Variations in older people's emergency care use by social care setting: a systematic review of international evidence.

BACKGROUND: Older adults' use of social care and their healthcare utilization are closely related. Residents of care homes access emergency care more often than the wider older population; however, less is known about emergency care use across other social care settings. SOURCES OF DATA: A systematic review was conducted, searching six electronic databases between January 2012 and February 2022. AREAS OF AGREEMENT: Older people access emergency care from a variety of community settings. AREAS OF CONTROVERSY: Differences in study design contributed to high variation observed between studies. GROWING POINTS: Although data were limited, findings suggest that emergency hospital attendance is lowest from nursing homes and highest from assisted living facilities, whilst emergency admissions varied little by social care setting. AREAS TIMELY FOR DEVELOPING RESEARCH: There is a paucity of published research on emergency hospital use from social care settings, particularly home care and assisted living facilities. More attention is needed on this area, with standardized definitions to enable comparisons between studies.

Which interventions are effective at decreasing or increasing emergency department attendances or hospital admissions from long-term care facilities? A systematic review.

OBJECTIVE: UK long-term care facility residents account for 185 000 emergency hospital admissions each year. Avoidance of unnecessary hospital transfers benefits residents, reduces demand on the healthcare systems but is difficult to implement. We synthesised evidence on interventions that influence unplanned hospital admissions or attendances by long-term care facility residents. METHODS: This is a systematic review of randomised controlled trials. PubMed, MEDLINE, EMBASE, ISI Web of Science, CINAHL and the Cochrane Library were searched from 2012 to 2022, building on a review published in 2013. We included randomised controlled trials that evaluated interventions that influence (decrease or increase) acute hospital admissions or attendances of long-term care facility residents. Risk of bias and evidence quality were assessed using Cochrane Risk Of Bias-2 and Grading of Recommendations Assessment, Development and Evaluation. RESULTS: Forty-three randomised studies were included in this review. A narrative synthesis was conducted and the weight of evidence described with vote counting. Advance care planning and goals of care setting appear to be effective at reducing hospitalisations from long-term care facilities. Other effective interventions, in order of increasing risk of bias, were: nurse practitioner/specialist input, palliative care intervention, influenza vaccination and enhancing access to intravenous therapies in long-term care facilities. CONCLUSIONS: Factors that affect hospitalisation and emergency department attendances of long-term care facility residents are complex. This review supports the already established use of advance care planning and influenza vaccination to reduce unscheduled hospital attendances. It is likely that more than one intervention will be needed to impact on healthcare usage across the long-term care facility population. The findings of this review are useful to identify effective interventions that can be combined, as well as highlighting interventions that either need evaluation or are not effective at decreasing healthcare usage. PROSPERO REGISTRATION NUMBER: CRD42020169604.

Measuring older people's socioeconomic position: a scoping review of studies of self-rated health, health service and social care use.

BACKGROUND: The challenges of measuring socioeconomic position in older populations were first set out two decades ago. However, the question of how best to measure older people's socioeconomic position remains pertinent as populations age and health inequalities widen. METHODS: A scoping review aimed to identify and appraise measures of socioeconomic position used in studies of health inequalities in older populations in high-income countries. Medline, Scopus, EMBASE, HMIC and references lists of systematic reviews were searched for observational studies of socioeconomic health inequalities in adults aged 60 years and over, published between 2000 and 2020. A narrative synthesis was conducted. FINDINGS: One-hundred and thirty-eight studies were included; 20 approaches to measuring socioeconomic position were identified. Few studies considered which pathways the chosen measures of socioeconomic position intended to capture. The validity of subjective socioeconomic position measures, and measures that assume shared income and educational capital, should be verified in older populations. Incomplete financial data risk under-representation of some older groups when missing data are socially patterned. Older study samples were largely homogeneous on measures of housing tenure, and to a lesser extent, measures of educational attainment. Measures that use only two response categories risk missing subtle differences in older people's socioeconomic circumstances. CONCLUSION: Poor choice of measures of socioeconomic position risk underestimating the size of health inequalities in older populations. Choice of measures should be shaped by considerations of theory, context and response categories that detect subtle, yet important, inequalities. Further evidence is required to ascertain the validity of some measures identified in this review.

Daily proactive problem-solving and next day stress appraisals: the moderating role of behavioral activation.

Background and objectives: Drawing upon transactional theory, this study examined the interactive effects of daily problem-prevention behaviors and an aspect of personality relevant to stress responses (i.e., behavioral activation) on next-day stress appraisals of problem-solving demands. Design and methods: Data were collected from 188 employees across a range of industries using an initial survey to collect information on personality, followed by twice-daily surveys over five consecutive work days to measure daily problem-prevention, stress appraisals and problem-solving demands. Results: Multilevel analyses revealed that behavioral activation system (BAS) affected stress appraisals in unique ways. As hypothesized, BAS had a positive direct effect on challenge appraisal. It also moderated the effects of problem-prevention on next-day hindrance appraisals, such that the relationship was more strongly positive for individuals with low levels of BAS. Conclusions: The results demonstrate the BAS has implications not just for promoting positive challenge appraisals, but also for alleviating detrimental effects on stress appraisal. Overall, the findings emphasize the value of exploring the interactive effects of day- and person-level factors on stress appraisals, thereby offering a platform for future research.

An investigation into the effect of changing the computed tomography slice reconstruction interval on the spatial replication accuracy of three-dimensional printed anatomical models constructed by fused deposition modelling.

INTRODUCTION: Three-dimensional (3D) printed models can be constructed utilising computed tomography (CT) data. This project aimed to determine the effect of changing the slice reconstruction interval (SRI) on the spatial replication accuracy of 3D-printed anatomical models constructed by fused deposition modelling (FDM). METHODS: Three bovine vertebrae and an imaging phantom were imaged using a CT scanner. The Queensland State Government's Animal Care and Protection Act 2001 did not apply as no animals were harmed to carry out scientific activity. The data were reconstructed into SRIs of 0.1, 0.3, 0.5 and 1 mm and processed by software before 3D printing. Specimens and printed models were measured with calipers to calculate mean absolute error prior to statistical analysis. RESULTS: Mean absolute error from the original models for the 0.1, 0.3, 0.5 and 1 mm 3D-printed models was 0.592 ± 0.396 mm, 0.598 ± 0.479 mm, 0.712 ± 0.498 mm and 0.933 ± 0.457 mm, respectively. Paired t-tests (P < 0.05) indicated a statistically significant difference between all original specimens and corresponding 3D-printed models except the 0.1 mm vertebrae 2 (P = 0.061), 0.3 mm phantom 1 (P = 0.209) and 0.3 mm vertebrae 2 (P = 0.097). CONCLUSION: This study demonstrated that changing the SRI influences the spatial replication accuracy of 3D-printed models constructed by FDM. Matching the SRI to the primary spatial resolution limiting factor of acquisition slice width or printer capabilities optimises replication accuracy.

Leveraging the experience of stressors: the role of adaptive systematic self-reflection.

Background: To date, little attention has been paid to the processes by which resilience is developed, and how the likelihood of a resilient outcome may be enhanced over the life course. Objective: This study investigates the potential for adaptive systematic self-reflection to support the development of situation resilience via stressor exposure. Design: An experimental randomized controlled design was conducted. Participants were randomly assigned to either the Systematic Self-reflection intervention (n = 61) or disengagement control group (n = 60). Method: Participants were 121 university students (female = 68%) ranging in age from 18 to 56 years. Participants experienced two psychosocial stressors and completed a baseline survey, a second survey occurred post-stressor 1, and a third post-stressor 2. Salivary cortisol was taken pre stressor 2, immediately post stressor 2, and at 10 min intervals until 30 min. Results: The intervention was associated with greater reductions in negative affect, than a disengagement control task, and prevented the continued reduction in positive affect observed in the disengagement control condition. Moreover, the intervention promoted a steeper cortisol recovery trajectory, than the control condition for those with higher pre-stressor cortisol. Conclusions: This study provides further evidence that certain self-reflective practices may be involved in the development of resilience from stressor exposure.

Higher social cue utilisation improves communication, reduces perceived workload, and improves performance amongst ad hoc dyads in simulated rail control.

The objective was to examine whether ad hoc dyads with different collective social cue utilisation would record differences in performance and perceptions of workload during a simulated rail control task that incorporated distinct levels of demand. The frequency of two types of communicative statements was also examined as mediating factors: closing the loop and informative responding. A quasi-experimental design was employed using 40 dyadic teams. The results indicated that ad hoc teams whose members comprised higher social cue utilisation recorded relatively faster response times and perceived lower levels of workload, and engaged in a greater frequency of communicative statements that involved 'closing the loop' and 'informative responses'. Social cue utilisation also exerted an indirect effect on perceived workload through informative responding. The outcomes have theoretical implications for models of ad hoc team performance, and practical implications for the selection and training of teams that operate on an ad hoc basis. Practitioner summary: This study indicates that, in the context of simulation tasks requiring teamwork, higher social cue utilisation amongst ad hoc team members is associated with communication, workload perception, and overall performance.

The Role of Social Cue Utilization and Closing-the-Loop Communication in the Performance of Ad Hoc Dyads.

OBJECTIVE: To examine whether social cue utilization impacts the performance of ad hoc dyads through its relationship with closing the loop, a communication process whereby team members respond more frequently to initiating statements made by others. BACKGROUND: There lacks unequivocal experimental evidence for any single cognitive-based process that might predict the performance of ad hoc teams. METHOD: Using a quasi-experimental design, 80 participants were classified into 40 dyads based on their levels of social cue utilization and attempted a team problem-solving task. A serial mediation model revealed an indirect effect of social cue utilization on the performance of ad hoc dyads through closing the loop. RESULTS: Analyses indicated that social cue utilization impacts on the performance of ad hoc dyads independently of nonverbal reasoning ability and emotional intelligence. Further, the level of social cue utilization within dyads exhibits a positive indirect impact on the performance of ad hoc dyads through closing the loop. CONCLUSION: Ad hoc dyads with higher levels of social cue utilization engaged in a greater frequency of closing-the-loop statements and showed better subsequent performance on a problem-solving task in comparison to dyads with lower levels of social cue utilization. APPLICATION: Potential applications include the optimization of ad hoc team composition within high reliability environments like aviation and power control as well as improving training interventions with a specific mechanism for improving the performance of ad hoc teams.

Building resilience through exposure to stressors: The effects of challenges versus hindrances.

This paper explores the potential for certain types of stressors to build resilience in the occupational setting. Using the challenge-hindrance stressor framework (Cavanaugh, Boswell, Roehling, & Boudreau, 2000), we propose that challenge stressors have the potential to promote the capacity for resilience, whereas hindrance stressors experienced in the workplace erode resilient functioning. Employing a 2-wave longitudinal design we examined the effects of challenge and hindrance stressors on psychological resilience and strain 3 months later. Two-hundred and 8 working adults (48.1% female) participated in both surveys. Findings indicated that Time 1 challenge stressors had a significant effect on psychological resilience 3 months later (Time 2). In contrast, Time 1 hindrance stressors positively predicted Time 2 strain and negatively predicted psychological resilience. Moreover, resilience mediated the relationship between Time 1 stressors and Time 2 strain. These results demonstrate the potential positive and negative impacts of workplace stressor types on psychological resilience, and provide an exploration of a mechanism through which challenge and hindrance stressors influence well-being. This analysis also investigated the role of resilience in moderating the relationship between hindrances and strain. Some evidence emerged for the moderating role of resilience in the hindrance-strain relationship. The implications of these findings and directions for future research are discussed. (PsycINFO Database Record

Hindrances are not threats: advancing the multidimensionality of work stress.

The challenge-hindrance framework has proved useful for explaining inconsistencies in relationships between work stressors and important outcomes. By introducing the distinction between threat and hindrance to this framework, we capture the potential for personal harm or loss (threat) associated with stressors, as distinct from the potential to block goal attainment (hindrance) or promote gain (challenge). In Study 1, survey data were collected from 609 retail workers, 220 of whom responded 6 months later. The results supported a 3-factor threat-hindrance-challenge stressor structure and showed that threat stressors are associated with increased psychological distress and emotional exhaustion, and reduced dedication, whereas hindrance stressors undermine dedication but may not be related to distress or exhaustion with threats included in the model. Study 2 utilized a diary study design, with data collected from 207 workers over 3 workdays. Findings revealed that the threat, hindrance, and challenge appraisals of individual workers are statistically distinct, and associated with stressors and well-being as anticipated: threats with role conflict and anxiety, hindrances with organizational constraints and fatigue, and challenges with skill demands and enthusiasm. Overall, moving to a 3-dimensional challenge-hindrance-threat framework for stressors and stress appraisals will support a more accurate picture regarding the nature, processes, and effects of stressors on individuals and organizations, and ensure prevention efforts are not misguided.

The merits of measuring challenge and hindrance appraisals.

BACKGROUND AND OBJECTIVES: The challenge-hindrance framework has shown that challenge stressors (work characteristics associated with potential personal gain) tend to have positive outcomes, whereas hindrance stressors (those which obstruct goals) have negative outcomes. However, typical research methods assume that stressors allocated to these categories are appraised consistently by different people and across different situations. We validate new measures of challenge and hindrance appraisals and demonstrate their utility in stress research. DESIGN AND METHODS: We used a cross-sectional survey of American employees (Study 1, n = 333), a diary survey of Australian employees (Study 2, n = 241), and a survey of Australian college students whose performance was evaluated independently (Study 3, n = 350). RESULTS: Even after accounting for the effects of stressors, challenge and hindrance appraisals consistently explained unique variance in affective states, with indications that stressors have indirect effects via appraisals. Such effects were seen within- as well as between-participants (Study 2). Appraisals also had expected associations with specific coping behaviors (Study 1), while challenge appraisal was associated with task performance (Study 3). CONCLUSIONS: The scales of challenge and hindrance appraisals were psychometrically sound across multiple contexts. RESULTS highlight the merit of considering appraisal in stress research.

The capability of static and dynamic features to distinguish competent from genuinely expert practitioners in pediatric diagnosis.

OBJECTIVE: The authors describe the development of a new, more objective method of distinguishing experienced competent nonexpert from expert practitioners within pediatric intensive care. BACKGROUND: Expert performance involves the acquisition and use of refined feature-event associations (cues) in the operational environment. Competent non-experts, although experienced, possess rudimentary cue associations in memory. Thus, they cannot respond as efficiently or as reliably as their expert counterparts, particularly when key diagnostic information is unavailable, such as that provided by dynamic cues. METHOD: This study involved the application of four distinct tasks in which the use of relevant cues could be expected to increase both the accuracy and the efficiency of diagnostic performance. These tasks included both static and dynamic stimuli that were varied systematically. A total of 50 experienced pediatric intensive staff took part in the study. RESULTS: The sample clustered into two levels across the tasks: Participants who performed at a consistently high level throughout the four tasks were labeled experts, and participants who performed at a lower level throughout the tasks were labeled competent nonexperts. The groups differed in their responses to the diagnostic scenarios presented in two of the tasks and their ability to maintain performance in the absence of dynamic features. CONCLUSION: Experienced pediatricians can be decomposed into two groups on the basis of their capacity to acquire and use cues; these groups differ in their diagnostic accuracy and in their ability to maintain performance in the absence of dynamic features. APPLICATION: The tasks may be used to identify practitioners who are failing to acquire expertise at a rate consistent with their experience, position, or training. This information may be used to guide targeted training efforts.

Society of Nuclear Medicine--57th annual meeting.

The 57th Annual Meeting of the Society of Nuclear Medicine, held in Salt Lake City, UT, USA, included topics covering new developments in imaging agents and radiopharmaceutical therapies in the field of nuclear medicine. This conference report highlights selected presentations related to imaging of the brain, the prediction of heart disease, and the detection and treatment of various cancers. Investigational drugs discussed include TF-2 plus [68Ga]IMP-288 and TF-2 plus [111In]IMP-288 (both Immunomedics Inc), [11C]PBR-170 (Royal Prince Alfred Hospital/Australian Nuclear Science & Technology Organization), [11C]LY-2795050 (Eli Lilly & Co), yttrium (90Y) clivatuzumab tetraxetan (Garden State Cancer Center/Immunomedics Inc), [18F]LMI-1195 (Lantheus Medical Imaging Inc), fluciclovine (18F) (GE Healthcare/Nihon Medi-Physics Co Ltd), [99mTc]MIP-1340 and [99mTc]MIP-1407 (both Molecular Insight Pharmaceuticals Inc).

Does personal initiative training work as a stress management intervention?

An experimental trial is reported that compares 2 stress management intervention programs and a waitlist control. Both programs involved training in problem-focused strategies of identifying and changing the sources of stress. One of the programs contained additional content on how to display more personal initiative (PI). Both programs involved 2 sessions held 1 week apart, each session lasting 3-4 hr. Strain was measured before training and at 7 and 13 weeks after the initial session. Results show that both programs were effective at reducing strain, whereas the waitlist group showed no change in strain. The PI program increased proactive behavior at 7 weeks as determined by independent evaluations, although the same pattern was not observed for PI self-reports. Proactive behavior did not appear to mediate the effects of training programs on strain.