Frailty identification and management among Brazilian healthcare professionals: a survey.

BACKGROUND: National and international guidelines on frailty assessment and management recommend frailty screening in older people. This study aimed to determine how Brazilian healthcare professionals (HCPs) identify and manage frailty in practice. METHODS: An anonymous online survey on the assessment and management of frailty was circulated virtually through HCPs across Brazil. RESULTS: Most of the respondants used non-specific criteria such as gait speed (45%), handgrip strength (37.6%), and comprehensive geriatric assessment (33.2%). The use of frailty-specific criteria was lower than 50%. The most frequently used criteria were the Frailty Index (19.1%), Frailty Phenotype (13.2%), and FRAIL (12.5%). Only 43.5% felt confident, and 40% had a plan to manage frailty. In the multivariate-adjusted models, training was the most crucial factor associated with assessing frailty, confidence, and having a management plan (p < 0.001 for all). Those with fewer years of experience were more likely to evaluate frailty (p = 0.009). Being a doctor increased the chance of using a specific tool; the opposite was true for dietitians (p = 0.03). Those who assisted more older people had a higher likelihood of having a plan (p = 0.011). CONCLUSION: Frailty assessment was heterogeneous among healthcare professions groups, predominantly using non-specific criteria. Training contributed to frailty assessment, use of specific criteria, confidence, and having a management plan. This data informs the need for standardized screening criteria and management plans for frailty, in association with increasing training at the national level for all the HCPs who assist older people.

Oral self-care among dependent older New Zealanders.

OBJECTIVES: The objective of the study was to describe the occurrence and associations of oral self-care by dependent older New Zealanders. BACKGROUND: Dependent older adults who require some level of assisted daily care have been shown to have poorer oral health than their independent counterparts, yet national estimates are lacking. MATERIALS AND METHODS: A secondary analysis was conducted of data from New Zealand's 2012 Older People's Oral Health Survey, a national survey that interviewed and examined a representative sample of 2,218 dependent older adults living in aged residential care or receiving home-based care. Survey data were weighted for statistical analyses, and modelling was carried out using a modified Poisson approach. RESULTS: Overall, 59.5% (95% CI: 55.1, 63.7) of participants brushed their teeth twice a day, with this rate higher among women, Asians and those without cognitive or physical impairment. Cleaning interdentally at least once a week was less common than brushing, at 25.9% (95% CI: 21.5, 30.9), and that proportion was significantly lower among those with higher dependency or who were cognitively or physically impaired. Almost 9 in 10 (87.8%; 95% CI 83.1, 91.4) used fluoride toothpaste, and adults of high socio-economic status had lower rates of fluoride toothpaste use. Only 15.0% (95% CI 12.4, 18.0) used mouthwash, with this being most prevalent in Pasifika. More than half of those who wore dentures also wore them at night. CONCLUSION: Oral self-care was sub-optimal among dependent older New Zealanders. Improving the situation should be a high priority.

Outcome measures from international older adult care home intervention research: a scoping review.

BACKGROUND: Care homes are increasingly important settings for intervention research to enhance evidence-informed care. For such research to demonstrate effectiveness, it is essential that measures are appropriate for the population, setting and practice contexts. OBJECTIVE: To identify care home intervention studies and describe the resident outcome measures used. DESIGN: Scoping review. METHODS: We reviewed international care home research published from 2015 to August 2022. We searched MEDLINE, EMBASE, CINAHL and ASSIA. We included any intervention study conducted in a care home, reporting resident outcomes. We extracted resident outcome measures, organised these using the domains of an adapted framework and described their use. RESULTS: From 7,330 records screened, we included 396 datasets reported in 436 publications. These included 12,167 care homes and 836,842 residents, with an average of 80 residents per study. The studies evaluated 859 unique resident outcomes 2,030 times using 732 outcome measures. Outcomes were evaluated between 1 and 112 times, with 75.1% of outcomes evaluated only once. Outcome measures were used 1-120 times, with 68.4% of measures used only once. Only 14 measures were used ≥20 times. Functional status, mood & behaviour and medications were the commonest outcome domains assessed. More than half of outcomes were assessed using scales, with a fifth using existing records or administrative data. CONCLUSIONS: There is significant heterogeneity in the choice and assessment of outcomes for intervention research in care homes. There is an urgent need to develop a consensus on useful and sensitive tools for care homes, working with residents, families and friends and staff.

Keep it Simple, Laboratory Parameters to Predict Complicated Acute Appendicitis in Children Younger Than Five Years.

BACKGROUND: The clinical presentation of acute appendicitis in the youngest age lacks specific signs and symptoms, and it is difficult to obtain an accurate clinical diagnosis. Once the diagnosis is made, it is necessary to determine if the appendicitis is simple and able to be managed non-surgically, or complicated, therefore requiring surgery. Together with the clinical picture and imaging, routine laboratory values play a vital role in this decision. The aim of this study is to evaluate routine blood in their ability to differentiate between complicated and uncomplicated acute appendicitis. METHOD: A retrospective analysis was conducted from a single pediatric surgery department of all children 5 years of age or younger who underwent surgery for acute appendicitis between the years 2010-2020. RESULTS: 728 children were diagnosed with acute appendicitis, and 42 children were under the age of 5 years. There was a significant difference in the C-reactive protein, white blood cell count, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio in the complicated group versus the uncomplicated group. The value of these together for prediction complicated appendicitis were 84.8% sensitivity, 80.9% specificity, 82.8% positive predictive value, and 72.8% negative predictive value. These values were all higher than both the Alvarado score and the PAS (P < .05). CONCLUSIONS: C-reactive protein, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio are simple laboratory parameters that can help identify complicated versus uncomplicated appendicitis in children 5 years old or younger. These universal parameters may help guide the treatment and decision to operate on a difficult to diagnose population.

Sustaining interventions in care homes initiated by quality improvement projects: a qualitative study.

INTRODUCTION: Inadequate and varied quality of care in care homes has led to a proliferation of quality improvement (QI) projects. This study examined the sustainability of interventions initiated by such projects. METHOD: This qualitative study explored the sustainability of seven interventions initiated by three QI projects between 2016 and 2018 in UK care homes and explored the perceived influences to the sustainability of interventions. QI projects were followed up in 2019. Staff leading QI projects (n=9) and care home (n=21, from 13 care homes) and healthcare (n=2) staff took part in semi-structured interviews. Interventions were classified as sustained if the intervention was continued at the point of the study. Thematic analysis of interview data was performed, drawing on the Consolidated Framework for Sustainability (CFS), a 40-construct model of sustainability of interventions. RESULTS: Three interventions were sustained and four interventions were not. Seven themes described perceptions around what influenced sustainability: monitoring outcomes and regular check-in; access to replacement intervention materials; staff willingness to dedicate time and effort towards interventions; continuity of staff and thorough handover/inductions in place for new staff; ongoing communication and awareness raising; perceived effectiveness; and addressing care home priorities. All study themes fell within 18 of the 40 CFS constructs. DISCUSSION: Our findings resonate with the CFS and are also consistent with implementation theories, suggesting sustainability is best addressed during implementation rather than treated as a separate process which follows implementation. Commissioning and funding QI projects should address these considerations early on, during implementation.

Comparison of self-perceived competence of recent dental graduates from the Universities of Otago and Dalhousie.

INTRODUCTION: This study investigates and compares the self-perceived competencies of recent dental graduates from the University of Otago (UoO) (Dunedin, New Zealand) and Dalhousie University (DU) (Nova Scotia, Canada). MATERIALS AND METHODS: A validated survey was emailed to recent graduates from the UoO (December 2019) and DU (May 2020). Chi-squared statistical analysis examined the differences between groups. RESULTS: The response rate was 73% from the UoO class and 75% from the DU class. Out of 59 competencies, 11 items showed a significant difference. Orthodontics and the surgical aspects of dentistry were the main areas where significant differences have been observed between the two cohorts. Out of the four items in orthodontics, a significantly higher proportion of DU graduates felt more competent than graduates from UoO in three items ("performing orthodontic treatment planning," "performing space maintenance/regaining" and "performing orthodontic full-arch alignment"; p < .001). Similarly, graduates from DU felt significantly more competent in three of the eight items in the oral and maxillofacial surgery domain ("managing complications of oral surgery," "performing soft-tissue biopsies" and "managing trauma to the dentofacial complex"; p < .001), all requiring surgical training and skills. CONCLUSION: Of the differences identified, graduates from DU reported higher levels of self-perceived competence compared with their UoO counterparts, especially in the orthodontics and oral and maxillofacial surgery domains. This could be because DU students have more practice in these specialties during their training. The results suggest that increased exposure for UoO students in these areas may be beneficial to their self-perceived competence.

Enhancing the student learning experience: Co-teaching biochemistry and clinical sciences within the dental curriculum.

Basic knowledge of biochemistry underpins oral and dental care. Undergraduate dental students do not always engage well with basic science teaching due to not appreciating its clinical relevance. Co-teaching provides one approach to overcome students' disengagement and involves two lecturers, with complementary expertise, presenting the curriculum together. This study investigated student experiences and engagement using co-teaching to integrate biochemistry with clinical sciences in the students' second-year dental curriculum. Two successive second year dental student cohorts were co-taught. Content was delivered by a biochemist and an oral biologist, either online (during the 2020 COVID lockdown) or in-person (2021). Each cohort was surveyed at the end of the teaching module using an online questionnaire containing both interval scale and free-text questions. Responses were received from 39 (42%) and 64 (85%) of students in 2020 and 2021, respectively. Students from both cohorts preferred the co-teaching approach with a mean of 8.74 on a 10-point interval scale. In 2020 and 2021, 77% and 76% of participants, respectively, preferred a combined biochemistry and clinical dentistry delivery, either in-person (37%), via Zoom (19%) or via video recording (14%). Thematic analysis of responses revealed students experienced enhanced engagement when co-taught and they attributed this to integration of the curriculum making the content more relevant and stimulating. Students preferred co-teaching to individual subjects being taught by a single teacher. Co-teaching established the relevance of theoretical biochemistry to clinical dental sciences and enhanced the students' learning experience.

No one is born with it: Australasian dental students' perceptions of learning manual dexterity.

Dentistry requires high manual dexterity, and few studies have investigated the challenges and impact on dental students of attaining manual dexterity skills. This study aimed to investigate dental students' perceptions of manual dexterity, including their awareness of manual dexterity requirements in dentistry, self-perceptions of manual dexterity competency, and whether manual dexterity should be part of admission to dentistry training. A link to a 12-item online Qualtrics survey was sent out to students in either their 2nd or 5th year of the Bachelor of Dental Surgery (BDS) degree at the University of Otago, New Zealand. The anonymous survey collected basic demographic data and included closed and open-ended questions about manual dexterity. Descriptive statistics were calculated for quantitative variables and a general inductive approach was used to analyze free-text responses. Those were later grouped into a theoretical domain framework. The overall response rate was 53%. All participants acknowledged the importance of manual dexterity in dentistry. Most participants thought that manual dexterity can be improved with practice and that including a manual dexterity test in the admission criteria may cause unnecessary stress for students. Striving to achieve manual dexterity impacted participants' performance in the BDS course. However, most participants viewed it as a challenge that can be overcome with practice and improvement, and that current BDS admission requirements are sufficient.

The Use of Inlay Bridge of the Posterior Fascia as Adjuvants to a Modified Rives-Stoppa Repair for Difficult Abdominal Wall Hernias.

BACKGROUND: Major abdominal wall defects remain a highly morbid complication. Occasionally a fascial defect is encountered, that despite all surgical efforts, is unable to completely approximate at the midline. Here we describe our method and outcomes of using a bridging mesh when the posterior fascia was unable to be approximated during the repair of large postoperative ventral hernias using the modified Rives-Stoppa technique. METHODS: A retrospective review was conducted looking at all the open abdominal wall hernia repairs between 2014 and 2020. The cohort of patients who had a bridge placed in addition to the traditional open modified Rives-Stoppa repair were used for this study. RESULTS: Nineteen patients had a mesh inlay bridge placed in addition to a modified Rives-Stoppa repair with a sublay (retrorectus) Ultrapro mesh. For the inlay mesh 13 Symbotex composite meshes were placed and 6 Vicryl meshes used. The average surface area of the defect was 358.1 cm^2. The average length of hospitalization was 8.8 days with a range of 3-24 days. During the immediate postoperative course there were 6 minor complications. During the follow-up period there were 2 recurrences. DISCUSSION: The use of inlay mesh bridge as an adjuvant to a modified Rives-Stoppa repair with a sublay ultrapro mesh is an effective technique for difficult abdominal wall repairs where the posterior fascia is unable to be approximated without tension.

Cooperation dynamics in dynamical networks with history-based decisions.

In many aspects of life on earth, individuals may engage in cooperation with others to contribute towards a goal they may share, which can also ensure self-preservation. In evolutionary game theory, the act of cooperation can be considered as an altruistic act of an individual producing some form of benefit or commodity that can be utilised by others they are associated with, which comes at some personal cost. Under certain conditions, individuals make use of information that they are able to perceive within a group in order to aid with their choices for who they should associate themselves within these cooperative scenarios. However, cooperative individuals can be taken advantage of by opportunistic defectors, which can cause significant disruption to the population. We study a model where the decision to establish interactions with potential partners is based on the opportune integration of the individual's private ability to perceive the intentions of others (private information) and the observation of the population, information that is available to every individual (public information). When public information is restricted to a potential partners current connection count, the population becomes highly cooperative but rather unstable with frequent invasions of cheaters and recoveries of cooperation. However, when public information considers the previous decisions of the individuals (accepted / rejected connections) the population is slightly less cooperative but more stable. Generally, we find that allowing the observation of previous decisions, as part of the available public information, can often lead to more stable but fragmented and less prosperous networks. Our results highlight that the ability to observe previous individual decisions, balanced by individuals personal information, represents an important aspect of the interplay between individual decision-making and the resilience of cooperation in structured populations.

Double-Balloon Kyphoplasty Results in Better Radiographic Outcomes Than a Single-Balloon Kyphoplasty in Treating Osteo-Porotic Spinal Fractures.

BACKGROUND: Studies have found that unilateral and bilateral kyphoplasty have comparable clinical outcomes. Only a few studies have compared the radiographic results of using unilateral vs. simultaneous bilateral approaches. We aimed to examine and compare the radiographic results of unilateral (UKP) vs. bilateral simultaneous double-balloon kyphoplasty (DKP) for treating symptomatic vertebral compression fractures (VCF). METHODS: A retrospective cohort of all patients treated for VCF by DKP and UKP over five years in a single medical center. From 2009 to 2012, we routinely performed UKP; from 2012, DKP was the routine due to potential benefits in vertebral realignment. We evaluated pre- and post-surgical fracture characteristics including vertebral height, sagittal and coronal Cobb angle, and fracture reduction. Statistical analysis included a t-test for independent variables and Pearson's correlation. RESULTS: The study cohort consisted of 81 patients (75.8 years ± 10.86) who underwent surgery, with a total of 119 vertebras. We performed 89 UKP on fractured vertebras and 30 DKP on 30 vertebrae. The UKP average fluoroscopy radiation exposure was 15.8 mGy (±11.5) per level compared to 11.2 mGy (±8.7) for DKP, p = 0.03. DKP showed significant fracture reduction, 2.8 degrees of Cobb angle, equaling the patient positioning effect on fracture reduction. CONCLUSION: DKP results in better fracture reduction than UKP, and equals the effect of patient positioning without increased radiation exposure or adverse events.

Developing a minimum data set for older adult care homes in the UK: exploring the concept and defining early core principles.

Reforms to social care in response to the COVID-19 pandemic, in the UK and internationally, place data at the heart of proposed innovations and solutions. The principles are not well established of what constitutes core, or minimum, data to support care home residents. Often, what is included privileges data on resident health over day-to-day care priorities and quality of life. This Personal View argues for evidence-based principles on which to base the development of a UK minimum data set (MDS) for care homes. Co-produced work involving care home staff and older people working with stakeholders is required to define and agree the format, content, structure, and operationalisation of the MDS. Implementation decisions will determine the success of the MDS, affecting aspects including data quality, completeness, and usability. Care home staff who collect the data need to benefit from the MDS and see value in their contribution, and residents must derive benefit from data collection and synthesis.

The uptake and use of a minimum data set (MDS) for older people living and dying in care homes: a realist review.

BACKGROUND: Care homes provide long term care for older people. Countries with standardised approaches to residents' assessment, care planning and review (known as minimum data sets (MDS)) use the aggregate data to guide resource allocation, monitor quality, and for research. Less is known about how an MDS affects how staff assess, provide and review residents' everyday care. The review aimed to develop a theory-driven understanding of how care home staff can effectively implement and use MDS to plan and deliver care for residents. METHODS: The realist review was organised according to RAMESES (Realist And Meta-narrative Evidence Synthesis: and Evolving Standards) guidelines. There were three overlapping stages: 1) defining the scope of the review and theory development on the use of minimum data set 2) testing and refining candidate programme theories through iterative literature searches and stakeholders' consultations as well as discussion among the research team; and 3) data synthesis from stages 1 and 2. The following databases were used MEDLINE via OVID, Embase, CINAHL (Cumulative Index to Nursing and Allied Health Literature), ASSIA [Applied Social Sciences Citation Index and Abstracts]) and sources of grey literature. RESULTS: Fifty-one papers informed the development of three key interlinked theoretical propositions: motivation (mandates and incentives for Minimum Data Set completion); frontline staff monitoring (when Minimum Data Set completion is built into the working practices of the care home); and embedded recording systems (Minimum Data Set recording system is integral to collecting residents' data). By valuing the contributions of staff and building on existing ways of working, the uptake and use of an MDS could enable all staff to learn with and from each other about what is important for residents' care CONCLUSIONS: Minimum Data Sets provides commissioners service providers and researchers with standardised information useful for commissioning planning and analysis. For it to be equally useful for care home staff it requires key activities that address the staff experiences of care, their work with others and the use of digital technology. REGISTRATION: PROSPERO registration number CRD42020171323.

A scoping review of the changing landscape of geriatric medicine in undergraduate medical education: curricula, topics and teaching methods.

PURPOSE: The world's population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in geriatric medicine that will potentially inform developments and updating of undergraduate medical curricula for geriatric content. METHODS: We systematically searched the electronic databases Ovid Medline, Ovid Embase and Pubmed, from 1st January 2009 to 18th May 2021. We included studies related to (1) undergraduate medical students and (2) geriatric medicine or ageing or older adults and (3) curriculum or curriculum topics or learning objectives or competencies or teaching methods or students' attitudes and (4) published in a scientific journal. No language restrictions were applied. RESULTS: We identified 2503 records and assessed the full texts of 393 records for eligibility with 367 records included in the thematic analysis. Six major themes emerged: curriculum, topics, teaching methods, teaching settings, medical students' skills and medical students' attitudes. New curricula focussed on minimum Geriatrics Competencies, Geriatric Psychiatry and Comprehensive Geriatric Assessment; vertical integration of Geriatric Medicine into the curriculum has been advocated. Emerging or evolving topics included delirium, pharmacotherapeutics, healthy ageing and health promotion, and Telemedicine. Teaching methods emphasised interprofessional education, senior mentor programmes and intergenerational contact, student journaling and reflective writing, simulation, clinical placements and e-learning. Nursing homes featured among new teaching settings. Communication skills, empathy and professionalism were highlighted as essential skills for interacting with older adults. CONCLUSION: We recommend that future undergraduate medical curricula in Geriatric Medicine should take into account recent developments described in this paper. In addition to including newly emerged topics and advances in existing topics, different teaching settings and methods should also be considered. Employing vertical integration throughout the undergraduate course can usefully supplement learning achieved in a dedicated Geriatric Medicine undergraduate course. Interprofessional education can improve understanding of the roles of other professionals and improve team-working skills. A focus on improving communication skills and empathy should particularly enable better interaction with older patients. Embedding expected levels of Geriatric competencies should ensure that medical students have acquired the skills necessary to effectively treat older patients.

Dental students' perceptions of the long case.

INTRODUCTION: The long case examination is used to assess clinical competency in dental education. However, the academic literature, much of which is in medical education, highlights concerns regarding the relevancy and authenticity of the long case. To date, dental students' experiences of the long case have been under-researched. This study examines students' experiences and perceptions of the long case examination at an Australasian dental school. MATERIALS AND METHODS: This study was a qualitative investigation. Students participated in interviews to discuss their perceptions and experiences of the long case examination. The interviews were voice-recorded and transcribed, and a thematic inductive analysis was undertaken. RESULTS: Three main themes emerged from the data: stress, where students described stressors before, during and after the long case; fairness, where students positioned the long case as either fair or not fair; and confusion, where students spoke about their perceived lack of understanding of the examination process and procedures. CONCLUSION: The concerns students raised regarding stress, fairness and confusion are considered and ways in which the long case might be developed in order to support students' learning are presented. Alternative structures or practices that might be explored include greater calibration of examiners and cases, and enhancements to how students are prepared for and prepare for the examination. The results of this research will inform ongoing development of assessment practices.

"It's just inappropriate": Harassment of dental students by patients.

INTRODUCTION: Harassment is an issue that occurs in all workplaces and institutions. Due to increased exposure to patients, higher rates of harassment are experienced in health care systems. Health care workers need to form a professional relationship with patients to attend to their health care needs; however, harassment by patients can disrupt this relationship and have detrimental physical, mental, and emotional impacts on the health practitioner. OBJECTIVE: The purpose of this study was to examine the prevalence and impact of harassment by patients toward clinical students at a prominent Australasian dental school. METHODS: A 14-item survey was distributed to clinical students. The survey collected basic demographic information and contained Likert-scale closed questions on harassment prevalence and experience and a free text question asking for details of a significant harassment experience. Descriptive statistics and analysis of free text data were performed. RESULTS: The response rate was 67%. About 20% of respondents reported experiencing at least one incident of harassment. Verbal harassment was most commonly reported, followed by sexual and racial harassment. All incidences of sexual harassment were reported by female students, while racial harassment was most frequently reported by students of Asian ethnicity. Most students indicated they were unsure of how to respond to harassment by patients. CONCLUSION: Dental students were exposed to harassment by patients. IMPLICATIONS: Appropriate policies and education on responding to harassment, alongside support for the same, could help ensure the safety and wellbeing of students.