep disturbance in primary brain tumour survivors and their caregivers: A study protocol of a clinical trial
No full textBackground: Sleep disturbance is a highly prevalent and impactful symptom experienced by those adversely affected by primary brain tumours. Despite this, there is a lack of literature exploring appropriate options for the management of sleep disturbance in these populations. As such, more holistic and patient-centred approaches to address sleep disturbance are needed. Exercise presents itself as a viable option for managing sleep disturbances given its numerous health benefits, minimal costs, and acceptability, though the feasibility of its use in the context of primary brain tumours is unknown.
Methods: Primary brain tumour survivors and their caregivers will enrol and participate in a supervised, eight-week exercise intervention delivered by telehealth. Feasibility will be assessed using predetermined study metrics, including eligibility, recruitment. and assessment completion rates. Acceptability will be assessed using retention to intervention rates, session attendance, and participant satisfaction. Sleep will be assessed both objectively, using ring sleep trackers, and subjectively, using questionnaires.
Conclusion: This study will be the first to explore the feasibility and acceptability of exercise for the management of sleep disturbance in primary brain tumour survivors and their caregivers. If successful, this protocol will contribute to the development and implementation of appropriate strategies to manage sleep disturbance in these populations
Therapeutic applications for homeopathy in clinical practice
No full textHomeopathy was founded some two hundred years ago by Dr Samuel Christian Hahnemann. Over time, it has grown to be among the most frequently used forms of alternative medicine in Europe and the USA. It is underpinned by the principle of ‘like cures like’, where highly diluted substances are used for therapeutic purposes, by producing similar symptoms to when the substance is used in healthy people. Many studies have been published on the value of homeopathy in treating diseases such as cancer, depression, psoriasis, allergic rhinitis, asthma, otitis, migraine, neuroses, allergies, joint disease, insomnia, sinusitis, urinary tract infections and acne, to name a few. We conducted a comprehensive review of the literature on homeopathy and evaluated its effectiveness in clinical practice. While there is evidence of the clinical benefts of homeopathy, its formal application requires more rigorous randomised controlled trials
Body image at the trunk: An investigation into externally referenced width perception and picture mapping
No full textBody image is a conscious representation of the body, encompassing how our body feels to us. Body image can be measured in a variety of ways, including metric and depictive measures. This study sought to assess body image at the trunk by investigating, and comparing, a metric and depictive measure. Sixty-nine healthy participants estimated their thorax, waist, and hip width by externally referencing mechanical calipers. Participants were also asked to select the true image of their trunk from a random display of nine images containing the true image and incrementally shrunken or enlarged images. Participants demonstrated evidence of thorax and waist width overestimation in the width perception task, with no evidence for hip misestimation. For the picture mapping task, the majority of participants were inaccurate. In participants who were inaccurate, approximately equal proportions underestimated and overestimated their trunk width. The two tasks were found to be independent of each other. Distortions, or inaccuracies, were apparent in a metric measure, and inaccuracies also present in a depictive measure, of body image at the trunk for healthy participants. An overestimation bias was apparent in the metric, but not depictive, task. No relationship was found between tasks.
Experiences of moral distress among health care professionals in oncology and palliative care in Australia: A qualitative investigation
No full textBackground: Cancer care involves challenging clinical problems requiring expertise of multiple disciplines and frequently necessitates nuanced decision-making. When decision-making and patterns of care conflict with the values of health care professionals (HCPs), moral distress may arise. Moral distress is defined as the unease resulting from the perceived violation of professional or personal values and ethical principles. It has been associated with increased burnout and lower workforce retention among HCPs. This study aimed to investigate moral distress among Australian oncology and palliative care HCPs to understand how, when, and why it is experienced.
Method: We conducted a qualitative interview study, with an online survey to collect demographic, practice-related characteristics, and level of moral distress. Interviews were conducted with oncology and palliative care HCPs in Australia to explore participants’ experiences of moral distress. Interviews were audio-recorded and transcribed. A thematic analysis was conducted using a framework analysis approach.
Results: We interviewed 33 participants, who were predominantly female (78%) and nurses (42%) with 50% having 15 years or more experience in oncology/palliative care. Thematic analysis revealed one meta-theme, Power and Hierarchy, and four themes: (1) values and their conflicts; (2) moral distress and the system; (3) moral distress and interpersonal interactions; and (4) internalized moral distress. At the core of HCPs’ experiences of moral distress were patient-centered and care-centered values and the imperative to not violate the oath to “Do No Harm.” Moral distress was perceived to be covert, primarily arising in response to day-to-day clinical dilemmas and resulted from interactions with other HCPs and structural factors. Moral distress appeared to be cumulative over time.
Conclusion: Moral distress arises when there are conflicts between an individual’s values and organizational culture, within teams, and within the HCPs themselves. Power and hierarchy within health care are critical elements contributing to moral distress where poor communication and limited recognition of differing views are present. There is a need for interventions facilitating open discussion of ethical concerns to reduce likelihood of moral distress and retain an experienced oncology and palliative workforce
The Development, Implementation, and Evaluation of an Online Program for Emergency Nurses Caring for Victims of Interpersonal Violence: A Mixed Methods Study
Get PDFForensic nursing encompasses a range of skills that can be utilised across healthcare services and legal services. The delivery of forensic nursing care covers a vast number of roles and practice areas that can improve patient outcome, including the care of victims of interpersonal violence who often face multiple barriers in achieving a positive medicolegal outcome. A nurse’s ability to identify a potential victim and initiate forensic nursing care in an emergency care setting can positively influence the patient’s engagement with support services and the justice system. Despite this, a review of the Australian literature has identified inconsistencies in forensic nursing practice in emergency care settings.
Interpersonal violence is a growing global concern – in particular, gender-based violence and violence against vulnerable populations. Nurses require education and support to deliver principles of forensic practice and incorporate trauma-informed care to support victims of interpersonal violence. The purpose of this study was to develop a national online forensic program for registered nurses working in an Australian emergency care setting and to determine whether these nurses perceived that the program positively influenced their patient care. This program aimed to fill the gap many health services in Australia experience as a result of the limited employment of forensic nursing roles.
The study used a multiphase mixed methods approach to collect data from stakeholders and participants working in emergency care settings across three phases and six data points. Phase one involved surveys with open ended and closed ended questions completed by stakeholders in health care and the criminal justice system from various States and Territories across Australia. Data analysis from phase one contributed to phase 2 in the development of the forensic nursing online program, which was reviewed by an expert panel. Phase 3 encompassed the distribution of the online program alongside the associated pre and post experience surveys. The surveys were distributed to nurses who work in an emergency care setting through the Australian College of Emergency Nursing (ACEN) and the College of Emergency Nursing of Australasia (CENA).
Data analysis supported the learning benefit of the program content and delivery method; additionally, across the phases, participants identified various enablers and barriers to the delivery of forensic nursing care in the emergency care setting. The internal conflict they experienced when patients refused assistance and the increased exposure to vicarious trauma was of concern to nurses’ welfare. Importantly, the study noted increased confidence in key forensic principles such as injury documentation and evidence collection. This finding is significant given that 50.7% (n = 36) of the participants stated they had received no previous education on forensic principles; however, 61.1% (n = 44) had encountered forensic patients on a daily or weekly basis.
The forensic nursing program has demonstrated its ability to provide key forensic nursing care principles to nurses through an online learning format; further, this introductory program enhanced nurses’ engagement with patient identification and their ability to deliver person-centred forensic care. The forensic nursing program, developed with stakeholder input, has provided a platform to support this extension of the registered nursing role in Australia
Estimating the rates of dementia using administrative data linked to cohort studies
No full textBackground: Current estimates of dementia and Alzheimer’s disease incidence and prevalence are required to understand the health needs of the elderly.
Objective: We used two Australia cohort studies, administrative datasets, and data linkage techniques to estimate dementia rates in Australia.
Methods: The study used Australian Longitudinal Study on Women’s Health and the Health in Men Cohort Study. Records of dementia were obtained from linked sources and incidence and prevalence estimates were produced. Capture-recapture methods were used to estimate numbers of dementia cases not identified through data linkage.
Results: There were 3399 (28.5%) men with dementia identified from any source and 3767 (34.8%) women. Rates of dementia incidence and prevalence were similar between sexes but were raised in men once estimates of unidentified cases were included.
Conclusions: Cohort studies and linked administrative data can be used together to produce current estimates of dementia prevalence and incidence comparable to other population estimate
Performance, Impact and Effectiveness Review: Emergency Department Musculoskeletal Diversion Pathway (MSK Diversion Pathway)
No full textPFS Consulting has been appointed to undertake a Performance, Impact and Effectiveness Review of the Emergency Department Musculoskeletal Diversion Outpatient Clinic Pathway (MSK Diversion Pathway). The aim of this project is to establish, measure and test the fundamentals of the MSK Diversion Pathway, in the following areas:
1) Cost-effectiveness analysis – evaluation and outcomes data to: - Determine appropriate performance measures that can be derived from the available empirical data, assess the appropriate level of granularity against which to apply given the data limitations, and determine an appropriate Control Group (considering COVID impacts, clinical and actuarial suitability and technical validity of the analysis approaches) - Identify conditions and patient profile that is best suited to the MSK Diversion Pathway, reassess performance based on moving to a mainstream “operational/scalable” model of care (from a “research” focused phase/establishment)
2) Financial sustainability, with a focus on proposed funding model and pilot/trial costs to: - Review current funding and program (including system) resourcing arrangements, interactions (limitations) of Activity Based Funding, and existing funding disincentives for MSK Diversion Pathway pilot - Determine the resourcing requirements and funding model, Compare and contrast with the existing ED pathway for identified patients, including current ED and Tier 2 funding (ABF), and consider interface with primary care (Medicare)
3) Scalability of the MSK Diversion Pathway, considering the opportunity to increase MSK activity and throughput (as a direct result of the pilot) focusing on opportunities to scale, and hospital efficiency outcomes from the MSK Diversion Pathway.
4) Potential as an innovative model of care under the National Health Reform Agreement (NHRA
