Dyspnea, the silent threat in Parkinson's: a mixed methods study.

BACKGROUND: Dyspnea is considered a silent threat to people diagnosed with Parkinson's disease and may be a common concern in patients, however, little is known about how it affects quality of life. This study explored the experiences of independently mobile people who are affected by dyspnea in daily life. METHODOLOGY: This was a cross-sectional mixed methods study that included an online questionnaire and semi-structured interviews. The participants were included if they were diagnosed with Parkinson's disease; had a self-reported Hoehn and Yahr Score I, II or III; were mobilizing independently; and were Arabic speakers. Participants were excluded if they had any other musculoskeletal, cardiac, respiratory, or neurological diseases; or were previous or current smokers; or had been previously hospitalized due to respiratory complications. RESULTS: A total of 117 participants completed the Arabic version of the Dyspnea-12 Questionnaire. Dyspnea was reported in all participants and that it had an adverse effect on their quality of life, especially during activities of daily living. Additionally, participants reported a lack of knowledge about pulmonary rehabilitation and were unaware of the availability and potential benefits of participation in programs. CONCLUSION: Dyspnea was reported in people in the early stages (Hoehn and Yahr Stages I, II, and III) of Parkinson's disease, and may benefit from routine assessment of lung function, dyspnea management and participation in pulmonary rehabilitation.

The relationship between sleep quality and gait in people with multiple sclerosis: A pilot study.

Background: Gait deficits are common among people with multiple sclerosis (PwMS). Therefore, investigating factors that may influence walking in PwMS is important. Previous studies in older adults and other neurological populations demonstrated the relationship between sleep quality and gait performance. Despite the fact that the prevalence of poor sleep quality is very high among PwMS, little is known about the effect of sleep quality on gait among PwMS. Objective: This study aimed to explore the relationship between sleep quality and gait performance in PwMS. Methods: Forty-one PwMS participated in the study between February 2019 and December 2019. Participants were asked to walk at a self-selected speed over 10 m with an inertial measurement unit (IMU) attached over the back. Walking speed, step length (left and right), and step time were calculated. Sleep was estimated objectively using a wrist-worn triaxle-accelerometer; the derived parameters were sleep efficiency (SE) and the number of awakening after sleep onset (NASO). Results: SE significantly correlated with step length (p=0.02). Furthermore, the NASO significantly correlated with gait speed (p=0.03), and step-time (p=0.02). These correlations remained significant even after adjusting for age and disease duration. Conclusion: We observed that when corrected for disease duration and age there were relationships between NASO and SE to gait parameters; these observations warrant further investigations.

Evaluating the effectiveness of a comprehensive education on low back pain treatment outcomes: A controlled clinical study.

OBJECTIVES: To investigate the effect of integrating an individualized, evidence-based low back pain comprehensive education package on low back pain treatment outcomes. DESIGN: Single-blind, controlled clinical study using the alternate allocation of patients. SETTING: Outpatient clinic. SUBJECTS: In total, 54 participants with chronic low back pain (46.75 ± 11.11 years, 80% females) were randomized to intervention (n = 27) or a control group (n = 27). INTERVENTION: The intervention group received additional four one-hour low back pain-related education sessions to eight 45 minutesstandard physical therapy sessions over 4 weeks. OUTCOME MEASURES: Assessed at baseline, post-intervention, and 3 months. Outcome measures included pain intensity (Visual Analogue Scale), knowledge (Low Back Pain Knowledge Questionnaire), attitude (the Back Pain Attitudes Questionnaire), disability (the Oswestry Disability Index), mental health symptoms (Depression Anxiety Stress Scale, DASS-21 scale), and fear-avoidance (Fear-Avoidance Beliefs Questionnaire). RESULTS: The intervention group showed significantly lower pain intensity ((4 weeks (3.58 ± 1.50 vs. 5.54 ± 1.92), 3 months (3.21 ± 1.74 vs. 5.69 ± 2.51)), higher knowledge ((4 weeks (21.67 ± 2.12 vs. 11.62 ± 3.47), three months (22.08 ± 3.40 vs. 12.23 ± 3.24)), lower negative attitudes ((4 weeks (99.29 ± 11.02 vs. 134.31 ± 12.97), 3 months (102.92 ± 15.58 vs. 132.42 ± 17.79)), lower disability ((4 weeks (26.30 ± 11.37 vs. 45.14 ± 18.67), 3 months (22.83 ± 16.06 vs. 44.13 ± 15.02)), lower stress score ((4 weeks (3.54 ± 3.01 vs. 8.81 ± 5.19), 3 months (3.21 ± 3.22 vs. 7.21 ± 4.36)), lower anxiety ((4 weeks (2.63 ± 3.16 vs. 6.42 ± 4.75), three months (2.63 ± 3.80 vs. 5.73 ± 4.44)), lower depression ((4 weeks (2.42 ± 2.15 vs. 6.42 ± 3.68), three months (2.63 ± 4.18 vs. 7.08 ± 4.41)), and lower fear-avoidance ((4 weeks (13.88 ± 12.32 vs. 50.88 ± 23.25), three months (15.50 ± 16.75 vs. 54.65 ± 31.81)). CONCLUSION: Integrating low back pain comprehensive education into standard physical therapy might optimize the treatment outcomes of low back pain.

Validation of the Arabic Version of the Movement Disorder Society-Unified Parkinson's Disease Rating Scale.

BACKGROUND: The Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) has become the gold standard for evaluating different domains in Parkinson's disease (PD), and it is commonly used in clinical practice, research, and clinical trials. OBJECTIVES: The objectives are to validate the Arabic-translated version of the MDS-UPDRS and to assess its factor structure compared with the English version. METHODS: The study was carried out in three phases: first, the English version of the MDS-UPDRS was translated into Arabic and subsequently back-translated into English by independent translation team; second, cognitive pretesting of selected items was performed; third, the Arabic version was tested in over 400 native Arabic-speaking PD patients. The psychometric properties of the translated version were analyzed using confirmatory factor analysis (CFA) as well as exploratory factor analysis (EFA). RESULTS: The factor structure of the Arabic version was consistent with that of the English version based on the high CFIs for all four parts of the MDS-UPDRS in the CFA (CFI ≥0.90), confirming its suitability for use in Arabic. CONCLUSIONS: The Arabic version of the MDS-UPDRS has good construct validity in Arabic-speaking patients with PD and has been thereby designated as an official MDS-UPDRS version. The data collection methodology among Arabic-speaking countries across two continents of Asia and Africa provides a roadmap for validating additional MDS rating scale initiatives and is strong evidence that underserved regions can be energically mobilized to promote efforts that apply to better clinical care, education, and research for PD. © 2022 International Parkinson and Movement Disorder Society.

Practical guide to undertaking scoping reviews for pharmacy clinicians, researchers and policymakers.

WHAT IS KNOWN AND OBJECTIVE: Scoping reviews are a valuable evidence synthesis methodology. They can be used to map the evidence related to any topic to allow examination of practice, methods, policy and where (and how) future research could be undertaken. As such, they are a useful form of evidence synthesis for pharmacy clinicians, researchers and policymakers to review a broad range of evidence sources. COMMENT: This commentary presents the most comprehensive and up to date methodology for scoping reviews published by Joanna Briggs Institute (JBI). This approach builds upon two older approaches by Arksey and O'Malley, and Levac. To assist reviewers working in the field of pharmacy with planning and conducting scoping reviews, this paper describes how to undertake scoping reviews from inception to publication with specific examples related to pharmacy topics. WHAT IS NEW AND CONCLUSION: The JBI scoping review methodology is a valuable evidence synthesis approach to the field of pharmacy and therapeutics. This approach can assist pharmacy clinicians, researchers and policymakers to gain an understanding of the extant literature, to identify gaps, to explore concepts, characteristics and to examine current practice.

The impact of outsourcing bed-based aged care services on quality of care: A multisite observational study.

BACKGROUND: Outsourcing health-care services has become popular globally, provided by both profit and non-for-profit organizations with varying degrees of quality. To date, few published studies have evaluated the quality of care in health services using outsourcing. OBJECTIVE: The purpose of this study was to determine if there were differences in quality of care (effectiveness, safety and patient experience) for a Transition Care Program designed to improve older people's independence and confidence after a hospital stay, when provided within a public health network compared to being outsourced to private facilities. METHODS: For clients discharged to a residential Transition Care Program operating across three sites from a large health service network (n = 1546), an audit of medical records was completed. Site 1 remained within the public health service (internally managed), whereas Sites 2 and 3 involved outsourcing to residential aged care facilities. The main outcome measures were discharge destination, length of stay and number of falls. Client demographics were analysed descriptively, and inferential statistics for continuous data and negative binomial regression for event data were used to examine differences between the sites. RESULTS: There were differences in quality of care between the internally and outsourced managed sites. One outsourced site discharged a smaller proportion to rehabilitation (P = 0.003) compared to the other two sites. There were differences in length of stay between the three sites. The length of stay was a mean of 4.8 days less at Site 1 (internally managed) (95% Confidence Interval (CI) 0.5 to 9.1) than Site 2 and 4.6 days less (95% CI 1.2 to 8.1) than Site 3. For those discharged to permanent residential care, the length of stay was 9.4 days less at the internal site than Site 2 (95% CI 3.5 to 15.2) and 7.0 days less than Site 3 (95% CI 1.9 to 12). Additionally, a lower rate of falls was recorded at Site 1 (internally managed) compared to Site 2 (outsourced) (incidence rate ratio = 0.44 (95% CI 0.32 to 0.60), P < 0.001). CONCLUSION: An internally managed Transition Care Program in a public health network was associated with better quality of care outcomes compared to outsourced services.

Adaptation strategies in transnational education: a case study of an australian Master of Health Administration Course offered to chinese managers.

BACKGROUND: Management decisions in health influence patient care outcomes; however, health management development courses in China are rare. This study aims to document and evaluate a transnational Master of Health Administration (MHA) course launched in 2000 for the benefit of Chinese health managers. METHODS: A case study of the MHA program jointly run by an Australian university and a Chinese Medical University was conducted. We reviewed the development of the MHA course through a document analysis (key events recorded in achieves, minutes, and audits) followed by reflection (by two course coordinators), extracting key themes related to adaptative strategies. We then conducted a questionnaire survey of 139 graduates seeking their views on relevance, satisfaction and challenges associated with each subject within the course, the relevance of key management skills (as determined by the Australasian College of Health Service Management competency framework), and the impact of the course on their personal career trajectories. Chi-square tests identified differences in the responses by age, gender, pre-training position, and current workplace. RESULTS: The curriculum pedagogy followed the principles of practice-based reflective learning. Research findings and student feedback shaped the curriculum design and subject content, to enhance management practices of the students. Survey participants expressed high levels of satisfaction and confirmed the relevance of all study subjects. Two subjects, health economics and data management, were perceived as being the most challenging. Of the ten management skills we assessed, relatively low self-rated confidence was found in "strategic thinking" and "planning". Younger and less experienced graduates were more likely to report learning challenges (p < 0.05). Frontline managers were least likely to obtain promotion by changing employers (χ2 = 6.02, p < 0.05) or being seconded to another position (χ2 = 9.41, p < 0.01). CONCLUSIONS: This case study illustrates the suitability of cross-country partnerships in health management training, which offers opportunities for managers to systematically explore and acquire a comprehensive set of management skills applicable to their career needs. Opportunities for developing training aligned to career development opportunities are critical for attracting and developing a competent and well-prepared health service management workforce in China.

Rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to palliative and end-of-life clients and carers.

OBJECTIVE: This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning. METHOD: Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data. RESULTS: A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps. SIGNIFICANCE OF RESULTS: Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.

Post-stroke fatigue level is significantly associated with mental health component of health-related quality of life: a cross-sectional study.

PURPOSE: Individuals post-stroke might have high levels of post-stroke fatigue (PSF) which might affect their quality of life. This study aimed to investigate the prevalence of post-stroke fatigue in Jordan and to comprehensively identify its possible associated factors. METHODS: A cross-sectional design was implemented through one-hour face-to-face assessment sessions. The modified fatigue impact scale, 12-item Short-Form Health Survey, Montreal Cognitive Assessment, Motor Assessment Log, Upper Extremity Fugl Meyer assessment, Nine Hole Peg Test, 10 Meter Walk Testing, active and passive goniometry, Hand-held dynamometry, and modified Ashworth scale were used as outcome measures. Prevalence of post-stroke fatigue and levels of quality of life were reported using descriptive analyses. Multiple variable linear regression analysis was used to identify PSF associated factors of post-stroke fatigue. P < 0.05 was considered significant for all statistical tests. RESULTS: 153 individuals with stroke participated in the study. A total of 117 participants (69.9%, 95% CI = 62.0-77.1%) were fatigued. Fatigue was significantly predicted by mental component of quality of life (ß -0.42 [95% CI -0.53--0.31]; p < 0.001), cognition (ß -0.69 [95% CI -1.08--0.29], p = 0.001), weekly sport hours (ß -0.94 [95% CI -1.73--0.14], p = 0.022), and shoulder abduction spasticity (ß -1.81 [95% CI -3.38--0.24], p = 0.024. The model explained 51% of the variation in the fatigue (F = 29.006, p < 0.001). CONCLUSION: Jordanian individuals with stroke have a high prevalence of fatigue. Mental related quality of life was significantly associated with PSF levels. Other factors significantly associated with PSF included cognition status, sport participation, and spasticity. Healthcare practitioners working in neurorehabilitation should take PSF and its significant correlates into consideration when treating individuals with stroke.

Implementation of sustainable complex interventions in health care services: the triple C model.

BACKGROUND: The changing and evolving healthcare environment means organisations are under increasing pressure to deliver value-based, high quality care to patients through enabling access, reducing costs and improving outcomes. These factors result in an increased pressure to deliver efficient and beneficial interventions to improve patient care and support sustainability beyond the scope of the implementation of such interventions. Additionally, the literature highlights the importance of coordination, cooperation and working together across areas is critical to achieving implementation success. This paper discusses the development of a triple C model for implementation that supports sustainability of complex interventions in health care services. METHODS: In order to develop the proposed implementation model, we adapted the formal tradition of theory building that is described in sociology. Firstly, we conducted a review of the literature on complex interventions and the available implementation models used to embed these interventions to identify the key aspects relating to successful implementation. Secondly, we devised a framework that encompassed these findings into a simple and workable model that can be easily embedded into everyday practice. This proposed model uses clear, systemic explanation, adds to the current knowledge in this area and is fit for purpose, providing healthcare workers with a simple easy-to-follow framework to embed practice change. RESULTS: A three-stage implementation model was devised based on the findings of the literature and named the Triple C model (Consultation, Collaboration and Consolidation). The three stages are interconnected and overlap to support sustainability is considered at all levels of the project ensuring its greater success. This model considers the sustainability within any implementation project. Sustainability of interventions are a key consideration for continuous and successful change in any health care organisation. A set of criteria were developed for each of the three stages to support adaptability and sustainment of interventions are maintained throughout the life of the intervention. CONCLUSION: Ensuring sustainability of interventions requires continuing effort and embedding the need for sustainability throughout all stages of an implementation project. The Triple C model offers a new approach for healthcare clinicians to support sustainability of organizational change.

Undertaking a scoping review: A practical guide for nursing and midwifery students, clinicians, researchers, and academics.

AIM: The aim of this study is to discuss the available methodological resources and best-practice guidelines for the development and completion of scoping reviews relevant to nursing and midwifery policy, practice, and research. DESIGN: Discussion Paper. DATA SOURCES: Scoping reviews that exemplify best practice are explored with reference to the recently updated JBI scoping review guide (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Scoping Review extension (PRISMA-ScR). IMPLICATIONS FOR NURSING AND MIDWIFERY: Scoping reviews are an increasingly common form of evidence synthesis. They are used to address broad research questions and to map evidence from a variety of sources. Scoping reviews are a useful form of evidence synthesis for those in nursing and midwifery and present opportunities for researchers to review a broad array of evidence and resources. However, scoping reviews still need to be conducted with rigour and transparency. CONCLUSION: This study provides guidance and advice for researchers and clinicians who are preparing to undertake an evidence synthesis and are considering a scoping review methodology in the field of nursing and midwifery. IMPACT: With the increasing popularity of scoping reviews, criticism of the rigour, transparency, and appropriateness of the methodology have been raised across multiple academic and clinical disciplines, including nursing and midwifery. This discussion paper provides a unique contribution by discussing each component of a scoping review, including: developing research questions and objectives; protocol development; developing eligibility criteria and the planned search approach; searching and selecting the evidence; extracting and analysing evidence; presenting results; and summarizing the evidence specifically for the fields of nursing and midwifery. Considerations for when to select this methodology and how to prepare a review for publication are also discussed. This approach is applied to the disciplines of nursing and midwifery to assist nursing and/or midwifery students, clinicians, researchers, and academics.

Pharmacological Treatment for Obesity in Adults: An Umbrella Review.

Objective: To synthesize the evidence from systematic reviews of clinical trials investigating the effectiveness of pharmacological therapies approved by the Australian Therapeutic Goods Administration and the US Food and Drug Administration for the management of obesity in adults. Data Sources: A 3-step literature search of the MEDLINE, EMBASE, CINAHL, and PubMed databases was conducted between March and May 2019. The key terms used were obesity, pharmacological therapy, antiobesity agent, antiobesity medication, weight loss, and systematic review. Study Selection and Data Extraction: Systematic reviews that evaluated the effectiveness of pharmacological therapies for the management of obesity in patients with a body mass index of or greater than 25 kg/m2. Data Synthesis: Nine systematic reviews involving three pharmacotherapies, liraglutide, orlistat, and naltrexone-bupropion were identified. The results indicate that the pharmacotherapies reduced weight when compared with placebo. Orlistat was effective in significantly reducing fasting blood glucose, HbA1c, total cholesterol, triglycerides, and systolic and diastolic blood pressure. All reviews discussed the presence or risk of gastrointestinal adverse effects including diarrhea, vomiting, and nausea related to orlistat and liraglutide. Relevance to Patient Care and Clinical Practice: This umbrella review compares the efficacy and safety of antiobesity medications for reducing weight and a discussion on their weight loss and metabolic control to guide clinicians when prescribing medications for obesity. Conclusions: All pharmacological therapies included in this review are superior to placebo in reducing weight. Clinicians should consider patient comorbidities and risk of adverse events when recommending medications for weight loss.

The attitudes and practice strategies of community pharmacists towards drug misuse management: A scoping review.

WHAT IS KNOWN AND OBJECTIVE: Community pharmacists have a key role to play in addressing drug misuse. The objective of this research was to systematically review the current evidence and investigate the attitudes and practice strategies of community pharmacists towards drug misuse management. METHODS: Data were extracted from 19 studies retrieved via a three-step search strategy using the Arksey and O'Malley methodological framework for conducting scoping reviews. RESULTS AND DISCUSSION: The attitudes and practice strategies of pharmacists towards drug misuse management and relevance to years of practice experience were discussed in seven of the 19 studies. Pharmacists reported gaps in knowledge and insufficient education and training on drug misuse-related topics. Barriers to the effective management of drug misuse included lack of time and staff training. The most commonly reported strategy to address drug misuse was referral back to the doctor. Eight of the studies identified the benefits of real-time prescription monitoring systems. Pharmacists have a key role to play in addressing drug misuse. Opportunities exist in the development of new and innovative approaches for harm minimization led by pharmacists, and in the examination and evaluation of the pharmacists' role in referral services, interventions and screening. WHAT IS NEW AND CONCLUSION: It is important to consider the role and contribution of early career pharmacists in the delivery of primary health care. They are the future of the pharmacy profession; therefore, it is critical that they are sufficiently trained and provided with the necessary resources to ensure high quality care in the management of drug misuse.

Successful implementation of a medication safety program for Aboriginal Health Practitioners in rural Australia.

OBJECTIVE: This study describes the development and implementation of a medication safety program for Aboriginal Health Practitioners practising in rural Australia. DESIGN: A two-stage process was used to develop and implement the medication safety program. Initially, a total of eight semi-structured interviews was undertaken with Aboriginal Health Practitioners to identify the main challenges faced while implementing medication safety in the organisation. This was followed by the development of a culturally appropriate medication safety program. SETTING: Aboriginal Community Controlled Health Service. PARTICIPANTS: Aboriginal Health Practitioners. MAIN OUTCOME MEASURE: The participants' knowledge, confidence, behaviour, and utilisation of medication safety developed resources. RESULTS: The development and implementation of the medication safety program in the Aboriginal Community Controlled Health Service consisted of addressing the barriers to medication safety cited by the Aboriginal Health Practitioner from the interviews, providing face-to-face educational sessions and developing a culturally appropriate educational resource to address the identified gaps. The program developed was evaluated by 17 Aboriginal Health Practitioners who took part in the study. The evaluation of Aboriginal Health Practitioners' knowledge, confidence, behaviour, utilisation of the medication safety program and resources was undertaken using an anonymous survey. A total of 31 participants completed the survey: 17 before the training and 14 at 6 months post-training. The data analysis, using t test, revealed a statistically significant change in the Aboriginal Health Practitioners' knowledge, confidence, behaviour and utilisation. CONCLUSION: The success of the implementation of a collaborative medication safety program within the Aboriginal Community Controlled Health Service is dependent on understanding the barriers to medication safety in the workplace associated within the organisation and emphasising a wide culture of patient safety.

Medication safety challenges in Aboriginal Health Care services.

OBJECTIVE: The aim of this study is to examine the challenges faced by the Aboriginal Health Practitioners in the community assisting their clients to manage medicines. DESIGN: Qualitative, in depth interviews with eight Aboriginal Health Practitioners employed at various Aboriginal Community Controlled Health services in Victoria were undertaken. SETTING: Rural Aboriginal Community Controlled Health Service. PARTICIPANTS: Aboriginal Health Practitioners who are registered with the Aboriginal and Torres Strait Islander Health Practice Board of Australia as an Aboriginal Health Practitioner and who have experience in the planning, provision, management and evaluation of health services within their scope of practice. RESULTS: This study revealed multiples challenges faced by Aboriginal Health Practitioners assisting clients with medication management. These were mainly divided into the attitudes and the culture of the workplace and barriers with medications use faced by the clients. The following subthemes were identified within the attitudes and workplace culture theme. These were reporting of errors, pamphlets not culturally appropriate, lack of education of Aboriginal Health Practitioner role and doctors' understanding of Aboriginal culture. The subthemes identified by the Aboriginal Health Practitioners that were specific to the clients included language barriers, immediacy, sharing medications by family members, medications disposal, self-diagnosis, traditional medicine, not feeling comfortable with doctors, literacy and alcohol use. CONCLUSION: This study has identified many barriers to medication safety in the Aboriginal community, and strategies to improve some of the challenges identified.

Altered cardiovascular function is related to reduced BDNF in Parkinson's disease.

Brain-derived neurotrophic factor (BDNF) has been linked to cardiovascular health and function, however, the exact role is yet to be understood. The current study examined the relationship of circulatory BDNF with vascular function in Parkinson's disease (PD). ELISA was used to determine plasma BDNF in PD patients and healthy control (CT). Additionally, forearm resting blood flow (RBf), vascular resistance (RVr), venous capacitance (RVc), and venous outflow (RVo) as well as post occlusion blood flow (OcBf), vascular resistance (OcVr), venous capacitance (OcVc), and venous outflow (OcVo) were obtained using strain-gauge plethysmography. Simple linear regression showed that being PD patient can predict (p < 0.05) 12.9% of BDNF, 16.8% of RVc, 15.0% of OcVc, and 13.6% of OcVo. Subsequent stepwise regression included BDNF, RVc, OcVc, and OcVo, showed that being PD patient predicted (p < 0.05) 58.0% of BDNF, 47.7% of OcVo, and 15.1% of OcVc. Another simple linear regression demonstrated that BDNF predicted (p < 0.05) 18.5% of OcBf, 22.0% of OcVr, and 24.1% of OcVc in PD. In a subsequent stepwise linear regression, BDNF explained 26% ofOcVr (p = 0.008) and 42% of OcVc (p = 0.002) in PD. The study showed that BDNF is reduced and related to altered vascular function in PD. The results suggest that BDNF might contribute to preserving and maybe improving vascular function in PD.

Medication safety challenges in primary care: Nurses' perspective.

AIMS AND OBJECTIVES: To identify the issues surrounding medication error reporting in community nursing and improvement strategies related to medication safety. BACKGROUND: Medication-related problems have been identified from various sources in the literature. Examples of these include incident reporting by healthcare professionals, medico-legal and patient complaints and systematic identification of organisational structure. Only a few studies report on the clinicians' perceptions of medication safety in community nursing and the challenges they face within their workplace to implement medication safety initiatives. DESIGN: Qualitative design, using conversation-style interviews with experienced registered nurses in primary care roles. METHODS: Using a general iterative approach of semantic analysis, our qualitative research study was guided by an essentialist paradigm. Our method for understanding included semi-structured in-depth interviews with 10 clinicians from a large community care organisation in rural Victoria in Australia. We developed an interview guide, which included open-ended questions on clinicians' experiences, perceived barriers and facilitators, and strategies to improve medication safety. RESULTS: Several barriers have been identified by healthcare practitioners that hinder medication safety in primary care including culture differences between community and hospital setting, politics within the healthcare system, lack of clarity around the nurses' roles and lack of error reporting. Other sources of errors cited by the participants were the lack of clarity or awareness of the processes and procedures of medication incidents reporting for staff within the organisation experience. Lack of education regarding medication safety, the dilemmas associated with reporting and documentation are also significant barriers.

A Classification System to Guide Physical Therapy Management in Huntington Disease: A Case Series.

BACKGROUND AND PURPOSE: Individuals with Huntington disease (HD), a rare neurological disease, experience impairments in mobility and cognition throughout their disease course. The Medical Research Council framework provides a schema that can be applied to the development and evaluation of complex interventions, such as those provided by physical therapists. Treatment-based classifications, based on expert consensus and available literature, are helpful in guiding physical therapy management across the stages of HD. Such classifications also contribute to the development and further evaluation of well-defined complex interventions in this highly variable and complex neurodegenerative disease. The purpose of this case series was to illustrate the use of these classifications in the management of 2 individuals with late-stage HD. CASE DESCRIPTION: Two females, 40 and 55 years of age, with late-stage HD participated in this case series. Both experienced progressive declines in ambulatory function and balance as well as falls or fear of falling. Both individuals received daily care in the home for activities of daily living. INTERVENTION: Physical therapy Treatment-Based Classifications for HD guided the interventions and outcomes. Eight weeks of in-home balance training, strength training, task-specific practice of functional activities including transfers and walking tasks, and family/carer education were provided. OUTCOMES: Both individuals demonstrated improvements that met or exceeded the established minimal detectible change values for gait speed and Timed Up and Go performance. Both also demonstrated improvements on Berg Balance Scale and Physical Performance Test performance, with 1 of the 2 individuals exceeding the established minimal detectible changes for both tests. Reductions in fall risk were evident in both cases. DISCUSSION: These cases provide proof-of-principle to support use of treatment-based classifications for physical therapy management in individuals with HD. Traditional classification of early-, mid-, and late-stage disease progression may not reflect patients' true capabilities; those with late-stage HD may be as responsive to interventions as those at an earlier disease stage.Video Abstract available for additional insights from the authors (see Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A172).

Professional, structural and organisational interventions in primary care for reducing medication errors.

BACKGROUND: Medication-related adverse events in primary care represent an important cause of hospital admissions and mortality. Adverse events could result from people experiencing adverse drug reactions (not usually preventable) or could be due to medication errors (usually preventable). OBJECTIVES: To determine the effectiveness of professional, organisational and structural interventions compared to standard care to reduce preventable medication errors by primary healthcare professionals that lead to hospital admissions, emergency department visits, and mortality in adults. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, three other databases, and two trial registries on 4 October 2016, together with reference checking, citation searching and contact with study authors to identify additional studies. We also searched several sources of grey literature. SELECTION CRITERIA: We included randomised trials in which healthcare professionals provided community-based medical services. We also included interventions in outpatient clinics attached to a hospital where people are seen by healthcare professionals but are not admitted to hospital. We only included interventions that aimed to reduce medication errors leading to hospital admissions, emergency department visits, or mortality. We included all participants, irrespective of age, who were prescribed medication by a primary healthcare professional. DATA COLLECTION AND ANALYSIS: Three review authors independently extracted data. Each of the outcomes (hospital admissions, emergency department visits, and mortality), are reported in natural units (i.e. number of participants with an event per total number of participants at follow-up). We presented all outcomes as risk ratios (RRs) with 95% confidence intervals (CIs). We used the GRADE tool to assess the certainty of evidence. MAIN RESULTS: We included 30 studies (169,969 participants) in the review addressing various interventions to prevent medication errors; four studies addressed professional interventions (8266 participants) and 26 studies described organisational interventions (161,703 participants). We did not find any studies addressing structural interventions. Professional interventions included the use of health information technology to identify people at risk of medication problems, computer-generated care suggested and actioned by a physician, electronic notification systems about dose changes, drug interventions and follow-up, and educational interventions on drug use aimed at physicians to improve drug prescriptions. Organisational interventions included medication reviews by pharmacists, nurses or physicians, clinician-led clinics, and home visits by clinicians.There is a great deal of diversity in types of professionals involved and where the studies occurred. However, most (61%) of the interventions were conducted by pharmacists or a combination of pharmacists and medical doctors. The studies took place in many different countries; 65% took place in either the USA or the UK. They all ranged from three months to 4.7 years of follow-up, they all took place in primary care settings such as general practice, outpatients' clinics, patients' homes and aged-care facilities. The participants in the studies were adults taking medications and the interventions were undertaken by healthcare professionals including pharmacists, nurses or physicians. There was also evidence of potential bias in some studies, with only 18 studies reporting adequate concealment of allocation and only 12 studies reporting appropriate protection from contamination, both of which may have influenced the overall effect estimate and the overall pooled estimate. Professional interventionsProfessional interventions probably make little or no difference to the number of hospital admissions (risk ratio (RR) 1.24, 95% confidence interval (CI) 0.79 to 1.96; 2 studies, 3889 participants; moderate-certainty evidence). Professional interventions make little or no difference to the number of participants admitted to hospital (adjusted RR 0.99, 95% CI 0.92 to 1.06; 1 study, 3661 participants; high-certainty evidence). Professional interventions may make little or no difference to the number of emergency department visits (adjusted RR 0.71, 95% CI 0.50 to 1.02; 2 studies, 1067 participants; low-certainty evidence). Professional interventions probably make little or no difference to mortality in the study population (adjusted RR 0.98, 95% CI 0.82 to 1.17; 1 study, 3538 participants; moderate-certainty evidence). Organisational interventionsOverall, it is uncertain whether organisational interventions reduce the number of hospital admissions (adjusted RR 0.85, 95% CI 0.71 to 1.03; 11 studies, 6203 participants; very low-certainty evidence). Overall, organisational interventions may make little difference to the total number of people admitted to hospital in favour of the intervention group compared with the control group (adjusted RR 0.92, 95% CI 0.86 to 0.99; 13 studies, 152,237 participants; low-certainty evidence. Overall, it is uncertain whether organisational interventions reduce the number of emergency department visits in favour of the intervention group compared with the control group (adjusted RR 0.75, 95% CI 0.49 to 1.15; 5 studies, 1819 participants; very low-certainty evidence. Overall, it is uncertain whether organisational interventions reduce mortality in favour of the intervention group (adjusted RR 0.94, 95% CI 0.85 to 1.03; 12 studies, 154,962 participants; very low-certainty evidence. AUTHORS' CONCLUSIONS: Based on moderate- and low-certainty evidence, interventions in primary care for reducing preventable medication errors probably make little or no difference to the number of people admitted to hospital or the number of hospitalisations, emergency department visits, or mortality. The variation in heterogeneity in the pooled estimates means that our results should be treated cautiously as the interventions may not have worked consistently across all studies due to differences in how the interventions were provided, background practice, and culture or delivery of the interventions. Larger studies addressing both professional and organisational interventions are needed before evidence-based recommendations can be made. We did not identify any structural interventions and only four studies used professional interventions, and so more work needs to be done with these types of interventions. There is a need for high-quality studies describing the interventions in more detail and testing patient-related outcomes.