Safeguarding adults at risk of abuse: identifying educational gaps amongst hospital staff to guide training.

BACKGROUND: Safeguarding refers to the protection of health and wellbeing and enabling "life free from harm, abuse and neglect" (Safeguarding People 2019). In Ireland, the Health Service Executive (HSE) drafted a revised 2019 policy to replace the original policy on safeguarding adults at risk of abuse. A Safeguarding Committee was founded in Beaumont Hospital, Dublin to prepare for policy implementation and staff training. AIMS: To establish staff awareness and understanding of safeguarding to guide training and policy implementation. METHOD: Cross-sectional study of 223 hospital staff using a 10-question paper survey. RESULTS: Suboptimal awareness of the revised HSE policy, reporting structures and confidence levels amongst staff. In-person and online training identified as the most popular methods of learning. CONCLUSIONS: Knowledge and confidence gaps can be addressed in future training. Identifying education gaps will help guide training and policy implementation.

Riesgo de maltrato en personas adultas mayores: validación de contenido de una escala / Older adults at risk of abuse: content validity of a scale

Resumen Objetivo: Realizar la validación de contenido en una escala que mide el riesgo de maltrato en personas adultas mayores. Método: Diseño instrumental, en el que se seleccionaron cuatro jueces expertos con experiencia en el área para llevar a cabo la evaluación de contenido de la escala; el proceso se realizó cuatro veces hasta conseguir el total acuerdo entre los jueces, según el método de juicio de expertos en la modalidad de agregados individuales y finalmente, se aplicó una prueba piloto. Resultados: Los jueces expertos llegaron a un total acuerdo respecto a la claridad, coherencia, lenguaje, relevancia de los ítems y suficiencia de las categorías planteadas tras cuatro revisiones, permitiendo la configuración de la escala con tres categorías y 80 ítems. Con la aplicación piloto se encontró que 66,7% de los mayores reportaron maltrato, el tipo de maltrato más frecuente fue el psicológico (29,2 %), se evidencian pocos factores de riesgo, aunque se destaca la presencia de estereotipos negativos sobre la vejez por parte de los mismos gerontes y limitaciones económicas. Conclusión: Con la validación de contenido la escala logra evaluar los factores de riesgo de maltrato del adulto mayor con claridad en la redacción, coherencia interna en cada ítem, sin inducción a las respuestas, un lenguaje adecuado a la población, dejando solo los ítems relevantes y permitiendo que estos fueran suficientes para la evaluación de las tres dimensiones propuestas; la aplicación de la prueba piloto permitió corroborar dicha validez.

Abstract Objective: To perform content validation on a risk scale that measures the risk of abuse in older adults. Method: Instrumental design, in which four expert judges with experience in the area were selected to carry out the content evaluation of the scale; the process was realized four times until full agreement was reached among the judges, according to the expert judgment method in the individual aggregate modality and finally, a pilot test was applied. Results: The expert judges reached a total agreement regarding the clarity, coherence, language, relevance of the items and sufficiency of the proposed categories after four revisions, allowing the configuration of the scale with three categories and 80 items. With the pilot application it was found that 66.7 % of the elders reported abuse, the most frequent type of abuse was the psychological one (29.2 %), there are few risk factors, although the presence of negative stereotypes about the old age on the part of the same older adults and economic limitations. Conclusion: With the validation of content the scale manages to assess the risk factors of abuse of the elderly with clarity in the writing, internal coherence in each item, without induction to the answers, a language appropriate to the population, leaving only the relevant items and allowing these to be sufficient for the evaluation of the three proposed dimensions; the application of the pilot test allowed corroborating this validity.

Abuse liability measures for use in analgesic clinical trials in patients with pain: IMMPACT recommendations.

Assessing and mitigating the abuse liability (AL) of analgesics is an urgent clinical and societal problem. Analgesics have traditionally been assessed in randomized clinical trials (RCTs) designed to demonstrate analgesic efficacy relative to placebo or an active comparator. In these trials, rigorous, prospectively designed assessment for AL is generally not performed. The Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials (IMMPACT) convened a consensus meeting to review the available evidence and discuss methods for improving the assessment of the AL of analgesics in clinical trials in patients with pain. Recommendations for improved assessment include: (1) performing trials that include individuals with diverse risks of abuse; (2) improving the assessment of AL in clinical trials (eg, training study personnel in the principles of abuse and addiction behaviors, designing the trial to assess AL outcomes as primary or secondary outcome measures depending on the trial objectives); (3) performing standardized assessment of outcomes, including targeted observations by study personnel and using structured adverse events query forms that ask all subjects specifically for certain symptoms (such as euphoria and craving); and (4) collecting detailed information about events of potential concern (eg, unexpected urine drug testing results, loss of study medication, and dropping out of the trial). The authors also propose a research agenda for improving the assessment of AL in future trials.