Listening and learning: a qualitative study of Scottish care home staff experiences of managing COVID-19 between March 2020-August 2022.

BACKGROUND: The serious outcomes of outbreaks of COVID-19 in care homes have been described internationally. The experiences of professionals working through outbreaks has received less attention, missing opportunities to acknowledge and learn lessons. Our aim was to explore the experiences of care home staff in Scotland of managing COVID-19 within their homes to help inform understanding and future practice. METHODS: From April to August 2022, 34 individual semi-structured interviews were conducted with care home staff working in homes which experienced an outbreak(s) of COVID-19. Reflexive thematic methods were used to analyse verbatim deidentified transcripts. FINDINGS: There was no singular experience of COVID-19 outbreaks within care homes. We identified four broad groupings of homes with outbreaks (significant outbreaks, managed outbreaks, outbreaks in remote/rural homes & outbreaks in homes supporting younger adults), with overlaps in timing and severity and variation in the support received and impact. The national response to the COVID-19 pandemic resulted in fundamental change to care home relationships. Staff responded by adaptation in uncertainty. However, they were challenged by emerging inequalities influencing residents' care. There were tensions between staff experience and evolving external approaches to regulation and oversight. All this change resulted in psychological impacts on staff. However, there was also widespread evidence of compassionate leadership and teamwork in their responses. Effective sources of support were underpinned by respectful relationships and continuity, tailored to individual contexts. CONCLUSIONS: The lived experiences of care home staff during the COVID-19 pandemic provide valuable insights applicable beyond the pandemic context. This includes: recognition of the specialism, complexity and diversity of care home practice; the value afforded by embedding genuine representation and involvement in planning, policy-making and research; the need for individualising to people in their contexts and the value of fostering respectful relationships across professional groups to support residents.

Symptom management for people with advanced dementia who are receiving end of life care.

PURPOSE OF REVIEW: This review aims to synthesise contemporary research on symptom management for people with advanced dementia who are thought to be in the final year of life. It highlights the unique challenges faced by palliative care and dementia care specialists, offering insights into the clinical decision-making required to support those with advanced dementia in various care settings. RECENT FINDINGS: Recent studies indicate that people with advanced dementia often experience significant unmet palliative care needs, particularly regarding symptom management. Pain, breathlessness, and psychological distress are frequently mismanaged, which contributes to suboptimal care. Moreover, the unpredictable trajectory of dementia complicates the identification of end-of-life needs, which can result in fragmented care. Caregivers, both professional and family, struggle with managing complex symptoms, while family caregivers in home settings face added burdens in providing care without sufficient support. SUMMARY: Palliative care for people with advanced dementia is currently inadequate due to a lack of tailored interventions, poor symptom management, and disjointed care systems. Enhancing training for caregivers, fostering interdisciplinary collaboration, and focusing on integrated care approaches across home and institutional settings are crucial to improving quality of life and symptom control for people with advanced dementia.

Involving patients and the public in nursing PhD projects: practical guidance, potential benefits and points to consider.

BACKGROUND: Funders, academic publishers and governance bodies increasingly require research to involve patients and the public. This also enables nurse researchers to increase the visibility of scholarly nursing roles, which are poorly understood by the public. There are different approaches to involvement, and a wealth of guidance about how it can and should be implemented. Less is known about how it should be done in the context of a nursing PhD. AIM: To discuss the experiences of the authors' nursing research group in involving patients and the public in PhD research, reflect on the benefits to be gained from doing so, and highlight considerations for those planning to involve patients and the public in their doctoral research projects. Discussion It is essential to decide in advance of a study who you will involve, how to reach them and why you are involving patients and the public. Some potential benefits of involvement are: more accessible documentation, refined methods and better research outputs created in collaboration with patients and the public. CONCLUSION: Patients and the public should be involved in nursing PhD projects. Not only does this improve the quality of the research and raise the profile of nursing research, but it provides the opportunity for students to learn skills that they can develop further throughout their academic careers. IMPLICATIONS FOR PRACTICE: Obtaining high-quality patient and public involvement is an important skill for nurse researchers. The first steps in acquiring this skill should be taken during research training.

Cutting through the intersections to care for caregivers: Secondary data analysis of a carers support service in Glasgow, Scotland.

As the number of people living longer with life-limiting conditions grows, so too does the number of caregivers and the complexity of the caring role. To understand more about the role and how caregivers can be supported, local and national registers have been created that collect data on caregivers. Our objective was to undertake comparative analysis of female and male adult caregiver assessments from a caregiver database created from a carers support service running in Glasgow, Scotland. Assessments were carried out over a 12-month period (01/04/17-29/03/18). We aimed to identify the prevalence of negative consequences of caring through descriptive statistical, comparative analysis. Seven hundred and eighty-three assessments were eligible for inclusion. In our dataset, 69% were female (n = 552), and 29% were male (n = 231). Female caregivers were more likely to be of working age but unemployed (p = 0.03) and experiencing mental ill-health (p = 0.011). Male caregivers were more likely to be retired (p < 0.001), caring for a parent (p = 0.017) and living with heart disease (p = 0.0004), addiction issues (p = 0.013) or diabetes (p = 0.042) than female caregivers. For caregivers using this support service, female and male caregivers experienced, recognised or reported negative impacts from caring on their personal identity, social life, ability to self-care and relationships similarly. Furthermore, a caregiver whose relationships had been negatively impacted was 13.8 times more likely (p > 0.00) to report a reduction in psychological well-being. Sex disaggregated data are an important consideration for caregiver research due to socio-political influences that impact caring roles and expectations. Disaggregating data by sex allow researchers to understand how the caring role differs between subsets and allow for the development of more targeted, sensitive support.

Measuring the success of interventions for caregivers: a focussed systematic review.

PURPOSE OF REVIEW: The selection and application of outcome measures are fundamental steps in the research process because they inform decisions around intervention efficacy. We aimed to describe the outcomes used in trials of supportive interventions for adult caregivers of people with three exemplar life-limiting conditions: heart failure, dementia or stroke. RECENT FINDINGS: We performed a focussed review of 134 published trials that included interventions designed to improve caregivers' health and wellbeing and/or ability to function in their caring role. We extracted and categorized all caregiver outcomes described in the studies. We identified inconsistency in the outcomes measured; frequent use of bespoke and adapted tools (29% of outcomes were bespoke), and a lack of clarity in outcome priorities (the mean number of outcomes per trial was four [range: 1-11]). Outcome scales that purport to measure the psychological impact of the caring role were the most popular tools in all three caregiver groups. SUMMARY: Outcomes used in trials related to adult caregivers are characterized by inconsistencies in outcome measure selection and assessment. This heterogeneity complicates comparisons of treatments and attempts to pool data.

Autocuidado e diabetes: descubra o "sabor" de uma vida saudável / Autocuidado e diabetes: descubra o "sabor" de uma vida saudável

Produto do projeto: Impacto da coordenação e acompanhamento do cuidado por telemonitoramento na qualidade da assistência prestada aos usuários do SUS portadores de doenças crônicas, egressos de internação hospitalar em Belo Horizonte, MG, Brasil.

Confiabilidade do uso de modelos digitais tridimensionais como exame auxiliar ao diagnóstico ortodôntico: um estudo piloto / Reliability of three-dimensional digital casts as a diagnostic tool for orthodontic treatment planning: a pilot study

OBJETIVO: os rápidos e contínuos avanços nas Ciências da Computação resultaram no aumento significativo do emprego de novas tecnologias em todos os níveis da sociedade. Na Ortodontia, radiografias e fotografias digitais já são usadas de forma rotineira. A utilização de modelos de estudo digitais vem sendo anunciada como o novo componente da documentação ortodôntica computadorizada. Como acontece quando uma nova tecnologia se torna disponível, o uso de modelos ortodônticos digitais tem gerado controvérsias. Alguns ortodontistas questionam a aplicabilidade de imagens tridimensionais em substituição aos modelos tradicionais de gesso, pois não há na literatura número relevante de estudos que tenham testado adequadamente tal tecnologia. Diante disso, o objetivo desse estudo foi testar a confiabilidade do uso de modelos dentários digitais como exame complementar ao diagnóstico ortodôntico. METODOLOGIA: três examinadores mediram a largura dos dentes permanentes, quatro segmentos dos arcos superiores e inferiores, distâncias intercaninos, distâncias intermolares, trespasses horizontal e vertical em modelos de gesso e em seus correspondentes digitais de seis pacientes, utilizando um paquímetro digital e o programa eModel, respectivamente. RESULTADOS E CONCLUSÕES: diante dos resultados, observou-se que todas as medidas avaliadas foram estatisticamente semelhantes nos dois tipos de modelos testados, com exceção das médias encontradas para a largura do dente 45 (p<0,05). Entretanto essa diferença é considerada clinicamente aceitável. Comprova-se com esse estudo a confiabilidade do uso dos modelos dentários digitais como exame complementar ao diagnóstico ortodôntico. Além disso, a facilidade de armazenamento de informações, o menor risco de perda de dados durante sua manipulação e transporte, bem como a diminuição do tempo gasto para realizar as medições foram considerados vantagens do uso dessa nova tecnologia na Ortodontia.

AIM: the fast and continuous advances in computer sciences have resulted in an increased usage of new technologies in all levels of the modern society. Orthodontics has also been influenced by this phenomenon. Digital radiographs and photographs have been commonly used in Orthodontics offices. Recently, digital study models have been advertised as the latest component of fully digitized orthodontic records. When a new diagnostic technology becomes available it may initially generate controversy, and with digital orthodontic casts it has not been different. Some orthodontists may question the reliability of this new diagnostic tool since there is not enough literature to support the substitution from traditional stone casts to digital models. Therefore, the aim of the present study was to compare the reliability of digital orthodontic models and stone casts as a diagnostic aid. METHODS: three examiners measured the width of the permanent teeth, intercanine and intermolar distances, overbite and overjet of stone and the corresponding digital casts from six patients. A digital caliper was used for measuring the stone casts and the eModel software to evaluate the digital models. RESULTS AND CONCLUSIONS: the results of this study showed no statistically significant difference among any of the measurements tested, except by the width of the lower second right premolar (p<0.05). However, these differences were not considered clinically relevant. These findings show that digital orthodontic casts are as reliable as stone study models as a diagnostic tool for orthodontic treatment planning. The easy data storage, the lower risk of breakage during its handling and transportation, and also the shorter time needed to obtain the diagnostic information were considered additional advantages of this new technology.

Critérios objetivos de avaliação clínica para a finalização ideal de casos tratados ortodonticamente / Objective clinical criteria for optimizing orthodontic treatment finishing

A finalização ortodôntica é uma etapa do tratamento onde o ortodontista deve continuar atento aos objetivos estabelecidos no diagnóstico e planejamento de cada caso. Além disso, o profissional deve trabalhar para refinar os resultados alcançados até então, eliminando fatores que possam contribuir para a remoção dos aparelhos. Alcançar a excelência na finalização pode parecer algo simples, em alguns casos. Entretanto, em determinados pacientes, a obtenção de uma oclusão ideal pode se tornar um grande desafio. A utilização de um protocolo de finalização, coordenando todos os critérios a serem avaliados antes de se considerar o tratamento encerrado, pode facilitar o processo de finalização dentro da rotina clínica do ortodontista. Sendo assim, o objetivo desse trabalho foi realizar uma revisão crítica da literatura a respeito dos critérios objetivos de finalização do tratamento ortodôntico e propor um protocolo de avaliação dos aspectos clínicos a serem observados pelos ortodontistas durante os estágios finais da terapia ortodôntica.