Deploying Robot-Led Activities for People with Dementia at Aged Care Facilities: A Feasibility Study.

OBJECTIVES: To explore the feasibility of deploying robot-led activities for people with dementia living in aged care facilities. DESIGN: Embedded mixed-methods design. SETTING AND PARTICIPANTS: Eleven residents (aged ≥65 years) with mild to moderate cognitive impairment were recruited from 2 aged care facilities in Brisbane, Australia. METHODS: We implemented a novel control logic, "Adam Program," for a human-like robot to provide proactive robot activities for people with dementia. Participants individually participated in a nonfacilitated robot intervention thrice a week for 5 weeks from November to December 2022. We video-recorded each intervention session and quantified participants' visual, behavioral, and verbal engagement. A semi-structured interview was conducted at the end of the 5-week intervention. The treatment fidelity strategies and finances were reported and evaluated. The Bowen Feasibility Framework guided data analysis into 6 focus areas: acceptability, demand, implementation, efficacy, integration, and practicality. RESULTS: Based on participants' perceptions, findings demonstrated adequate acceptability and demand for robot-led activities. Findings reported a high level of visual engagement (98.54%) and an increased trend of behavior engagement over 5 weeks. Participants independently communicated with Adam, with most (97.02%) verbal engagements free of human facilitation. The treatment fidelity strategies regarding the activity delivery, intervention received, and intervention skills are provided alongside the equipment expenses, revealing the feasibility of integrating robot-led activities for people with dementia in aged care facilities. CONCLUSIONS AND IMPLICATIONS: Using human-like robots to independently lead interactive activities for people with dementia at aged care facilities is feasible and acceptable. Although robot-led activities require further improvement, this study explored a practical-driven solution that provided guidelines for developing and implementing robot-led activities in aged care settings. Future studies could replicate similar robot-led activities for further investigation and evaluation. Strategies for multilevel determinants of Adam's implementation based on a context assessment are recommended for future research.

Relationships between professional identity, motivation, and innovative ability among nursing intern students: A cross-sectional study.

Objective: To explore the relationships among motivation, professional identity, and innovative ability of nursing intern students. Background: Professional identity and innovative ability are important for nursing students' core competitiveness and care quality. During the internship, nursing students integrate theoretical knowledge and practice, and have a rapid growth. Motivation is positively associated with professional identity and innovative ability. However, there are limited studies examining the professional identity, motivation, and innovative ability of nursing intern students. Design: A descriptive cross-sectional online study. Methods: Students in the nursing schools in southwest and central of China were included in this study and conducted from June to July 2022. A total of 474 nursing intern students were recruited from 16 nursing schools. Research data were collected with "Participants' Demographics Form", "the Professional Identity Questionnaire for Nursing Students", "the Revised Life Goals Questionnaire", and "the Revised Multidimensional Innovative Questionnaire". Independent-sample t-tests, one-way analysis of variance, correlation coefficients, and structural equation modeling were used in data analysis. This study adhered to the STROBE guidelines. Results: A significantly positive correlation was determined among the professional identity (67.55 ± 8.42), motivation (53.38 ± 5.54), and innovative ability (47.99 ± 5.46) of nursing students (r > 0.4, P < 0.001). Motivation had a mediating effect on professional identity and innovative ability (P = 0.003), accounting for 10.9% (0.075/0.689) of the total effect. Conclusions: There was a positive correlation among professional identity, motivation, and innovative ability. Developing motivation and professional identity can enhance nursing intern students' ability to innovate.

Factors related to nurses' beliefs regarding pain assessment in people living with dementia.

AIM: To evaluate registered nurses' beliefs and related factors regarding pain assessment in people living with dementia. DESIGN: A descriptive cross-sectional survey was conducted between July 2022 and April 2023. METHODS: An online survey comprised of demographics, knowledge scale, and beliefs scale relating to pain assessment in dementia was distributed to registered nurses (RNs) caring for people living with dementia in Australia. RESULTS: RNs (N = 131) completed the survey. Most respondents were females (87.0%) and self-identified as Caucasian (60.3%). The mean beliefs score was 72.60 (±6.39) out of a maximum possible score of 95. RNs' beliefs about pain assessment varied based on their education, dementia pain assessment knowledge, nursing experience, and ethnicity. Hierarchical multiple regression analysis revealed factors significantly related to the beliefs score (i.e. education and dementia pain assessment knowledge). CONCLUSION: The relationship between education and knowledge, and the beliefs score indicates the potential to improve RNs' knowledge and overcome their erroneous beliefs about pain assessment in dementia. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Education and training in assessing pain in people living with dementia should be tailored to overcome RNs' misconceived beliefs. These programmes should be integrated into continuous learning programmes. IMPACT: Some RNs' beliefs about pain assessment in dementia were not evidence-based, and knowledge and educational status were the strongest factors related to RNs' beliefs. RNs' erroneous beliefs about pain assessment in dementia need to be addressed to improve pain assessment and management. Researchers should explore the potential of educational interventions to overcome RNs' misconceived beliefs about pain assessment in dementia. REPORTING METHOD: This study was reported adhering to the Strengthening the Reporting of Observational Studies in Epidemiology checklist. PATIENT OR PUBLIC CONTRIBUTION: RNs caring for people living with dementia participated as survey respondents. Additionally, RNs were involved in the pre-testing of the study's survey instrument.

The association between variability of risk factors and complications in type 2 diabetes mellitus: a retrospective study.

The variability in diabetes risk factors, such as uric acid and lipids, may influence the development of complications. This study aimed to investigate the influence of such variability on the occurrence of diabetic complications. A retrospective analysis of electronic medical records was conducted with type 2 diabetic patients who received treatment at a tertiary care hospital in Chengdu, Sichuan Province, between 2013 and 2022. The risk factor variability is presented as the standard deviation (SD). The associations between the variability and complications were examined using a binary logistic regression model. The study included 369 patients with type 2 diabetes. The findings revealed that outpatient special disease management served as a protective factor against the development of complications [OR = 0.53, 95% confidence interval (CI) (0.29-0.10)], particularly for the prevention of diabetic peripheral neuropathy [OR = 0.51, 95% CI (0.30-0.86)]. Variability in total cholesterol (TC-SD) was found to be a risk factor for the development of complications [OR = 2.42, 95% CI (1.18-4.97)] and acted as a risk factor for diabetic peripheral vasculopathy [OR = 2.50, 95% CI (1.25-5.02)]. TC-SD is a risk factor for the occurrence of diabetic peripheral neuropathy and diabetic peripheral vasculopathy, whereas outpatient special disease management functions as a protective factor against complications and diabetic peripheral neuropathy. Thus, in addition to glycaemic control, the regulation of lipid levels should be emphasized, particularly among patients without outpatient special disease management, to delay the onset of complications.

Corrigendum: Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

[This corrects the article DOI: 10.3389/fnins.2023.1161279.].

Effects of light therapy on sleep and circadian rhythm in older type 2 diabetics living in long-term care facilities: a randomized controlled trial.

Background: Light influences the secretion of melatonin in the body and regulates circadian rhythms, which play an important role in sleep and mood. The light level of rooms in long-term care facilities is usually far below the threshold required to regulate the body's circadian rhythm, and insufficient light can easily lead to sleep and mood disturbances among older residents in nursing homes. Therefore, the objective of this study was to investigate the effects of light therapy on sleep and circadian rhythm in older adults with type 2 diabetes residing in long-term care facilities. Methods: This study was a prospective, single-blind, randomized controlled trial. Participants were randomly assigned to either the light therapy (LT) group or the control group and received the intervention for four weeks. Primary outcomes included the Pittsburgh Sleep Quality Index (PSQI) and objective sleep parameters recorded by a sleep monitoring bracelet, Morningness-Eveningness Questionnaire (MEQ). The secondary outcome included glycated serum protein (GSP). Data was collected at three time points: at baseline (T0), immediate post-treatment (T1), and 4-week follow-up (T2). A linear mixed model analysis was used to analyzed the data. Results: We enrolled 45 long-term care residents. Compared with the control group, significant reductions in PSQI scores were observed at T1 and T2. At T2, the sleep score of objective sleep parameters was significantly higher in the LT group compared to the control group. Additionally, compared to the baseline T0, MEQ scores were significantly lower in the LT group at T1 and T2, with no significant difference in the control group. There was no significant difference between groups in glycated serum protein values at T1 and T2. However, compared to T0, glycated serum protein values decreased in the LT group while increased in the control group at T2. Conclusion: Light therapy had a positive effect on subjective sleep quality and circadian rhythm time type in long-term care residents with type 2 diabetes, and had a possible delayed effect on objective sleep. However, no discernible alterations in blood glucose levels were detected in this study.

Associations between facial expressions and observational pain in residents with dementia and chronic pain.

AIM: To identify specific facial expressions associated with pain behaviors using the PainChek application in residents with dementia. DESIGN: This is a secondary analysis from a study exploring the feasibility of PainChek to evaluate the effectiveness of a social robot (PARO) intervention on pain for residents with dementia from June to November 2021. METHODS: Participants experienced PARO individually five days per week for 15 min (once or twice) per day for three consecutive weeks. The PainChek app assessed each resident's pain levels before and after each session. The association between nine facial expressions and the adjusted PainChek scores was analyzed using a linear mixed model. RESULTS: A total of 1820 assessments were completed with 46 residents. Six facial expressions were significantly associated with a higher adjusted PainChek score. Horizontal mouth stretch showed the strongest association with the score, followed by brow lowering parting lips, wrinkling of the nose, raising of the upper lip and closing eyes. However, the presence of cheek raising, tightening of eyelids and pulling at the corner lip were not significantly associated with the score. Limitations of using the PainChek app were identified. CONCLUSION: Six specific facial expressions were associated with observational pain scores in residents with dementia. Results indicate that automated real-time facial analysis is a promising approach to assessing pain in people with dementia. However, it requires further validation by human observers before it can be used for decision-making in clinical practice. IMPACT: Pain is common in people with dementia, while assessing pain is challenging in this group. This study generated new evidence of facial expressions of pain in residents with dementia. Results will inform the development of valid artificial intelligence-based algorithms that will support healthcare professionals in identifying pain in people with dementia in clinical situations. REPORTING METHOD: The study adheres to the CONSORT reporting guidelines. PATIENT OR PUBLIC CONTRIBUTION: One resident with dementia and two family members of people with dementia were consulted and involved in the study design, where they provided advice on the protocol, information sheets and consent forms, and offered valuable insights to ensure research quality and relevance. TRIAL REGISTRATION: Australian and New Zealand Clinical Trials Registry number (ACTRN12621000837820).

Clinical characteristics of peripherally inserted central catheter-related complications in cancer patients undergoing chemotherapy: a prospective and observational study.

PURPOSE: The incidence of peripherally inserted central catheter (PICC)-related complications is higher in cancer patients than in noncancer patients. However, the pattern of specific complication occurrence over time remains unclear. The purpose of this study was to investigate the clinical characteristics of PICC-related complications in cancer patients undergoing chemotherapy. METHODS: This prospective, observational study was conducted at a university-affiliated hospital in Western China. Cancer patients undergoing PICC insertion for anticancer treatment were recruited and followed up until the first week after catheter removal. Any complications, including occurrence time and outcomes, were recorded. The trajectory of specific PICC-related complications over time were identify based on the Kaplan‒Meier curve analysis. RESULTS: Of the 233 patients analyzed, nearly half (n = 112/233, 48.1%) developed 150 PICC-related complication events. The most common were symptomatic catheter-related thrombosis (CRT) (n = 37/233, 15.9%), medical adhesive-related skin injury (MARSI) (n = 27/233, 11.6%), and catheter dislodgement (n = 17/233, 7.3%), accounting for 54.0% (n = 81/150, 54.0%) of total complications events. According to Kaplan‒Meier curve analysis, symptomatic CRT, pain, phlebitis, and insertion site bleeding were classified as the "early onset" group mainly occurring within the first month post-insertion. Catheter fracture and catheter-related bloodstream infection were classified as the "late onset" group occurring after the second month post-insertion. MARSI, catheter dislodgement, occlusion, and insertion site infection were classified as the "persistent onset" group persistently occurring during the whole catheter-dwelling period. Among the 112 patients with PICC-related complications, 50 (44.6%) patients had their catheters removed due to complications, and 62 (55.4%) patients successfully retained their catheters until treatment completion through conventional interventions. The major reasons for unplanned catheter removal were catheter dislodgement (n = 12/233, 5.2%), symptomatic CRT (n = 10/233, 4.3%), and MARSI (n = 7/233, 3.0%), accounting for 58.0% (n = 29/50, 58.0%) of the total unplanned catheter removal cases. Catheter dwelling times between patients with complications under successful interventions (130.5 ± 32.1 days) and patients with no complications (138.2 ± 46.4 days) were not significantly different (t = 1.306, p = 0.194; log-rank test = 2.610, p = 0.106). CONCLUSIONS: PICC-related complications were pretty common in cancer patients undergoing chemotherapy. The time distribution of PICC-related complications varied, and medical staff should develop time-specific protocols for prevention. Because more than half of the patients with PICC-related complications could be managed with conventional interventions, PICCs remain a priority for cancer patients undergoing short-term chemotherapy. The study was registered in 02/08/2019 at Chinese Clinical Trial Registry (registration number: ChiCTR1900024890).

Technology in aged care: a qualitative survey of academic, research, and technology industry professionals.

AIMS AND OBJECTIVES: The study's aim was two-fold: (1) to explore the experiences and perceptions of industry, academic, and research professionals concerning technologies used within aged care; and (2) to identify needs-led priorities for the future development and application of technologies within aged care. BACKGROUND: Global population ageing requires a recalibration of aged care policies, systems, and services to promote and support healthy ageing. It is expected that technology will play an important role in this regard. This study qualitatively assessed the landscape of technology use in aged care from the perspective of industry, academic, and research professionals. DESIGN: A purposefully designed cross-sectional survey collecting experiences, perspectives, and barriers about technology through open responses. METHODS: Using convenience sampling, thirty-five participants completed an online survey between April and October 2020. A descriptive qualitative content analysis approach was used to analyse the written responses. Reporting of findings followed the EQUATOR's Standards for Reporting Qualitative Research checklist. RESULTS: Four themes were identified that characterised the use of technologies within aged care: (1) User Perceptions and Attitudes: wariness and reluctance to technology; (2) Systemic Issues within Aged Care: Under-resourced with opportunities for innovation; (3) Technology-Related Barriers: Equity, costs, privacy, integration, and interoperability and (4) Research Priorities: Co-design and integration of technology. CONCLUSIONS: The existing technology does not meet the needs of older people, aged care personnel and the system in general, which prevents its successful implementation and uptake.

The clinical topography of peripherally inserted central catheter-related thrombosis in cancer patients: A prospective and longitudinal observational study based on ultrasound scans every two days.

AIMS: To delineate the clinical topography of peripherally inserted central catheter (PICC)-related thrombosis in cancer patients. BACKGROUND: Most of the clinical features of PICC-related thrombosis are based on a single follow-up, which is insufficient to reflect the full topography of a thrombosis. DESIGN: This is an observational study conducted at West China Hospital, according to the STROBE guidelines. METHODS: Cancer patients scheduled for PICC placement were potentially eligible; patients with contraindications to PICC placement or existing diseases affecting blood flow were excluded; and those who later withdrew or did not reply to our contact request during the follow-up period were eliminated from this study. Ultrasound was used to detect thrombosis from the insertion site, proximal insertion site, axillary vein to the subclavian vein once every two days for two weeks post insertion. The thrombosis and its involved venous segments, onset time and symptoms and signs were recorded. RESULTS: Among the 173 included patients, 126 (72.8 %) were identified as having thrombosis. Specifically, 113 and 126 patients were identified as having thrombosis within the first three days and the first week post insertion, respectively. In the 126 patients, thrombosis occurred at the insertion site (72.8 %) concurrently with thrombosis at the proximal insertion site (n = 120, 69.4 %), thrombosis in the axillary vein (n = 94, 54.3 %), and/or thrombosis in the subclavian vein (n = 41, 23.7 %). The log-rank test demonstrated that thrombosis in these four venous segments decreased significantly from the distal to the proximal central vein (log-rank test = 117.128, P < .001). Of 31 patients (17.9 %) who presented symptomatic thrombosis, only five patients experienced obvious swelling in the upper arm, and the other 26 patients exhibited atypical symptoms, such as soreness, tightness, numbness, tingling, or other discomforts in the palm, arm, armpit, and/or shoulder. In some thrombotic cases, ultrasonic assessment of PICC-related thrombosis did not parallel clinical symptoms and signs. CONCLUSION: PICC-related thrombosis is common and can occur very early post insertion in cancer patients, and most thromboses present atypical symptoms. More than half of the cases with thrombosis evaluated involve multiple venous segments, and the farther the venous segments are from the central vein, the higher the incidence of thrombosis tend to be and the earlier the onset time are. RELEVANCE TO CLINICAL PRACTICE: The results highlight the importance that medical staff pay particular attention to patients with catheters in the first week post insertion and be alert to thrombosis presenting atypical symptoms while keeping in mind that clinical symptoms and signs are not reliable for diagnosing thrombosis. CLINICAL REGESTRATION: Clinical Trials ChiCTR1900024890.

Status and associated factors of gerontological nurse specialists' core competency: a national cross-sectional study.

BACKGROUND: Nurses' core competency directly affects patients' safety and health outcomes. Gerontological nurse specialists play an essential role in improving older adults' health status. However, little is known about their core competency level and the factors influencing core competency. Therefore, this study aimed to investigate the status of core competency and factors influencing the core competency of gerontological nurse specialists in China. METHODS: A multicenter cross-sectional study was conducted on gerontological nurse specialists certified by province-level or above organizations across China between March 2019 and January 2020. The Revised Core Competency Evaluation Instrument for Gerontological Nurse Specialists was used to measure participants' core competency. The median, frequencies, and percentages were used to describe participants' characteristics and level of core competency. Multivariate stepwise regression analysis was applied to analyze the factors influencing core competency. RESULTS: The median score of gerontological nurse specialists' core competency was 3.84, and professional development skills and research and analysis decision-making skills had the lowest scores among the dimensions. The multivariate stepwise regression analysis showed that individual-level factors (i.e., working experience length of geriatric nursing and attitudes toward caring for older adults), employer-level factors (i.e., departments, job responsibilities, the degree of satisfaction toward the attention and support and the promotion rules provided by the hospital or department), and training-associated factors (i.e., economic zone where training organizations are located and the degree to which the training content met clinical needs) are independently associated with gerontological nurse specialists' core competency level (P < 0.05). CONCLUSIONS: This study showed that gerontological nurse specialists' core competency needs further improvements, especially regarding professional development skills and research and analysis decision-making skills. Additionally, individual-, training-, and employer-level factors could influence their core competency level, indicating that interventions targeting these factors could be applied to improve the core competency of gerontological nurse specialists.

Moderate-to-high risk of obstructive sleep apnea with excessive daytime sleepiness is associated with postoperative neurocognitive disorders: a prospective one-year follow-up cohort study.

Background: Few studies found that obstructive sleep apnea (OSA) may be related to postoperative neurocognitive disorders (PND) including postoperative delirium (POD) and cognitive decline (POCD) in the early postoperative period. However, the results are controversial and need further verification, and no research has explored the effect of OSA on the incidence of PND during the 1-year follow-up periods. Furthermore, OSA patients with excessive daytime sleepiness (EDS) as a severe phenotype have more significant neurocognitive impairments, but the relationship between OSA with EDS and PND within 1 year after surgery has not been studied. Objectives: To explore the effect of moderate-to-high risk of OSA and the moderate-to-high risk of OSA with EDS on PND within 1 year after surgery. Methods: In this prospective cohort study, including 227 older patients, moderate-to-high risk of OSA (using STOP-BANG), subjective EDS (using Epworth Sleepiness Scale), and objective EDS (using Actigraphy) were selected as exposures. Key outcomes included POD during hospitalization (using Confusion Assessment Method-Severity), POCD at discharge, 1-month and 1-year after surgery (using Mini-Mental State Examination and Telephone Interview for Cognitive Status-40). We applied multiple logistic regression models to estimate the effect of moderate-to-high risk of OSA and moderate-to-high risk of OSA with EDS on PND. Results: In the multivariate analysis, moderate-to-high risk of OSA was not associated with POD during hospitalization and POCD at discharge, 1-month, and 1-year after surgery (p > 0.05). However, the moderate-to-high risk of OSA with subjective EDS was related to POCD at discharge compared to the moderate-to-high risk of OSA or normal group (no moderate-to-high risk of OSA and no EDS) (p < 0.05). In addition, moderate-to-high risk of OSA with objective EDS was associated with POCD at discharge, 1-month, and 1-year postoperatively compared to the moderate-to-high risk of OSA or normal group (p < 0.05). Conclusion: Moderate-to-high risk of OSA with EDS, not moderate-to-high risk of OSA alone, was a clinically helpful predictor for POCD within 1-year after surgery and should be routinely assessed before surgery.

Corrigendum: Molecular characteristics of choledochal cysts in children: transcriptome sequencing.

[This corrects the article DOI: 10.3389/fgene.2021.709340.].

Non-pharmacological interventions for older adults with postprandial hypotension: A scoping review.

BACKGROUND: Older adults frequently suffer from postprandial hypotension, associated with an increased risk of falls, syncope, acute cardiovascular and cerebrovascular diseases, and even death. Researchers use non-pharmacological interventions, but related literature is dispersed and lacks a latest summary. OBJECTIVE: The aim of this study was to map and examine non-pharmacological interventions currently employed to assist older adults with postprandial hypotension and lay a solid foundation for future studies. METHODS: This study adhered to the JBI methodology for scoping reviews and preferred reporting items for systematic reviews and meta-analyses extension for scoping reviews. PubMed, Web of Science, Embase, Cochrane Library, CINAHL, SCOPUS, Chinese Biomedical Journal, China National Knowledge Infrastructure, VIP and WAN FANG Data were retrieved from their inception to 1 August 2022. RESULTS: Two randomized controlled trials and seven quasi-experimental studies were included. Small meals, exercise interventions, fibre with meals, green tea and water therapy have been reported to prevent postprandial hypotension effectively; however, position changes have been reported to have no impact on postprandial blood pressure decrease. Additionally, the blood pressure determination methods and test meals may affect observed trial effects. CONCLUSION: Large samples and long-term follow-up studies are needed to prove the efficacy and safety of existing non-pharmacological interventions. Future studies should develop a BP determination method based on the postprandial BP decline trajectory induced by a given test meal to improve the reliability of study results. RELEVANCE TO CLINICAL PRACTICE: This review broadly summarizes existing studies on developing and validating non-pharmacological interventions for older adults with postprandial hypotension. It also analyses special factors that may influence the trial effects. This may provide a useful reference for future research.

Implementing PainChek and PARO to Support Pain Assessment and Management in Residents with Dementia: A Qualitative Study.

BACKGROUND: Pain is a common problem but often undiagnosed and untreated in people with dementia. AIMS: This study explored the experiences of residents with dementia, family, andformal carers with (1) pain assessment and management for residents with dementia; (2) the use of the PainChek app for pain assessment, and (3) the use of a social robot PARO for pain management in residents with dementia. DESIGN: A qualitative study. SETTINGS/PARTICIPANTS: Interviews were conducted with 13 residents withdementia, three family members, and 18 formal carers from a residential aged carefacility. METHOD: Residents with dementia interacted with PARO for 15 mins, five days perweek for three weeks. The PainChek app assessed pain levels before and after eachsession. After three-week intervention, individual interviews were conducted withresidents, family, and formal carers who experienced or observed the use of PainChekapp and PARO for residents. Interviews were audio-recorded, transcribed, andanalyzed using thematic analysis. RESULTS: Four themes were identified regarding pain in residents with dementia: (1) the impact, challenges and strategies of pain assessment and management; (2) benefits and barriers of using PainChek app to assess pain; (3) benefits of interacting with PARO to manage pain and behavioral symptoms; and (4) implementing PainChek app and PARO to support pain assessment and management in dementia care. CONCLUSIONS: Technology, such as PainChek and PARO, is promising to improve painassessment and reduce pain for people with dementia. Barriers to using technologyinclude limited staff training and the implementation of person-centered care.

Cultural Influence on Nurses' Pain Observations Related to Dementia: An Integrative Review.

BACKGROUND: Nurses play a pivotal role in pain observation in people living with dementia. However, currently, there is little understanding of the influence culture may have on the way nurses observe pain experienced by people living with dementia. AIM: This review explores the influence of culture on nurses... pain observations experienced by people living with dementia. SETTINGS: Studies were included regardless of the setting (e.g., acute medical care, long-term care, community). DESIGN: An integrative review. PARTICIPANTS/SUBJECTS: PubMed, Medline, Psychological Information Database, Cochrane Library, Scopus, Web of Science, Cumulative Index of Nursing and Allied Health Literature, and ProQuest were included in the search. METHODS: Electronic databases were searched using synonyms for "dementia," "nurse," "culture," and "pain observation." The review included ten primary research papers following the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. RESULTS: Nurses reported that pain observation in people living with dementia is challenging. Four themes were identified by data synthesis: (1) using behaviors for pain observation; (2) information from carers for pain observation; (3) pain assessment tools for pain observation; and (4) role of knowledge, experience, and intuition in pain observation. CONCLUSIONS: There is a limited understanding of the role of culture on nurses' pain observations. However, nurses take a multifaceted approach to observing pain using behaviors, information from carers, pain assessment tools, and their knowledge, experience, and intuition.

Light Therapy to Improve Sleep Quality in Older Adults Living in Residential Long-Term Care: A Systematic Review.

OBJECTIVES: Because light can regulate sleep rhythms, numerous studies have investigated whether light therapy can improve sleep disorders in older people, but its efficacy remains controversial. Therefore, this systematic review aimed to examine and summarize current evidence about the efficacy of light therapy to improve sleep for older people in residential long-term care. DESIGN: Systematic review. SETTING AND PARTICIPANTS: Older people living in long-term care settings. METHODS: Systematic searches were conducted in the databases PubMed, Web of Science, Cochrane, EMBASE, CINAHL, China National Knowledge Infrastructure, China Science and Technology Journal Database, WanFang, Chinese Biomedical Literature Database, and in reference lists within relevant articles. Studies were eligible for inclusion if they evaluated light therapy for older people with sleep disorders in long-term care settings. RESULTS: This systematic review includes 21 articles, summarizing light therapy with different durations and intensities. The light intervention was typically administered between 7:00 and 12:00 am for 30-120 minutes. The interventions lasted from 1 week to several months, and the intensity of the light intervention usually ranged from 2500 to 10,000 lux. Short-term exposure (30-60 minutes) with high light levels (≥10,000 lux), relatively long-term exposure (1-2 hours) with moderate light levels (2500-10,000 lux), or long-term exposure (1-4 hours or full day) with low light levels (≤2500 lux) were associated with improved sleep indicators for older people in long-term care settings. CONCLUSIONS AND IMPLICATIONS: The efficacy of light therapy in long-term care settings may be affected by the duration of exposure, time and length of intervention, intensity of light, and equipment used to administer the therapy. Further research must be conducted to optimize light therapy parameters. Large, high-quality randomized controlled trials are needed to deepen our understanding of the effects of light therapy on sleep in older people living in long-term care settings.

Family Involvement in Pain Management for People Living With Dementia: An Integrative Review.

This review aimed to synthesize current evidence on family involvement in pain management for people living with dementia from the perceptions of family carers and health care professionals. An integrative review was conducted using CINAHL, Embase, PubMed, PsycINFO and Cochrane Library electronic databases. The Mixed Methods Appraisal Tool was used to appraise the articles, followed by thematic analysis. Twelve studies were included and four themes were identified: (1) The roles and responsibilities of family carers; (2) Enablers and barriers for pain identification; (3) Strategies and concerns for pain management; and (4) Lack of staff education and communication with health care providers. Family carers play an important role in pain assessment and management for people living with dementia, but they cannot be actively involved in this process due to a lack of communication with health care providers. An integrated approach that includes education and communication with family carers and health care providers is needed.

Meso-Rex bypass shunt vs. transposition shunt for cavernous transformation of portal vein in children.

Background: Cavernous transformation of the portal vein (CTPV) causes portal hypertension in children. Among Meso-Rex treatments, it is unclear whether the Meso-Rex bypass shunt (MRB) or the Meso-Rex transposition shunt (MRT) offers lower postoperative morbidity. Our objective was to evaluate postoperative outcomes, comparing MRB and MRT for children with CTPV. Methods: A retrospective study was conducted on children undergoing Meso-Rex for CTPV from January 2010 to December 2020. The primary outcome was shunt complications, including shunt stenosis and thrombus. The secondary outcome was re-operation. Results: Of the 43 patients included, 21 underwent MRT and 22 underwent MRB. MRT was associated with a higher rate of shunt complications when compared to MRB (23.8 vs. 9.1%, p = 0.191). The patients exhibited a higher rate of re-operation under the MRT than under the MRB (19 vs. 4.5%, p = 0.138). The operative time in the MRT group was significantly shorter than in the MRB group. Compared to MRT, the reduction in the length and thickness of the spleen was significantly greater in the MRB group. The increases in platelets were significantly higher in the MRB group than in the MRT group. The postoperative shunt velocity of MRB was notably faster than MRT. There was no significant difference in postoperative portal pressure between the two groups (p > 0.05). Conclusion: Both MRB and MRT result in acceptable postoperative outcomes, but MRT is associated with higher post-shunt complications, which often increase the re-operation rate. This study suggests that MRB may offer advantages for children with CTPV.