Older Adult Transitions into Long-Term Care: A Meta-Synthesis.

As older adults age, they often experience health changes that require the need for long-term care (LTC). Transition to LTC can be stressful and lead to a further decline in health. The purpose of the current meta-synthesis was to provide an appraisal of older adults' transition experiences to LTC. This systemic appraisal included current qualitative research on these experiences, with analysis of the data guided by the middle range theory of transition. Three amalgamated themes were identified: (a) painful loss that requires a mourning process, (b) seeking stability through gaining autonomy to sustain a new sense of self, and (c) acceptance when a unique inner balance is reached. [Journal of Gerontological Nursing, 43(3), 41-49.].

Remaining in the nursing home versus transfer to acute care: resident, family, and staff preferences.

Resident and family insistence on transfer is a major factor in the occurrence of potentially avoidable transfers from nursing homes (NHs) to acute care. The purpose of this study was to explore resident, family, and staff preferences regarding transfer to acute care. A sample of 271 NH residents, family members, staff, and medical providers were interviewed. Seventy-seven percent of residents reported that they had not given any thought to the question of whether they would want to be transferred to acute care. Family members wanted more information than residents, but more residents (39%) thought they should be fully involved in the transfer decision than their family members (12%) or staff (12%). Staff preferred keeping residents in the NH. Families were divided between transferring residents and having them remain in the NH. More residents indicated that their desire to transfer would depend on the severity of their condition and their prognosis. Ethnic group differences were noted. Results suggest that discussion of this issue should occur soon after admission and that differences in perspectives may be expected from those involved.

Publishing your scholarship: a survey of pearls from top reviewers.

Experts have described ways to improve peer review quality. Perspectives from expert reviewers are largely absent in the health professions education literature. To gather guidance from expert reviewers, to aid authors striving to publish and reviewers aiming to perform their task effectively. This study surveyed the Journal of Graduate Medical Education (JGME) 'Top Reviewers' from 2017, 2018, and 2019. 'Top Reviewers' perform four or more reviews per year, with high average ratings. Top reviewers were sent an 11-item survey in February 2020. The survey included three demographic questions and eight open-ended, free-text questions about the concepts reviewers most often target in their reviews. We calculated descriptive statistics and performed a thematic analysis of open-ended responses. Of 62 eligible top reviewers, 44 (71%) responded to the survey. Only eight (18.2%) and seven (15.9%) respondents reported having 'stock phrases' or a reviewer template used for reviewer feedback to authors, respectively. The what (research question, methods), how (presentation, writing), and why (relevance, impact) were the resulting themes summarizing how reviewers categorized and responded to common problems. For 'really good papers' reviewers found the what acceptable and focused on how and why. For 'really bad' papers, reviewers focused on big picture feedback, such as the value of the study. Top reviewers from a single health professions education journal appear to have similar approaches to conducting reviews. While most do not use stock phrases or templates, they share similar strategies to differentiate 'good' vs. 'bad' papers through the what, why, and how of a manuscript.

A1 adenosine receptor activation promotes angiogenesis and release of VEGF from monocytes.

Adenosine is a proangiogenic purine nucleoside released from ischemic and hypoxic tissues. Of the 4 adenosine receptor (AR) subtypes (A1, A2A, A2B, and A3), the A2 and A3 have been previously linked to the modulation of angiogenesis. We used the chicken chorioallantoic membrane (CAM) model to determine whether A1 AR activation affects angiogenesis. We cloned and pharmacologically characterized chicken AR subtypes to evaluate the selectivity of various agonists and antagonists. Application of the A1 AR-selective agonist N6-cyclopentyladenosine (CPA; 100 nmol/L) to the CAM resulted in a 40% increase in blood vessel number (P<0.01), which was blocked by the A1 AR-selective antagonist C8-(N-methylisopropyl)-amino-N6-(5'-endohydroxy)-endonorbornan-2-yl-9-methyladenine (WRC-0571; 1 micromol/L). Selective A2A AR agonists did not stimulate angiogenesis in the CAM. In an ex vivo rat aortic ring model of angiogenesis that includes cocultured endothelial cells, fibroblasts, and smooth muscle cells, 50 nmol/L CPA did not directly stimulate capillary formation; however, medium from human mononuclear cells pretreated with CPA, but not vehicle, increased capillary formation by 48% (P<0.05). This effect was blocked by WRC-0571 (1.5 micromol/L) or anti-VEGF antibody (1 microg/mL). CPA (5 nmol/L) stimulated a 1.7-fold increase in VEGF release from the mononuclear cells. This is the first study to show that A1 AR activation induces angiogenesis. Stimulation of A2 ARs on endothelial cells results in proliferation and tube formation, and A2 and A3 ARs on inflammatory cells modulate release of angiogenic factors. We conclude that adenosine promotes a coordinated angiogenic response through its interactions with multiple receptors on multiple cell types.

Story-Sharing Intervention to Improve Depression and Well-Being in Older Adults Transitioning to Long-Term Care.

Older adults frequently experience depression and reduced well-being when transitioning to long-term care (LTC) that can lead to increased risk for mortality. In the current randomized controlled trial, older adults (N = 93) who were transitioning to LTC facilities in Southeast Florida were enlisted. It was hypothesized that when transitioning to LTC (a) story sharing (i.e., sharing stories in groups) could lead to reduced depression and improved well-being, and (b) baseline sociodemographic characteristics could predict depression and well-being. Baseline results revealed that participants were not depressed and had moderate well-being, and postintervention results indicated that there were no significant improvements in depression (p = 0.35) and well-being (p = 0.41). Some baseline sociodemographic characteristics predicted depression (p = 0.04) and well-being (p = 0.03). Future research should incorporate moderate depression as an inclusion criterion and more weeks of story-sharing sessions. Targets: Adults age 65 and older transitioning to LTC. Intervention Description: Two to three participants met as a group to share five stories over 3 weeks. Mechanisms of Action: Story sharing will improve well-being. Outcomes: Participant level of well-being will improve, and sociodemographic characteristics and factors related to the move will predict risk for depression and reduced well-being. [Res Gerontol Nurs. 2019; 12(2):81-90.].

The effectiveness of screening for prostate cancer: a nested case-control study.

BACKGROUND: Screening for prostate cancer is done commonly in clinical practice, using prostate-specific antigen (PSA) tests or digital rectal examination (DRE). Evidence is lacking, however, to confirm a survival benefit among screened patients. We evaluated the effectiveness of PSA, with or without DRE, in reducing mortality. METHODS: We conducted a multicenter nested case-control study at 10 Veterans Affairs medical centers in New England. Among 71 661 patients receiving ambulatory care between 1989 and 1990, 501 case patients were identified as men who were diagnosed as having adenocarcinoma of the prostate from 1991 through 1995 and who died sometime between 1991 and 1999. Control patients were men who were alive at the time the corresponding case patient had died, matched (1:1 ratio) for age and Veterans Affairs facility. The exposure variable (determined blind to case-control status) was whether PSA testing or DRE was performed for screening prior to the diagnosis of prostate cancer among case patients, with the same time interval for control patients. The association of screening and overall or cause-specific (prostate cancer) mortality was adjusted for race and comorbidity. RESULTS: A benefit of screening was not found in our primary analysis assessing PSA screening and all-cause mortality (adjusted odds ratio, 1.08; 95% confidence interval, 0.71-1.64; P=.72), nor in a secondary analysis of PSA and/or DRE screening and cause-specific mortality (adjusted odds ratio, 1.13; 95% confidence interval, 0.63-2.06; P=.68). CONCLUSIONS: These results do not suggest that screening with PSA or DRE is effective in reducing mortality. Recommendations for obtaining "verbal informed consent" from men regarding such screening should continue.