Do people with cognitive impairment benefit from cochlear implants? A scoping review.

PURPOSE: To identify and evaluate the evidence for the benefits of cochlear implants for people with cognitive impairment or dementia in terms of speech recognition, quality of life, behavioural and psychological symptoms of dementia, cognition, function in daily life, mental well-being, and caregiver burden. METHODS: Ten electronic databases were searched systematically from inception to December 2023 for studies reporting on outcomes for cochlear implants that included adults identified with cognitive impairment, mild cognitive impairment, or dementia. RESULTS: Thirteen studies were included in this review with a combined total of 222 cochlear implant patients with cognitive impairment, mild cognitive impairment. Two studies were non-randomised controlled design, the remainder were single group studies, case series or single case studies. Evidence suggested that people with cognitive impairment benefit in terms of improved speech recognition from cochlear implants, although they may benefit less than those with healthy cognition and the degree of benefit depends on the level of cognitive impairment. There was no evidence for increased adverse events among those with cognitive impairment. There was limited or no evidence for any other outcome. CONCLUSION: People with cognitive impairment or dementia do benefit from cochlear implants. To inform policy and clinical practice, further data are needed about the broader benefits of cochlear implants for people with cognitive impairment or dementia, and referral, eligibility, and cochlear implant support needs for people with cognitive impairment and their caregivers.

Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health?

BACKGROUND: Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards 'normal birth', whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has not been explored. We examined the relationship between the content of antenatal preparation received and birth experience, taking into account obstetric complications and procedures. As birth experience can have a profound impact on a mother's postnatal well-being, we also investigated associations with mothers' postnatal mood and anxiety. METHODS: N = 253 first-time mothers completed a cross-sectional survey measuring demographic and clinical factors, antenatal preparation content (categorised as normality-focused or broader-focused), obstetric complications and procedures experienced, birth experience (measured using three separate indices; the Childbirth Experience Questionnaire, emotional experiences, and presence/absence of birth trauma), postnatal depression and anxiety, and qualitative information on how the COVID-19 pandemic had affected birth experience. RESULTS: Regarding birth experience, receiving more broader-focused preparation was associated with a more positive birth experience irrespective of complications/procedures experienced, while receiving only normality-focused preparation was beneficial in the context of fewer complications/procedures. Regarding birth trauma, receiving more broader-focused preparation was associated with lower likelihood of reporting birth as traumatic only in the context of more complications/procedures. Degree of normality-focused preparation was unrelated to experience of birth trauma. Lastly, while more complications/procedures were associated with greater anxiety and low mood, only greater normality-focused preparation was linked with better postnatal mental health. CONCLUSIONS: Antenatal preparation including both normality- and broader-focused information is positively related to women's birth experience. While normality-focused preparation seems most beneficial if fewer complications/procedures are experienced, broader-focused preparation may be most beneficial in the context of a greater number of complications/procedures. As complications/procedures are often unpredictable, offering broader-focused preparation routinely is likely to benefit women's birth experience. This antenatal preparation should be freely available and easily accessible.

Capabilities, opportunities and motivations of staff to provide hearing support to long-term care home residents with dementia.

OBJECTIVE: Many long-term care home (LTCH) residents have dementia and hearing loss, causing communication difficulties and agitation. Residents rely on staff for hearing support, but provision is often inconsistent. This study used the Behaviour Change Wheel's Capability, Opportunity and Motivation model to understand why LTCH staff do or do not, provide hearing support to residents with dementia who they believe could benefit from it. DESIGN: An online survey exploring hearing support provision, capabilities, opportunities, motivations and demographics. Data were analysed using descriptive statistics, within-participants ANOVA and multiple linear regression. STUDY SAMPLE: 165 LTCH staff. RESULTS: Staff provided hearing support to 50% of residents with dementia who they thought would benefit. Self-reported physical and psychological capabilities (skills/knowledge) were significantly higher than physical opportunity (having time/resources). The physical capability was significantly higher than social opportunity (collaborative working) and reflective motivation (feeling motivated). Lower levels of hearing support provision were predicted by LTCH funding (private vs. local authority), job role (care assistant vs. nurse) and fewer physical opportunities. CONCLUSIONS: Boosting capabilities through training alone may not be as effective as increasing opportunities via environmental restructuring. Opportunities may include strengthening working relationships with audiologists and ensuring hearing and communication aids are available within LTCHs.

The Victorian Comprehensive Cancer Centre lung cancer clinical audit: collecting the UK National Lung Cancer Audit data from hospitals in Australia.

BACKGROUND: Clinical audit may improve practice in cancer service provision. The UK National Lung Cancer Audit (NLCA) collects data for all new cases of thoracic cancers. AIM: To collect similar data for our Victorian patients from six hospitals within the Victorian Comprehensive Cancer Centre and associated Western and Central Melbourne Integrated Cancer Service. METHODS: We conducted a retrospective audit of all newly diagnosed patients with lung cancer and mesothelioma in 2013 across the six Victorian Comprehensive Cancer Centre/Western and Central Melbourne Integrated Cancer Service hospitals. The objectives were to adapt the NLCA data set for use in the Australian context, to analyse the findings using descriptive statistics and to determine feasibility of implementing a routine, ongoing audit similar to that in the UK. Individual data items were adapted from the NLCA by an expert steering committee. Data were collated from the Victorian Cancer Registry, Victorian Admitted Episodes Dataset and individual hospital databases. Individual medical records were audited for missing data. RESULTS: Eight hundred and forty-five patients were diagnosed across the sites in 2013. Most were aged 65-80 (55%) and were male (62%). Most had non-small-cell lung cancer (81%) with 9% diagnosed with small cell lung cancer and 2% with mesothelioma. Data completeness varied significantly between fields. For those with higher levels of completeness, headline indicators of clinical care were comparable with NLCA data. The Victorian population seem to lack access to specialist lung cancer nurse services. CONCLUSION: Lung cancer care at participating hospitals appeared to be comparable with the UK in 2013. In future, prospective data collection should be harmonised across sites and correlated with survival outcomes. One area of concern was a lack of documented access to specialist nursing services.

Patient-reported outcomes in cancer survivors: a population-wide cross-sectional study.

PURPOSE: There is a lack of robust population-based data regarding the lived experience of cancer survivors. This study assessed the quality of life (QoL) of survivors of breast, colorectal, or prostate cancer, non-Hodgkin lymphoma or melanoma 1, 3 and 5 years post-diagnosis. Associations between various demographic and disease-related factors and QoL were assessed. METHODS: A cross-sectional postal survey was undertaken. Eligible participants were identified from a population-based cancer registry. Patient-reported outcomes including QoL, symptom issues and information needs were collected using validated questionnaires. RESULTS: Difficulties with all QoL domains were more prevalent amongst cancer survivors compared with the general population, particularly difficulties with usual activities (28 vs 15%) and anxiety or depression (35 vs 22%). Symptoms such as trouble sleeping, always feeling tired, trouble concentrating and fear of cancer recurrence persisted up to 5 years post-diagnosis. Factors associated with reduced QoL included having another long-standing health condition, cancer not responding fully to treatment, not having or not being certain of having a written care plan and being female. CONCLUSIONS: Cancer survivors experience inferior QoL and cancer-related symptoms for years following diagnosis. These results support further investigation into factors that contribute to poorer survivor outcomes and enhanced identification and intervention strategies for those requiring additional support.

Presentations to general practice before a cancer diagnosis in Victoria: a cross-sectional survey.

OBJECTIVE: To assess variations in the number of general practitioner visits preceding a cancer diagnosis, and in the length of the interval between the patient first suspecting a problem and their seeing a hospital specialist. DESIGN, SETTING AND PARTICIPANTS: Analysis of data provided to the Cancer Patient Experience Survey (CPES; survey response rate, 37.7%) by 1552 patients with one of 19 cancer types and treated in one of five Victorian Comprehensive Cancer Centre hospitals, 1 October 2012 - 30 April 2013. MAIN OUTCOME MEASURES: The primary outcome was the proportion of patients who had had three or more GP consultations about cancer-related health problems before being referred to hospital. The secondary outcome was the interval between the patient first suspecting a problem and their seeing a hospital specialist. RESULTS: 34% of the patients included in the final analyses (426 of 1248) had visited a GP at least three times before referral to a hospital doctor. The odds ratios (reference: rectal cancer; adjusted for age, sex, language spoken at home, and socio-economic disadvantage index score) varied according to cancer type, being highest for pancreatic cancer (3.2; 95% CI, 1.02-9.9), thyroid cancer (2.5; 95% CI, 0.9-6.6), vulval cancer (2.5; 95% CI, 0.7-8.7) and multiple myeloma (2.4; 95% CI, 1.1-5.5), and lowest for patients with breast cancer (0.4; 95% CI, 0.2-0.8), cervical cancer (0.5; 95% CI, 0.1-2.1), endometrial cancer (0.5; 95% CI, 0.2-1.4) or melanoma (0.7; 95% CI, 0.3-1.5). Cancer type also affected the duration of the interval from symptom onset to seeing a hospital doctor; it took at least 3 months for more than one-third of patients with prostate or colon cancer to see a hospital doctor. CONCLUSION: Certain cancer types were more frequently associated with multiple GP visits, suggesting they are more challenging to recognise early. In Victoria, longer intervals from the first symptoms to seeing a hospital doctor for colon or prostate cancer may reflect poorer community symptom awareness, later GP referral, or limited access to gastroenterology and urology services.

Perspectives on the Mental Health Act 2014 (Vic).

OBJECTIVE: This article will consider the potential impact of Victoria's new Mental Health Act 2014 (Vic) from the perspectives of consumers, careers and members of the treating team. This article will examine how some of the more drastic legal reforms will impact clinical processes, procedures and decision making. CONCLUSIONS: The new Act takes significant steps towards empowering consumers. However, its practical application will take some time to appraise. Only time will reveal how the Mental Health Tribunal handles its newfound powers, whether consumers will benefit from a more collaborative approach to clinical decision making and ultimately whether the Act will empower consumers.

Enablers and Barriers to Hearing aid Use in People Living With Dementia.

Hearing loss is highly prevalent in dementia; however, people with dementia are less likely to use hearing aids consistently than people with intact cognition are. This qualitative study is the first of its kind to explore factors that influence hearing aid use from the perspective of community-living people with mild to moderate dementia and their care partners. Eleven UK-based dyads from the European SENSE-Cog Randomized Controlled Trial of a sensory intervention for people with dementia completed semi-structured interviews based on the Theoretical Domains Framework (TDF). Our findings suggest that the TDF domains environmental context and resources, behavioral regulation, reinforcement, and social influences are of greatest relevance to hearing aid use in dementia. Within these domains, we identified a range of factors that may influence the target behavior of hearing aid use. The findings suggest that adoption of multifaceted, flexible intervention approaches may support hearing aid use in dementia.

Ketamine-Assisted Group Psychotherapy for Frontline Healthcare Workers with COVID-19-Related Burnout and PTSD: A Case Series of Effectiveness/Safety for 10 Participants.

This study reports on 10 frontline healthcare workers, employed during the COVID-19 pandemic and experiencing symptoms of burnout and PTSD, treated with group ketamine-assisted psychotherapy (KAP) in a private outpatient clinic setting. Participants attended 6 sessions once weekly. These included 1 preparation session, 3 ketamine sessions (2 sublingual, 1 intramuscular), 2 integration sessions. Measures of PTSD (PCL-5), depression (PHQ-9), and anxiety (GAD-7) were administered at baseline and post-treatment. During ketamine sessions, the Emotional Breakthrough Inventory (EBI) and the 30-item Mystical Experience Questionnaire (MEQ-30) were recorded. Participant feedback was gathered 1-month post-treatment. We observed improvements in participants' average PCL-5 (59% reduction), PHQ-9 (58% reduction), and GAD-7 (36% reduction) scores from pre- to post-treatment. At post-treatment, 100% of participants screened negative for PTSD, 90% had minimal/mild depression or clinically significant improvement, and 60% had minimal/mild anxiety or clinically significant improvement. MEQ and EBI scores had large variations among participants at each ketamine session. Ketamine was well tolerated, and no significant adverse events were reported. Participant feedback corroborated findings of improvements observed in mental health symptoms. We found immediate improvements treating 10 frontline healthcare workers experiencing burnout, PTSD, depression, and anxiety using weekly group KAP and integration.

"We're just winging it". Identifying targets for intervention to improve the provision of hearing support for residents living with dementia in long-term care: an interview study with care staff.

PURPOSE: Hearing loss and dementia are common in long-term care home (LTCH) residents, causing communication difficulties and worsened behavioural symptoms. Hearing support provided to residents with dementia requires improvement. This study is the first to use the Behaviour Change Wheel (BCW) to identify barriers and propose interventions to improve the provision of hearing support by LTCH staff. METHODS: Semi-structured interviews with 10 staff members were conducted. Transcripts were analysed according to the BCW's Theoretical Domains Framework alongside reflective thematic analysis. Relevant intervention functions and exemplar interventions were proposed. RESULTS: Staff believed hearing support to be beneficial to residents (Beliefs about Consequences) but lacked knowledge of hearing loss management (Knowledge). Poor collaborations between LTCHs and audiology (Environmental Context and Resources), led to despondency, and apprehension about traditional hearing aids for residents (Optimism). Despite feeling responsible for hearing support, staff lacked personal accountability (Social/Professional Role and Identity). CONCLUSIONS: Future interventions should include staff Training (on hearing support), Education (on the consequences of unsupported hearing loss), Enablement (dementia-friendly hearing devices), Incentivisation and Modelling (of Hearing Champions) and Environmental Restructuring (flexible audiology appointments to take place within the LTCH). Interventions should be multi-faceted to boost the capabilities, opportunities and motivations of LTCH staff.

Hearing support for care home residents with dementia:Long-term care staff report inadequate knowledge and awareness of how to support residents' hearing needs and a lack of personal accountability for providing hearing support.They also report poor collaborations with audiologists and apprehension about traditional hearing aids.Barriers to hearing support stem from gaps in the capabilities, opportunities and motivations of staff, therefore, interventions should be designed to target all three constructs.Interventions to aid hearing support provision should target staffs' education, training, enablement, persuasion, modelling, incentivisation and environmental restructuring to boost staff capabilities, opportunities and motivations to provide hearing support.

Microcalcification crystallography as a potential marker of DCIS recurrence.

Ductal carcinoma in-situ (DCIS) accounts for 20-25% of all new breast cancer diagnoses. DCIS has an uncertain risk of progression to invasive breast cancer and a lack of predictive biomarkers may result in relatively high levels (~ 75%) of overtreatment. To identify unique prognostic biomarkers of invasive progression, crystallographic and chemical features of DCIS microcalcifications have been explored. Samples from patients with at least 5-years of follow up and no known recurrence (174 calcifications in 67 patients) or ipsilateral invasive breast cancer recurrence (179 microcalcifications in 57 patients) were studied. Significant differences were noted between the two groups including whitlockite relative mass, hydroxyapatite and whitlockite crystal maturity and, elementally, sodium to calcium ion ratio. A preliminary predictive model for DCIS to invasive cancer progression was developed from these parameters with an AUC of 0.797. These results provide insights into the differing DCIS tissue microenvironments, and how these impact microcalcification formation.

Effectiveness of Hearing Rehabilitation for Care Home Residents With Dementia: A Systematic Review.

OBJECTIVES: To report the effectiveness of, and barriers and facilitators to, hearing rehabilitation for care home residents with dementia. DESIGN: Systematic review. SETTING AND PARTICIPANTS: Care home residents with dementia and hearing loss. METHODS: No restrictions on publication date or language were set and gray literature was considered. Eligible studies were critically appraised and presented via a narrative review. RESULTS: Sixteen studies, most of low to moderate quality, were identified. Hearing rehabilitation, including hearing devices, communication techniques, and visual aids (eg, flashcards), was reported to improve residents' communication and quality of life and reduce agitation, with improvements in staff knowledge of hearing loss and job satisfaction. Residents' symptoms of dementia presented barriers, for example, losing or not tolerating hearing aids. Low staff prioritization of hearing loss due to time pressures and lack of hearing-related training for staff were further barriers, particularly for residents who required assistance with hearing devices. Adopting a person-centered approach based on residents' capabilities and preferences and involving family members facilitated hearing device use. CONCLUSIONS AND IMPLICATIONS: Residents with dementia can benefit from hearing rehabilitation. Identifying and implementing efficient, individualized hearing rehabilitation is necessary for those with complex cognitive needs. Increased funding and support for the social care sector is required to address systemic issues that pose barriers to hearing rehabilitation, including time pressures, lack of training for staff and access to audiology services for residents.

Systematic Review of Factors Associated With Hearing Aid Use in People Living in the Community With Dementia and Age-Related Hearing Loss.

OBJECTIVES: To investigate factors that influence hearing aid use according to the Theoretical Domains Framework (TDF). The TDF is a behavioral science framework that aids understanding of factors that influence behavior. DESIGN: Systematic review. SETTING AND PARTICIPANTS: People living in the community with dementia and age-related hearing loss who have air conduction hearing aids. METHODS: Systematic literature review following PRISMA guidelines. We searched for studies in 9 databases, including Ovid MEDLINE, Scopus, and OpenGrey. We undertook an interpretive data synthesis by mapping findings onto the TDF. We assessed confidence in the findings according to the GRADE-CERQual approach. RESULTS: Twelve studies (6 quantitative, 3 qualitative, and 3 mixed methods) were included in the review. The majority of these were rated low-moderate quality. We identified 27 component constructs (facilitators, barriers, or noncorrelates of hearing aid use) nested within the 14 domains of the TDF framework. Our GRADE-CERQual confidence rating was high for 5 findings. These suggest that hearing aid use for people living in the community with dementia and hearing loss is influenced by (1) degree of hearing aid handling proficiency, (2) positive experiential consequences, (3) degree of hearing aid comfort or fit, (4) person-environment interactions, and (5) social reinforcement. CONCLUSIONS AND IMPLICATIONS: Hearing aid interventions should adopt a multifaceted approach that optimizes the capabilities of people with dementia to handle and use hearing aids; addresses or capitalizes on their motivation; and ensures their primary support network is supportive and encouraging of hearing aid use. The findings also emphasize the need for further high-quality research that investigates optimal hearing aid use, influencing factors, and interventions that support hearing aid use.

Telehealth in cancer care during the COVID-19 pandemic.

INTRODUCTION: The Victorian COVID-19 Cancer Network (VCCN) Telehealth Expert Working Group aimed to evaluate the telehealth (TH) experience for cancer patients, carers and clinicians with the rapid uptake of TH in early 2020 during the COVID-19 pandemic. METHODS: We conducted a prospective multi-centre cross-sectional survey involving eight Victorian regional and metropolitan cancer services and three consumer advocacy groups. Patients or their carers and clinicians who had TH consultations between 1 July 2020 and 31 December 2020 were invited to participate in patient and clinician surveys, respectively. These surveys were opened from September to December 2020. RESULTS: The acceptability of TH via both video (82.9%) and phone (70.4%) were high though acceptability appeared to decrease in older phone TH users. Video was associated with higher satisfaction compared to phone (87.1% vs 79.7%) even though phone was more commonly used. Various themes from the qualitative surveys highlighted barriers and enablers to rapid TH implementation. DISCUSSION: The high TH acceptability supports this as a safe and effective strategy for continued care and should persist beyond the pandemic environment, where patient preferences are considered and clinically appropriate. Ongoing support to health services for infrastructure and resources, as well as expansion of reimbursement eligibility criteria for patients and health professionals, including allied health and nursing, are crucial for sustainability.

Scent-sniffing dogs can discriminate between native Eurasian and invasive North American beavers.

The invasion of a species can cause population reduction or extinction of a similar native species due to replacement competition. There is a potential risk that the native Eurasian beaver (Castor fiber) may eventually be competitively excluded by the invasive North American beaver (C. canadensis) from areas where they overlap in Eurasia. Yet currently available methods of census and population estimates are costly and time-consuming. In a laboratory environment, we investigated the potential of using dogs (Canis lupus familiaris) as a conservation tool to determine whether the Eurasian or the North American beaver is present in a specific beaver colony. We hypothesized that dogs can discriminate between the two beaver species, via the odorant signal of castoreum from males and females, in two floor platform experiments. We show that dogs detect scent differences between the two species, both from dead beaver samples and from scent marks collected in the field. Our results suggest that dogs can be used as an "animal biosensor" to discriminate olfactory signals of beaver species, however more tests are needed. Next step should be to test if dogs discern between beaver species in the field under a range of weather conditions and habitat types and use beaver samples collected from areas where the two species share the same habitat. So far, our results show that dogs can be used as a promising tool in the future to promote conservation of the native beaver species and eradication of the invasive one. We therefore conclude that dogs may be an efficient non-invasive tool to help conservationist to manage invasive species in Europe, and advocate for European wildlife agencies to invest in this new tool.

The Eurasian beaver (Castor fiber) is apparently not a host to blood parasites in Norway.

Parasites can alter the physiology and behaviour of host species and negatively impact on their fitness thus affecting population densities. This is the first investigation into the presence of blood parasites in the Eurasian beaver (Castor fiber); a species that has been the subject of many translocation and reintroduction programmes. Two hundred and seventy blood slides prepared from the blood of 27 beavers from southern Norway were microscopically analysed for the presence of blood parasites. This study reports an absence of blood parasites in the Norwegian Eurasian beavers sampled.

Covalent attachment of proteins to solid supports and surfaces via Sortase-mediated ligation.

BACKGROUND: There is growing interest in the attachment of proteins to solid supports for the development of supported catalysts, affinity matrices, and micro devices as well as for the development of planar and bead based protein arrays for multiplexed assays of protein concentration, interactions, and activity. A critical requirement for these applications is the generation of a stable linkage between the solid support and the immobilized, but still functional, protein. METHODOLOGY: Solid supports including crosslinked polymer beads, beaded agarose, and planar glass surfaces, were modified to present an oligoglycine motif to solution. A range of proteins were ligated to the various surfaces using the Sortase A enzyme of S. aureus. Reactions were carried out in aqueous buffer conditions at room temperature for times between one and twelve hours. CONCLUSIONS: The Sortase A transpeptidase of S. aureus provides a general, robust, and gentle approach to the selective covalent immobilization of proteins on three very different solid supports. The proteins remain functional and accessible to solution. Sortase mediated ligation is therefore a straightforward methodology for the preparation of solid supported enzymes and bead based assays, as well as the modification of planar surfaces for microanalytical devices and protein arrays.

A molecular mousetrap determines polarity of termination of DNA replication in E. coli.

During chromosome synthesis in Escherichia coli, replication forks are blocked by Tus bound Ter sites on approach from one direction but not the other. To study the basis of this polarity, we measured the rates of dissociation of Tus from forked TerB oligonucleotides, such as would be produced by the replicative DnaB helicase at both the fork-blocking (nonpermissive) and permissive ends of the Ter site. Strand separation of a few nucleotides at the permissive end was sufficient to force rapid dissociation of Tus to allow fork progression. In contrast, strand separation extending to and including the strictly conserved G-C(6) base pair at the nonpermissive end led to formation of a stable locked complex. Lock formation specifically requires the cytosine residue, C(6). The crystal structure of the locked complex showed that C(6) moves 14 A from its normal position to bind in a cytosine-specific pocket on the surface of Tus.

Enzymatic esterification of lavandulol--a partial kinetic resolution of (S)-lavandulol and preparation of optically enriched (R)-lavandulyl acetate.

The asymmetric esterification of the racemic primary alcohol lavandulol was achieved using lipase B from Candida antarctica and acetic acid as acyl donor in 80% yield. The enantioselectivity of the process was characterised, and a preparative resolution of 25 mM racemic lavandulol, stopped at approx. 55% conversion, yielded (S)-lavandulol in 42% yield and 52% e.e. and (R)-lavandulyl acetate in 51% yield and 48% e.e.