Evaluation of a Workshop on Therapeutic Lying and Dementia Care for Long-Term Care Staff Supporting Persons With Dementia.

BACKGROUND: Therapeutic lying is an intervention used by health care professionals (HCPs) when a person with dementia is disoriented and distressed and when all other interventions have not succeeded in deescalating the symptoms of dementia. METHOD: The goal of this study was to evaluate a workshop on therapeutic lying and dementia care for HCPs specializing in the care of persons living with dementia with symptoms of dementia. Seventeen HPCs, including nurses and personal support workers (PSWs), participated in the workshop and evaluation survey. RESULTS: The workshop did not affect the attitudes of HCPs toward therapeutic lying and dementia, their sense of competence in providing care to patients with dementia, or their rate of admitting to using therapeutic lying in dementia care settings. All of the PSWs and 50.0% of the nurses admitted to using therapeutic lying as an intervention. Conclusion: Current nursing ethics standards and training practices may cause reluctance among nurses to include therapeutic lying in care plans as a last resort and as a person- and family-centered intervention to deescalate the symptoms of dementia. [J Contin Educ Nurs. 2021;52(9):438-444.].

Responding to responsive behaviours: A clinical placement workshop for nursing students.

As our population ages, it is important for the next generation of nurses to feel prepared to care for people with dementia. Communicating with a person with dementia who is experiencing responsive behaviours can be challenging. Furthermore, new graduate nurses may experience a phenomenon called reality shock when they do not feel prepared for the reality of nursing. Reality shock can lead to nurse turnover and poor retention rates. This study evaluated a workshop for first-year practical nursing students focusing on applying a person-centered communication framework when caring for people with dementia experiencing responsive behaviours. The results suggested that training students during their clinical placements on dementia communication may be effective in helping prepare nurses to care for this patient population.

Early integration of palliative care in a long-term care home: A telemedicine feasibility pilot study.

OBJECTIVE: Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences. METHOD: This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys. RESULTS: For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021). SIGNIFICANCE OF RESULTS: The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.

The relationship between physical activity levels and pain in children with juvenile idiopathic arthritis.

OBJECTIVE: Pain and reduced physical activity levels are common in children with juvenile idiopathic arthritis (JIA). Currently, there is no consensus about the role of physical activity in managing pain in JIA. The purpose of our study was to assess the relationship between physical activity level and pain in children ages 11 to 18 years with JIA. METHODS: A random sample of 50 patients with JIA were approached by mailed questionnaires. Physical activity was determined using the Physical Activity Questionnaire (PAQ). Pain measures included the Numerical Rating Scale (pain severity), SUPER-KIDZ body diagram (number of painful areas), and the Child Activities Limitations Inventory-21 (pain interference). Generalized linear models were used to assess the relationship between physical activity and pain, as well as the roles of sex and age. RESULTS: The response rate was 84%. Thirty-four respondents completed the questionnaire package. The median age was 15 years. The mean PAQ score was 2.16/5. Physical activity declines with increasing age in youth with JIA (r = 0.53, p = 0.0014). Lower physical activity is associated with greater pain interference (r = 0.39, p = 0.0217) and more severe pain (r = 0.35, p = 0.0422). CONCLUSION: Children with JIA report significantly less activity than healthy children based on PAQ scores, with physical activity declining throughout adolescence. Physical activity is inversely related to pain interference and severity in children with JIA. Our findings suggest that physical activity interventions may play an important role in the management of pain in JIA.

Warfarin in systemic sclerosis-associated and idiopathic pulmonary arterial hypertension. A Bayesian approach to evaluating treatment for uncommon disease.

OBJECTIVE: Warfarin is recommended in systemic sclerosis-associated pulmonary arterial hypertension (SSc-PAH) and idiopathic PAH (IPAH) to improve survival. There is no evidence to support this in SSc-PAH and the evidence in IPAH is conflicting. We evaluated the ability of warfarin to improve survival using 2 large SSc-PAH and IPAH cohorts. METHODS: The effect of warfarin on all-cause mortality was evaluated. Bayesian propensity scores (PS) were used to adjust for baseline differences between patients exposed and not exposed to warfarin, and to assemble a matched cohort. Bayesian Cox proportional hazards models were constructed using informative priors based on international PAH expert elicitation. RESULTS: Review of 1138 charts identified 275 patients with SSc-PAH (n = 78; 28% treated with warfarin) and 155 patients with IPAH (n = 91; 59% treated with warfarin). Baseline differences in PAH severity and medications were resolved using PS matching. In the matched cohort of 98 patients with SSc-PAH (49 treated with warfarin), the posterior median hazard ratio (HR) was 1.06 [95% credible interval (CrI) 0.70, 1.63]. In the matched cohort of 66 patients with IPAH (33 treated with warfarin), the posterior median HR was 1.07 (95% CrI 0.57, 1.98). The probability that warfarin improves median survival by 6 months or more is 23.5% in SSc-PAH and 27.7% in IPAH. Conversely, there is a > 70% probability that warfarin provides no significant benefit or is harmful. CONCLUSION: There is a low probability that warfarin improves survival in SSc-PAH and IPAH. Given the availability of other PAH therapies with demonstrable benefits, there is little reason to use warfarin to improve survival for these patients.

Effect of warfarin on survival in scleroderma-associated pulmonary arterial hypertension (SSc-PAH) and idiopathic PAH. Belief elicitation for Bayesian priors.

OBJECTIVE: Warfarin use in scleroderma (SSc)-associated pulmonary arterial hypertension (PAH) and idiopathic PAH (IPAH) is controversial. A prerequisite for a trial is the demonstration of community uncertainty. We evaluated experts' beliefs about the effect of warfarin on 3-year survival in SSc-PAH and IPAH, and factors that influence warfarin use. METHODS: PAH experts attending the 2008 American College of Rheumatology or American Thoracic Society meetings expressed the probability of 3-year survival without and with warfarin and their degree of uncertainty by applying adhesive dots, each representing a 5% weight of probability, in "bins" on a line, creating a prior probability distribution or prior. Using a numeric rating scale, participants rated factors that influence their use of warfarin. RESULTS: Forty-five experts (44% pulmonologists, 38% rheumatologists, 16% cardiologists, 2% internists) underwent the belief elicitation interview. In SSc-PAH, the mean probabilities of 3-year survival without and with warfarin were 54% and 56%, respectively. Pessimistic experts believe that warfarin worsens survival by 7%. Optimistic experts believe that warfarin improves survival by 13%. In IPAH, the mean probabilities of 3-year survival without and with warfarin were 68% and 76%. Factors (mean rating out of 10, 0 = not at all important, 10 = extremely important) that influence experts' use of warfarin were functional class (5.4), age (5.4), pulmonary artery pressure (5.2), peripheral vascular disease (3.6), disease duration (2.8), and sex (1.7). CONCLUSION: Bayesian priors effectively quantify and illustrate experts' beliefs about the effect of warfarin on survival in SSc-PAH and IPAH. This study demonstrates the presence of uncertainty about the effect of warfarin, and provides justification for a clinical trial.

A valid and reliable belief elicitation method for Bayesian priors.

OBJECTIVE: Bayesian inference has the advantage of formally incorporating prior beliefs about the effect of an intervention into analyses of treatment effect through the use of prior probability distributions or "priors." Multiple methods to elicit beliefs from experts for inclusion in a Bayesian study have been used; however, the measurement properties of these methods have been infrequently evaluated. The objectives of this study were to evaluate the feasibility, validity, and reliability of a belief elicitation method for Bayesian priors. STUDY DESIGN AND SETTING: A single-center, cross-sectional study using a sample of academic specialists who treat pulmonary hypertension patients was conducted to test the feasibility, face and construct validity, and reliability of a belief elicitation method. Using this method, participants expressed the probability of 3-year survival with and without warfarin. Applying adhesive dots or "chips," each representing 5% probability, in "bins" on a line, participants expressed their uncertainty and weight of belief about the effect of warfarin on 3-year survival. RESULTS: Of the 12 participants, 11 (92%) reported that the belief elicitation method had face validity, 10 (83%) found the questions clear, and 11 (92%) found the response option easy to use. The median time to completion was 10 minutes (5-15 minutes). Internal validity testing found moderate agreement (weighted kappa=0.54-0.57). The intraclass correlation coefficient for test-retest reliability was 0.93. CONCLUSION: This method of belief elicitation for Bayesian priors is feasible, valid, and reliable. It can be considered for application in Bayesian clinical studies.