A scoping review exploring reablement models of training and client assessment for older people in primary health care.

AIM: The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice. BACKGROUND: The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse. METHODS: The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors. RESULTS: A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation. CONCLUSION: This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of 'ageing in place' policy.

Trade-Off Between Speed and Cost in Shortcuts to Adiabaticity.

Achieving effectively adiabatic dynamics is a ubiquitous goal in almost all areas of quantum physics. Here, we study the speed with which a quantum system can be driven when employing transitionless quantum driving. As a main result, we establish a rigorous link between this speed, the quantum speed limit, and the (energetic) cost of implementing such a shortcut to adiabaticity. Interestingly, this link elucidates a trade-off between speed and cost, namely, that instantaneous manipulation is impossible as it requires an infinite cost. These findings are illustrated for two experimentally relevant systems-the parametric oscillator and the Landau-Zener model-which reveal that the spectral gap governs the quantum speed limit as well as the cost for realizing the shortcut.

Clinical evaluation of a rapid, pupil-based assessment of retinal damage associated with glaucoma.

AIMS: To evaluate the effectiveness of a new test, the Pupilmetrix() PLR60, which uses the pupillary light reflex (PLR) to detect asymmetric retinal damage in patients diagnosed with glaucoma. METHODS: 30 patients, clinically diagnosed as having glaucoma, were recruited to the study, 29 of whom completed testing using the PLR60. A control group of 30 patients who had glaucoma excluded by clinical examination were also recruited and tested using the same protocol on the PLR60. RESULTS: Of the 110 eyes with test outcomes, overall agreement between the PLR60 result and clinical diagnosis (glaucoma positive or negative) per eye was 84.7%. Sensitivity was 93.1% (95% CI 77.2%-99.2%) and specificity was 76.7% (95% CI 57.7%-90.1%). Average (SD) test times (min:sec) for both eyes were 3:21 (0:33) minutes for the glaucoma group and 2:40 (0:35) minutes for the non-glaucoma group. CONCLUSIONS: The results of this preliminary study suggest that the PLR as used in the Pupilmetrix PLR60 test is able to discriminate between patients with glaucomatous retinal defects and those with clinically normal retinas with a diagnostic accuracy that is potentially useful for screening for glaucoma. Test times were markedly quicker than with standard visual field testing.

Fully automatic external defibrillators in acute care: Clinicians' experiences and perceptions.

BACKGROUND: Fully automatic external defibrillators (FAEDs) reduce the time to defibrillation [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32; Mattioni T, Kanaan N, Riggio D, Bahu M, Lin D, Welch S, et al. Performance of an automatic external-cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. Am J Cardiol 2003;91:1323-6] and improve outcomes [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32]. There is, however, no guidance or standard about their use in the UK. This paper presents the results of a study, which explored clinicians' experiences and perceptions of using FAEDs in acute care in the UK. AIMS: This study sought to understand clinicians' experiences and perceptions of the use of FAEDs in acute care and their impact on decision making. METHODS: Using a qualitative approach, 43 nurses and four physicians were included in a trial of FAEDs in a Coronary Care Unit (CCU) and cardiology ward during 2004. Semi-structured interviews were conducted with nurses and physicians prior to and following the trial. Data were analysed using thematic analysis [Attride-Stirling J, Thematic networks: an analytic to research. Qual Res 2001;1(3):385-405]. RESULTS: Decision control, safety, a lack of confidence in the technology, previous experience and concerns about the psychological affect on patients affected clinicians' decision making and limited the use of the FAED. CONCLUSION: Despite reported benefits of the FAED [Martinez-Rubio A, Kanaan N, Borggrefe M, Block M, Makijarvi M, Fedele F, et al. Advances in treating in-hospital cardiac arrest: safety and effectiveness of a new automatic external cardioverter-defibrillator. J Am Coll Cardiol 2003;41(4):627-32; Mattioni T, Kanaan N, Riggio D, Bahu M, Lin D, Welch S, et al. Performance of an automatic external-cardioverter-defibrillator algorithm in the discrimination of supraventricular from ventricular tachycardia. Am J Cardiol 2003;91:1323-26], personal and contextual issues affected the clinicians' decision making. More and better understanding about how FAEDs and their context of use may challenge established practice is required in order that it is utilised in the most effective way.