Prevalence and factors associated with mental health status in Parkinson's disease: Data from the 45 and Up Study.

INTRODUCTION: Parkinson's disease (PD) is associated with a range of non-motor symptomologies such as anxiety and depression. OBJECTIVE: The purpose of this research was to investigate the prevalence and factors associated with mental health status in persons with PD. DESIGN: This retrospective data linkage study analysed a subset of data from the Sax Institute's 45 and Up Study based in the population of the state of New South Wales (NSW), Australia. Data was analysed between 2005-2009 of persons who self-identified with PD. Secure data access was provided through the Sax Institute's Secure Unified Research Environment (SURE). Participants were aged 45+ years of age and living in NSW, Australia. Regression analysis was performed on psychological distress (K10), previous diagnosis of anxiety, and/or depression, with independent variables for locality, demographic, health, medical, and sociocultural factors. FINDINGS: A total of 1676 persons self-identified with PD from the 45 and Up Study Wave 1 baseline and were linked to the 2010 Social, Economic and Environmental Factors (SEEF) survey dataset. Mental health manifestations are common in PD with 29% and 32% reporting a previous medical diagnosis of anxiety and depression, respectively. Rural locality was associated with an increased likelihood of psychological distress, anxiety, and depression compared to metropolitan locality. DISCUSSION: Mental health status in PD was associated with living in rural areas, medical service access, female gender, ageing, physical mobility, Australian born, social interactions, and in a coupled relationship. CONCLUSION: Further research is required on the longitudinal impact of these associations on mental health in PD.

Exploring Parkinson's disease prevalence in regional, rural and remote Australia: A systematic scoping review.

INTRODUCTION: Idiopathic Parkinson's disease (PD) is the second most prevalent neurodegenerative disorder worldwide. Due to ageing populations, prevalence estimates for PD are set to increase in western countries including Australia. OBJECTIVE: This study aims to investigate the prevalence of PD in regional, rural and remote areas of Australia, to inform the provision of equitable PD-specific care. DESIGN: A scoping review, following the Joanna Briggs Institute methodology for scoping reviews and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of four databases and the search engine google scholar was completed in May 2022 and updated in September 2023. Article screening and quality appraisal were undertaken independently by at least two reviewers. FINDINGS: Of 514 records screened, six articles (between 1966 and 2019) were identified and included for review. Wide variations in PD prevalence were evident, ranging from 0.58 to 8.5 per 1000 people. Two studies suggested prevalence may be higher in regional, rural and remote areas of Australia than in urban localities. DISCUSSION: The limited number of studies identified, and wide variation in prevalence rates makes it difficult to draw firm conclusions to inform heath care planning and resource allocation. CONCLUSION: A paucity of reliable prevalence data indicates the need for well-designed, country-specific epidemiological studies to be conducted to estimate the actual impacts of the disease to inform public health planning, particularly in regional, rural and remote areas where access to PD-specific care is already inequitable.

A Qualitative Study of Older Patients' and Family Caregivers' Perspectives of Transitional Care From Hospital to Home.

BACKGROUND AND PURPOSE: The need for high-quality long-term healthcare services is increasing across the globe as the population ages. Strategies for improving transitional care from hospital to home are needed. This study aimed to explore the perspectives of patients aged 65 years and over and their family caregivers transitioning from hospital to home in an urban area of Turkey. METHODS: Thematic analysis of in-depth semi-structured interviews was conducted with older patients (n = 14), with at least one chronic disease and admitted to the hospital for a minimum of 3 days, and family caregivers (n = 11) who voluntarily participated. RESULTS: Main themes were "confused feelings of safety and stress"; "worried about being left alone"; and "disrupted healthcare journey." The proactive rehabilitation model was used to elaborate on the study findings and interpret the perspectives and experiences of older patients and their family caregivers, which can be used for improving the quality of care after discharge from hospital. IMPLICATIONS FOR PRACTICE: A high-quality transitional care program requires taking care of the feeling of safety in older patients and their family caregivers by the multidisciplinary team and their enhanced involvement in care initiatives after hospital discharge.

A Systematic Review of the Legal Considerations Surrounding Medicines Management.

This study explores the legal considerations surrounding medicines management, providing a synthesis of existing knowledge. An integrative systematic review of the current international knowledge was performed. The search encompassed the online databases of PubMed (including Medline), Scopus, CINAHL, and Web of Science using MeSH terms and relevant keywords relating to the legal considerations of medicines management in healthcare settings. The search process led to the identification of 6051 studies published between 2010 and 2020, of which six articles were found to be appropriate for data analysis and synthesis based on inclusion criteria. Research methods were varied and included qualitative interviews, mixed-methods designs, retrospective case reports and cross-sectional interrupted time-series analysis. Their foci were on the delegation of medicines management, pharmacovigilance and reporting of adverse drug reactions (ADRs) before and after legislation by nurses, physicians and pharmacists, medico-legal litigation, use of forced medication and the prescription monitoring program. Given the heterogenicity of the studies in terms of aims and research methods, a meta-analysis could not be performed and, therefore, our review findings are presented narratively under the categories of 'healthcare providers' education and monitoring tasks', 'individual and shared responsibility', and 'patients' rights'. This review identifies legal aspects surrounding medicines management, including supervision and monitoring of the effects of medicines; healthcare providers' knowledge and attitudes; support and standardised tools for monitoring and reporting medicines' adverse side effects/ADRs; electronic health record systems; individual and shared perceptions of responsibility; recognition of nurses' roles; detection of sentinel medication errors; covert or non-voluntary administration of medication, and patient participation.

Transitional 'hospital to home' care of older patients: healthcare professionals' perspectives.

BACKGROUND: Transitional care is a key area of care provision to older people with chronic and complex health conditions and is associated with the quality of care delivered in the healthcare system. AIMS: This study aimed to explore the perspectives of healthcare providers, including nurses and physicians, regarding transitional care from hospital to home in an urban area of Turkey. METHODS: A qualitative study using a thematic analysis method was carried out. In-depth semi-structured interviews were held with eight clinical nurses and five general physicians involved in the provision of healthcare services to older patients in the transitional care process from hospital to home. FINDINGS: The thematic analysis of in-depth semi-structured interviews with 13 healthcare professionals led to the development of the following themes: 'uninterrupted chain of care transfer', 'commitment to meet patient's needs' and 'support and removing ambiguities'. CONCLUSIONS: Key factors impacting on the quality and safety of transitional care and continuity of healthcare are communication and collaboration between healthcare staff and settings, and older patients' as well as family caregivers' awareness and their feelings of responsibility towards the continuity of care at home.

Looking for the "Little Things": A Multi-Disciplinary Approach to Medicines Monitoring for Older People Using the ADRe Resource.

Advances in medicines have increased the effectiveness of treatments and the social and cultural authority of doctors. However, as prescribing has become the dominant modality of treatment, the "pharmaceuticalization" of medical practice has often resulted in treatment "at a distance", with doctors having limited contact with patients. Older and poorer people, who are socially distanced from medical prescribers, suffer more adverse drug reactions (ADRs) than the general population. A team approach to checking patients systematically for ADRs, as detailed in manufacturers' literature, can minimise medication errors, but regular review is rare. This paper explains the benefits of medicines monitoring to protect older patients from iatrogenic harm, such as over-sedation, falls, or drug-induced Parkinsonism. We show how multidisciplinary initiatives to optimise prescribing can be supported by using a recognised resource-the adverse drug reaction profile (ADRe). The profile identifies and documents patients' signs and symptoms of putative ADRs. Better monitoring allows professionals to adjust prescribing and respond to identified problems with agility. Implementation of systematic monitoring will require changes to the regulatory regime and better inter-professional cooperation. Providing carers, nurses and pharmacists with a structured system to monitor patients would democratise relevant medical knowledge and help address ageism and the socio-economic health divide.

Learning from Patient Safety Incidents in the Emergency Department: A Systematic Review.

BACKGROUND: Patient safety incidents are commonly observed in critical and high demanding care settings, including the emergency department. There is a need to understand what causes patient safety incidents in emergency departments and determine the implications for excellence in practice. OBJECTIVE: Our aim was to systematically review the international literature on patient safety incidents in emergency departments and determine what can be learned from reported incidents to inform and improve practice. DISCUSSION: Patient safety incidents in emergency departments have a number of recognized contributing factors. These can be used as groundwork for the development of effective tools to systematically identify incident risk. Participation in efforts to diminish risk and improve patient safety through appropriate incident reporting is critical for removing barriers to safe care. CONCLUSIONS: This review enhances our awareness of contributing factors to patient safety incidents within emergency departments and encourages researchers from different disciplines to investigate the causes of practice errors and formulate safety improvement strategies.

Adverse Drug Reactions in Norway: A Systematic Review.

Prescription medicines aim to relieve patients' suffering but they can be associated with adverse side effects or adverse drug reactions (ADRs). ADRs are an important cause of hospital admissions and a financial burden on healthcare systems across the globe. There is little integrative and collective knowledge on ADR reporting and monitoring in the Norwegian healthcare system. Accordingly, this systematic review aims to investigate the current trends in ADR reporting, monitoring, and handling in the Norwegian healthcare system and describe related interventions. Appropriate keywords, with regard to ADRs in both English and Norwegian languages, were used to retrieve articles published from 2010 to 2019. Six articles met the inclusion criteria. The findings offer a comprehensive picture of ADR reporting and monitoring in the Norwegian healthcare system. Psychotropic medicines were most commonly implicated by patients, while professionals most commonly reported ADRs associated with anticoagulants. The current ADR systems were compiled with the involvement of both patients and healthcare providers to record all types of drugs and ADRs of various severities, and aimed at improving ADR tracking. However, there is a need to improve current initiatives in terms of feedback and quality, and more studies are needed to explore how ADR profiles, and the associated vigilance, can improve the safety of medicines management in Norway.

Adverse Drug Reactions, Power, Harm Reduction, Regulation and the ADRe Profiles.

The power and influence of healthcare systems comes largely from the ability to prescribe efficacious medicine. However, medicine can sometimes cause harm rather than bring benefits. Systematically checking patients for the adverse effects of medicines, as listed in manufacturers' literature, would protect patients from iatrogenic harm, but this is rarely undertaken. We argue for the benefits of this approach using the example of the prescription of antipsychotics to older adults. Prescribing antipsychotics to control challenging behaviours associated with dementia is a controversial matter, and regulatory intervention is under discussion. Improved regulatory systems could protect against iatrogenic harm, such as over-sedation, falls, tremor, or drug-induced Parkinsonism. However, measuring the impact and outcomes of regulatory interventions has proved difficult, not least because there are rarely systematic records of all adverse effects of medicines. We indicate how regulatory initiatives to reduce antipsychotic prescribing can be supported by systematic monitoring and documentation of patients' signs and symptoms of putative adverse drug reactions. Monitoring documentation then provides the rationale and support for professionals' responses to identified problems. Longitudinal monitoring records would improve understanding of the impact and outcomes of adverse drug reactions (ADRs) on health and wellbeing, and the many costs of ADRs.

Transition from clinician to academic: an interview study of the experiences of UK and Australian Registered Nurses.

AIM: The aim of this study was to explore and compare the experiences of nurses in Australia and the UK as they moved from clinical practice into higher education institutions. BACKGROUND: When nurse education moved from hospitals into higher education institutions, the roles and career pathways of nurse educators changed. DESIGN: The design method used in this study was qualitative interview study. METHODS: Semi-structured interviews were undertaken with 14 nurse educators, seven in Australia and seven in the UK, in 2011-2012. Thematic analysis of the transcripts was undertaken and triangulated with automated content and thematic analysis by Leximancer© software. FINDINGS: Nurse academics in Australia and the UK voiced similar enthusiasms and concerns. These coalesced around four emergent themes: adapting to change, external pressures, teaching and progress up the academic ladder. The Leximancer© analysis for both sites ranked 'research' as the primary theme, linked with 'time', 'University' and 'nursing' on both sites. Respondents were aware of the importance of research to career progression in universities, but most prioritized their teaching and clinical commitments for the sake of their organizations. Most respondents were supported in their doctoral studies, but the absence of postdoctoral research teams, mentors and role models was striking. CONCLUSION: Additional support is needed to ensure that nurse academics are able to pursue research beyond doctoral level.

Nursing as a scientific undertaking and the intersection with science in undergraduate studies: implications for nursing management.

AIM: To explore the science-nursing tension and impact for nursing students studying bioscience. BACKGROUND: Several studies have examined why nursing students struggle to be successful in bioscience subjects. Undeveloped science background and theory-practice gaps are noted as contributing factors. METHODS: A qualitative study explored the science-nursing tension with 100 Australian Registered Nurses using focus groups and a survey. RESULTS: The survey response rate was 85 from 550. Of survey respondents, 88% viewed nursing as an applied science. An emphasis on procedural skills and task busyness undermines theoretical understanding of care and can be a negative influence upon the student bioscience experience. Practicum mentors confident in scientific knowledge enhance the student experience of bioscience by providing opportunities for integration with practice. CONCLUSIONS: Competing philosophies that reinforce the science-nursing tension have an impact upon student endeavours yet the nexus created by practice can be used to activate student curiosity and scientific understanding. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to structure the student practicum to encompass scientific theory applied to practice with equal emphasis on task efficiency. This improves student attitudes to learning bioscience and potentially minimizes the impact of the science-nursing tension on student learning.