The Lived Experience of Older Adults Transferring Between Long-Term Care Facilities During the COVID-19 Pandemic.

Long-term care facility (LTCF) residents have been disproportionately affected by coronavirus disease 2019 (COVID-19), from increased mortality and restrictive public health measures. The current study aims to describe the experiences of residents relocating between LTCFs at the onset of the COVID-19 pandemic. Emphasis was placed on residents' sense of home and how the pandemic and ensuing isolation affected their transition. This qualitative study follows the principles of constructivist grounded theory. Seven of 10 residents interviewed had cognitive impairment (mean age = 84 years). Four primary themes were elicited from the interviews focusing on residents' perceptions of their environment and highlights the value placed on privacy and control, the multifaceted feeling of loss during the pandemic, the importance of relationships as a source of comfort and pleasure, and resilience shown by residents in times of hardship. Our study indicates that residents experienced dichotomy and paradox during the pandemic, attempting to strike a balance between isolation and camaraderie, infection risk and mental health, and loss and resilience. The need for familial contact and socialization must be balanced against infection control measures. [Journal of Gerontological Nursing, 48(1), 29-33.].

Experiences and priorities of older adults during the COVID-19 pandemic.

BACKGROUND: Throughout the COVID-19 pandemic, older adults have been prioritized in public health campaigns to limit social interactions and 'cocoon' in their homes. This limits the autonomy of older people and may have unintended adverse consequences. AIMS: To ascertain the self-reported physical and psychological effects of 'cocooning' and the expressed priorities of older adults themselves during the pandemic. METHODS: This is a cross-sectional, survey-based study involving 93 patients aged 65 and older, attending geriatric medicine out-patient and ambulatory day hospital services or our in-patient rehabilitation units. Demographic data was obtained from the medical records. Frailty level was calculated using the Clinical Frailty Scale (CFS), and disease burden was calculated with the Charlson Comorbidity Index. RESULTS: Mean age was 79.1 (range 66-96), 24% had dementia, and most were mildly frail (CFS < 5). One-third reported new feelings of depression, decreased mobility, and loss of enjoyment as a consequence 'cocooning'. Loneliness was more prevalent amongst in-patients (38% vs 9%, p > 0.001). Respondents worried more about the risks of COVID-19 to their family than themselves. Expressed priorities varied from 'enjoying life as much as possible' to 'protecting the development of children'. CONCLUSIONS: Adverse consequences of 'cocooning' were commonly expressed amongst older adults. Public health policy should take into account the heterogeneity of this population and be sensitive to their self-expressed wishes and priorities.

A complexidade da tarefa afeta negativamente o equilíbrio e a mobilidade de idosos saudáveis / Negative effect of task complexity on the balance and mobility of healthy older adults

Resumo Objetivo Analisar o impacto da complexidade da tarefa sobre mobilidade e equilíbrio de idosos saudáveis. Métodos Noventa idosos foram incluídos neste estudo. Os participantes foram submetidos a tarefas que simularam problemas comuns ao envelhecimento, como baixa acuidade visual, alterações na base de apoio e dificuldades em realizar atividades simultâneas. Para avaliação da mobilidade utilizou-se o teste Timed Get Up and Go associado a atividades de dupla-tarefa cognitiva e motora. Para o equilíbrio utilizou-se uma plataforma de força avaliada em diferentes bases de apoio e informações visuais. Testes cognitivos foram aplicados com objetivo de caracterizar a amostra e analisar a associação entre as variáveis motoras e cognitivas. Na análise estatística utilizou-se o teste de Friedman para verificar o efeito da complexidade da tarefa nos idosos e o coeficiente de correlação de Spearman para verificar a associação entre as variáveis motoras e cognitivas. O nível de significância foi estipulado em 5%. Resultados A complexidade da atividade interferiu na mobilidade dos participantes, exigindo um maior número de passos e tempo para realizar a tarefa (p=0,001). De maneira semelhante, uma base de apoio diminuída e informações visuais restritas causaram uma maior insegurança nos participantes frente às reações de equilíbrio (p=0,001). Testes de correlação apontaram associações significativas entre funções executivas e tarefas motoras complexas (p<0,05). Conclusão Idosos saudáveis apresentam instabilidade motora quando submetidos a tarefas complexas, potencializando as alterações provenientes do envelhecimento. A associação entre as variáveis cognitivas e motoras sugere a necessidade de assistência multiprofissional para preparar os idosos no enfrentamento de desafios diários.

Abstract Objective to analyze the impact of task complexity on the mobility and balance of healthy older adults. Methods ninety older adults were enrolled in the study. The participants performed tasks that simulated problems common to aging, such as low visual acuity, changes in the base of support and difficulties in carrying out activities simultaneously. Mobility was evaluated with the Timed Get Up and Go test during dual cognitive and motor tasks. Balance was assessed using a force plate with different bases of support and visual information. Cognitive tests were applied to characterize the sample and to analyze the association between the motor and cognitive variables. For statistical analysis, the Friedman test was used to verify the impact of task complexity on the older adults and the Spearman correlation coefficient was used to verify the association between the motor and cognitive variables. Significance was set at 5%. Results task complexity impacted the mobility of participants, with a greater number of steps and time required to complete the test (p=0.001). Similarly, small bases of support and restricted visual information resulted in greater insecurity among the participants in terms of balance reactions (p=0.001). Correlation tests identified significant associations between executive functions and complex motor tasks (p<0.05). Conclusion healthy older adults exhibited motor instability when performing complex tasks, potentiating aging-related changes. The association between the cognitive and motor variables suggests the need of multi-professional care to prepare older adults for their daily challenges.

Crianças e procedimentos cirúrgicos: efeitos da informação / Children and surgical procedures: effects of information / Los niños y los procedimientos quirúrgicos: efectos de la información

A falta de conhecimentos e informações entre crianças expostas a procedimentos cirúrgicos pode estar relacionada funcionalmente a manifestações de ansiedade. O presente trabalho descreve uma revisão de literatura acerca dos efeitos da disponibilização de informação sobre os comportamentos de crianças expostas a cirurgias eletivas. Foram consultados os portais dos Periódicos CAPES, PROQUEST e SciELO, sem restrição de bases de dados. Os resultados, organizados em categorias funcionais, destacam: (a) crianças se beneficiam da familiarização prévia com a equipe e instruções sobre como lidar com situações desconfortáveis; (b) passeios guiados pelo hospital, livretos, teatro de fantoches, jogos e vídeos são formatos potencialmente eficazes para redução de ansiedade; e (c) a informação parece constituir um preditor de maior colaboração e redutor de preocupações dos acompanhantes. No entantoainda não há consenso sobre critérios de escolha de informação e efeitos sobre a colaboração comportamental das crianças com os procedimentos a serem executados.

Lack of knowledge and information among children exposed to surgical procedures may be functionally related to manifestations of anxiety. This paper describes a literature review on the effects of providing information on the behavior of children exposed to elective surgeries. The portals of CAPES, PROQUEST and SciELO journals were consulted, without restriction of databases. The results, organized in functional categories, highlight: (a) children benefit from prior familiarization with the team and instructions on how to deal with uncomfortable situations; (b) tours through hospital, booklets, puppet theater, board games and videos are potentially effective formats for anxiety reduction; and (c) information seems to be a predictor of greater collaboration and lesser concern of the companions. However, there is still no consensus on the criteria for choosing information and effects on children's behavioral collaboration with the procedures to be performed.

La falta de conocimientos e información entre niños expuestos a procedimientos quirúrgicos puede estar relacionada funcionalmente con manifestaciones de ansiedad. El presente trabajo describe una revisión de literatura sobre los efectos de la disponibilidad de información sobre los comportamientos de niños expuestos a las cirugías electivas. Se consultaron los portales de los Periódicos CAPES, PROQUEST y SciELO, sin restricción de bases de datos. Los resultados, organizados en categorías funcionales, destacan: (a) niños se benefician de la familiarización previa con el equipo e instrucciones sobre cómo lidiar con situaciones incómodas; (b) paseos guiados por el hospital, folletos, teatro de títeres, juegos y videos son formatos potencialmente eficaces para reducir la ansiedad; y (c) la información parece constituir un predictor de mayor colaboración y reductor de preocupaciones de los acompañantes. Sin embargo, aún no hay consenso sobre criterios de elección de información y efectos sobre la colaboración comportamental de los niños con los procedimientos a ser ejecutados..

A Systematic Review of the Causes and Management of Nonthrombotic Embolic Stroke of Tissue Origin.

INTRODUCTION: Various bodily tissues have been reported to enter the arterial circulation and embolize to the brain resulting in ischemic stroke. Most frequently nonthrombotic embolic stroke (NTES) of tissue origin is iatrogenic or related to an underlying disease process. With the increase in elective surgery and intravascular procedures, NTES may increase in prevalence. AIM: To compile a summary of the background, incidence, presentation, and treatment of NTES of tissue origin, by conducting a systematic review of the current literature. SUMMARY OF REVIEW: We searched EMBASE and MEDLINE for articles on NTES of tissue origin published in English with no restriction on publication date (search date June 2017). 800 articles were identified and screened and 159 articles were ultimately reviewed in full text and included in qualitative analysis. Articles deemed relevant were assessed by a second reviewer to confirm compatibility with the inclusion criteria. References of included articles were reviewed for relevant publications. We categorized the pathology of the emboli into the following groups: amniotic fluid (4 publications), tumour (60 publications), fat (43 publications), cholesterol (19 publications), and intravascular debris (12 publications). We then summarized the available literature on each cause of NTES. CONCLUSIONS: NTES of tissue origin is an uncommon but important diagnosis to consider particularly in younger stroke patients and in certain clinical settings. Treatment for NTES is currently anecdotal and based on small case series. Embolectomy may emerge as the therapy of choice due to the longer treatment timeframe and heterogeneity of the emboli.

A Systematic Review of the Causes and Management of Ischaemic Stroke Caused by Nontissue Emboli.

INTRODUCTION: The inadvertent or purposeful introduction of foreign bodies or substances can lead to cerebral infarction if they embolize to the brain. Individual reports of these events are uncommon but may increase with the increased occurrences of their risk factors, for example, intra-arterial procedures. METHOD: We searched EMBASE and MEDLINE for articles on embolic stroke of nontissue origin. 1889 articles were identified and screened and 216 articles were ultimately reviewed in full text and included in qualitative analysis. Articles deemed relevant were assessed by a second reviewer to confirm compatibility with the inclusion criteria. References of included articles were reviewed for relevant publications. We categorized the pathology of the emboli into the following groups: air embolism (141 reports), other arterial gas embolisms (49 reports), missiles and foreign bodies (16 reports), and others, including drug embolism, cotton wool, and vascular sclerosant agents. CONCLUSION: Air and gaseous embolism are becoming more common with increased use of interventional medical procedures and increased popularity of sports such as diving. There is increasing evidence for the use of hyperbaric oxygen for such events. Causes of solid emboli are diverse. More commonly reported causes include bullets, missiles, and substances used in medical procedures.

Morbidity and Mortality Following Relocation of Highly Dependent Long-Term Care Residents: A Retrospective Analytical Study.

In recent years, 1,200 long-term care facility (LTCF) beds have been closed in Ireland, resulting in residents being transferred between facilities. The current study examined morbidity and mortality in residents relocated between LTCFs. The outcomes were studied for residents who transferred between LTCFs compared to residents who did not move (i.e., controls). A retrospective analysis was performed recording demographic data and markers of function and frailty. As a measure of morbidity, new antidepressant medication prescriptions and antibiotic drug use were examined. Mortality at 30 and 90 days was recorded. In total, 76 transferred residents and 62 control residents were studied. Both groups were highly dependent and had a high 90-day mortality rate (18.4% versus 17.7%). Higher prescription rates of antibiotic drugs occurred among relocated residents prior to transfer (59.2% versus 27.4%, p = 0.017). Residents who transferred had a greater number of new antidepressant medication prescriptions than control residents (19.7% versus 8.1%, p = 0.05). Proper planning and vigilance by staff are essential to minimize any distress caused to residents during times of relocation. [Journal of Gerontological Nursing, 42(11), 34-38.].

The synergy of tobacco and alcohol and glutathione S-transferase θ 1 gene deletion and oral squamous cell carcinoma.

BACKGROUND: Oral squamous cell carcinoma (OSCC) is the leading cancer among males in India. It is related to tobacco habits and alcohol consumption as well as the individual susceptibility for xenobiotic metabolizing enzyme polymorphisms. Glutathione S-transferase θ 1 (GSTT1) is a Phase II metabolic enzyme which is directly involved in catalyzing chemicals to mutagenic intermediates. This gene is characterized by genetic polymorphism resulting in complete gene deletion and subsequent absence of the enzyme, which ultimately dictates the risk of cancer development. Scraping buccal mucosa to obtain DNA from the cells is a simple, readily acceptable and rapid method to detect and assess the gene. AIM: To assess GSTT1 gene deletion in individuals giving a history of tobacco smoking and/or chewing and alcohol consumption and absence of clinically detectable lesions; and in OSCC cases to gauge if GSTT1 gene deletion confers protection to an individual and whether it can be used as a "single" marker to arrive at this conclusion. To validate the use of buccal scrape for determining the genotype of an individual by assessing the polymorphism at GSTT1 gene locus (22q11.2). MATERIALS AND METHODS: Fifty-two cases were evaluated using buccal mucosal scrapes of tobacco habituates for 8 or more years, without clinically evident lesion (Group I) and from mucosa of tobacco habituates with clinically evident and histopathologically confirmed OSCC (Group II). DNA extraction and genotype at GSTT1 gene locus was determined by polymerase chain reaction assay. STATISTICAL ANALYSIS: The results were statistically analyzed using Chi-square test. RESULTS: 90.66% of subjects had GSTT1 null genotype in Group I subjects. In Group II, subjects with both clinically and histopathologically diagnosed oral cancer, about 76.96% had GSTT1 null genotype. CONCLUSION: GSTT1 null genotype confers protection to individuals with tobacco habits and alcohol consumption, predominantly to those who used chewable form of tobacco and especially among female population. However, the influence of many other environmental, genetic and epigenetic factors should be considered for the genesis/occurrence of cancer.

Analysis of the invasive edge in primary and secondary oral squamous cell carcinoma: An independent prognostic marker: A retrospective study.

BACKGROUND AND OBJECTIVES: Oral squamous cell carcinoma (OSCC) is one of the most common head and neck carcinomas and corresponds to 95% of all oral cancers with an increasing morbidity and mortality. Its prognosis is affected by several clinicopathologic factors, one of which is pattern of invasion (POI). The histological features of OSCC may differ widely, but there is general agreement that the most useful prognostic information can be deduced from the invasive front of the tumor. In this retrospective study, our aim was to compare the POI, the status of connective tissue and the status of inflammation at the tumor-host interface in primary and recurrent (secondary) OSCC and test the validity of POI, to serve as a potential marker to assess the prognosis of the patient. MATERIALS AND METHODS: Differentiation of tumors, POI, status of connective tissue and inflammation was assessed in 168 cases of primary and recurrent cases of OSCC. STATISTICAL ANALYSIS: Fisher's exact test was used to determine the statistical significance and P < 0.05 was considered to be statistically significant. RESULTS: Our study showed that majority of the primary and secondary tumors were well differentiated, 117 [95.9%] and 34 [73.9%], respectively. Predominant POI in the primary and secondary tumor group was Pattern II and least was Pattern V. Worst pattern in primary tumor and highest distribution was seen for Pattern III (53.3%), and least for Pattern V (0.00%). In secondary tumors, the predominant worst pattern was Pattern IV (50.0%) and least distribution was seen for Pattern I (0.00%). Connective tissue status for both primary and secondary tumors showed the predominance of loose type (85.2% and 79.2%) and least was variable type (0.8% and 0.6%), respectively. Status of inflammation in the primary tumor group showed a predominance of moderate grade of inflammation (50.0%) and very mild grade of inflammation (6.6%) was the least type. In the secondary tumor group, moderate grade (43.5%) of inflammation was predominant and very mild grade (5.4%) was the least. All the parameters showed a statistically significant difference on the application of Fisher's exact test between the two groups. CONCLUSION: Our study showed that POI could serve as an individual prognostic marker irrespective of the histologic differentiation of tumor. Tumor desmoplasia could be considered as an important reflection of the tumor-host interaction, especially in aggressive cancers. Host immune defense, especially tumor infiltrating lymphocytes must be noted as critical factors related to survival rate in OSCC patients. Assessment of mentioned parameters may lead to sound prognostic assessment and appropriate treatment planning thus reducing the possibility of recurrence or relapse. Hence, the parameters evaluated in our study could serve as independent or interdependent prognostic markers.

Aggrandizing oral submucous fibrosis grading using an adjunct special stain: A pilot study.

INTRODUCTION: Oral submucous fibrosis (OSMF) is graded according to various histological factors which include the epithelial changes and the connective tissue changes. These features though could be identified in routine hematoxylin and eosin (H and E) staining; they could be better appreciated in special stains. This pilot study is an attempt to identify a single special stain that can act as an adjunct to H and E stain to help grade this potentially malignant disease. AIMS AND OBJECTIVES: To assess if special stains can improvise on differentiating the various histological changes seen in OSMF and to accordingly grade OSMF cases. MATERIALS AND METHODS: Formalin-fixed paraffin-embedded tissue sections of OSMF-10 cases of each grade (n = 30). Three special stains: Van-Gieson, Mallory's trichrome and Masson trichrome. STATISTICAL ANALYSIS: The results obtained were tabulated and statistically analyzed using Chi-square test. OBSERVATIONS AND RESULTS: The thickness and degree of keratinization were best detected in Mallory's stain (100%) and were statistically significant; the subepithelial changes were better detected using special stains, especially Mallory's stain (100%). The changes in collagen fibers were better visualized in all three special stains but were not statistically significant. The changes in blood vessels were better detected in Van-Gieson's and Mallory's stain; the obtained results were statistically significant. The degree of fibrosis between muscle bundles could be detected in all the three special stains, but when compared the results were not statistically significant. The questionable areas of muscle degeneration, especially in deeper connective tissue were better detected in Mallory's (43%) and Masson's stain (43%) as compared to Van-Gieson stain (14%) and the results obtained were statistically significant. The inflammatory cells and dysplastic features are better visualized in routine H and E stains. CONCLUSION: Pathogenesis of OSMF is related to fibro-elastic and muscle degenerative changes in the connective tissue followed by secondary changes in epithelium. Routine H and E, stains all the connective tissue components in various shades of pink, use of special stains bestows contrast between different components of connective tissue, thus improvising grading of OSMF. Mallory's stain can be used as a single adjunct to H and E stain as both pattern of keratinization in the epithelium and changes in the superficial and deeper connective tissue could be ascertained.