Screening for Elder Abuse in the Veterans Health Administration: Varied Approaches Across a National Health System.

BACKGROUND: Elder abuse (EA) is common and has devastating health consequences yet is rarely detected by healthcare professionals. While EA screening tools exist, little is known about if and how these tools are implemented in real-world clinical settings. The Veterans Health Administration (VHA) has experience screening for, and resources to respond to, other forms of interpersonal violence and may provide valuable insights into approaches for EA screening. OBJECTIVE: Describe EA screening practices across a national integrated healthcare system serving a large population of older adults at risk for EA. DESIGN: Survey of all 139 VHA medical centers from January to August 2021. PARTICIPANTS: Surveys were completed by the Social Work Chief, or delegate, at each site. MAIN MEASURES: The survey assessed the presence and characteristics of EA-specific screening practices as well as general abuse/neglect screening conducted with patients of all ages, including older adults. Follow-up emails were sent to sites that reported screening requesting additional details not included in the initial survey. KEY RESULTS: Overall, 130 sites (94%) responded. Among respondents, 5 (4%) reported screening older adults for EA using a previously published tool, while 6 (5%) reported screening for EA with an unstudied or locally developed tool. Forty-eight percent reported screening patients of all ages for general abuse/neglect using unstudied questions/tools, and 44% reported no EA screening at their site. Characteristics of screening programs (e.g., frequency, clinical setting, provider type) varied widely between sites, as did respondents' understanding of the definition of screening. CONCLUSIONS: High variability in screening practices for abuse/neglect and lack of EA-specific screening in a system that has successfully deployed other standardized screening approaches present an important opportunity to standardize and improve EA detection practices. Lessons learned in VHA could help advance the evidence base for EA screening more broadly to increase overall detection rates for EA nationally.

Risk factors for periprosthetic femoral fracture risk around a cemented polished taper-slip stem using an osteoporotic composite bone model.

This biomechanical study aimed to determine if variations in stem material, stem geometry, stem offset and cement viscosity affect mechanical resistance to postoperative periprosthetic fracture (PFF) after hip arthroplasty with a commonly used cemented polished taper-slip (PTS) stem (CPT, Zimmer Biomet) in a novel osteoporotic composite femoral bone model. Thirty-six osteoporotic composite femoral models were tested using a standardised in-vitro loading technique to simulate a typical PFF. Outcome measures were torque to failure (N), fracture energy (N/m2) and rotation to failure (°). Comparisons were made by stem material (cobalt chrome vs stainless steel), stem geometry (CPT stem vs Exeter stem), stem offset (standard offset vs extra extended offset) and cement viscosity (high viscosity vs low viscosity). Statistical comparisons were carried out with significance set at p < 0.05. All tested samples produced clinically representative fracture patterns with varying degrees of bone and cement comminution. There was no statistically significant difference in torque to failure, fracture energy or rotation to failure between any of the compared variables (all p > 0.05). This is the first biomechanical study on mechanical resistance to PFF using osteoporotic composite bone models. For the CPT stem, it confirms that stem material, stem offset, stem geometry and cement viscosity do not affect mechanical resistance to PFF in an osteoporotic bone model.

Development of qualified nurses' psychological skills: an evaluation.

UNLABELLED: A series of workshops was run by two paediatric clinical psychologists for children's nurses in five London teaching hospitals. These were evaluated immediately after completion and indicated that nurses had found the workshops helpful. AIM: To determine whether the benefits described by attendees immediately after workshops were being realised in the clinical setting at three months. METHOD: A qualitative exploration of the current experiences of the nurses was conducted. Responses to open questions on evaluation forms were transcribed and analysed using a content analysis approach. FINDINGS: Participants identified that they benefited greatly from the workshops. Themes concerning the nature of benefits to emerge included: having greater awareness and understanding of the feelings and behaviours of others, feeling more confident at work and also finding it useful to hear about the experiences of others. CONCLUSION: Nurses value and benefit from psychologically oriented training workshops. Further research around the benefits perceived by patients and managers would add weight to this argument.

Screening for Distress in Young People After Treatment for Sarcoma: A Feasibility Study.

Few validated tools are available in childhood cancers settings to assess distress and worry. Twenty-one young people (mean age = 14 years), with an average 4 years since diagnosis, attended a sarcoma follow-up clinic and were asked to complete questionnaires assessing general mood and behavior, quality of life, and distress. All young people completed the Distress Thermometer. However, as the age range was quite wide (9-18 years), different questionnaires were also used with different age groups to assess feasibility and acceptance. In addition, young people were asked for their views about the questionnaires they had completed, asked about previous psychological support, and were asked to rate how useful they had found the medical appointment. Finally, they were asked whether or not they would like a member of the psychology team to contact them to discuss any issues that had been raised by the questionnaires. Patients reported impaired health status and worry about lifestyle, daily activities, and emotional well-being. A health-related quality of life measure (EQ-5D) and an adapted version of the Distress Thermometer were more sensitive than traditional measures and may serve as useful tools to screen for psychological concerns in busy clinical settings.