Insights from ARCOS-V's Transition to Remote Data Collection during the COVID-19 Pandemic: A Descriptive Study.

INTRODUCTION: The ARCOS-V study, an epidemiological study on stroke and transient ischaemic attack (TIA), faced the challenge of continuing data collection amidst the COVID-19 pandemic. This study aimed to describe the methodological changes and challenges encountered during the transition from paper-based methods to digital data collection for the ARCOS-V study and to provide insights into the potential of using digital tools to transform epidemiological research. METHODS: The study adapted to remote data collection using REDCap and Zoom, involving daily health record reviews, direct data entry by trained researchers, and remote follow-up assessments. The process was secured with encryption and role-based access controls. The transition period was analysed to evaluate the effectiveness and challenges of the new approach. RESULTS: The digital transition allowed for uninterrupted monitoring of stroke and TIA cases during lockdowns. Using REDCap and Zoom improved data reach, accuracy, and security. However, it also revealed issues such as the potential for systematic data entry errors and the need for robust security measures to protect sensitive health information. CONCLUSION: The ARCOS-V study's digital transformation exemplifies the resilience of epidemiological research in the face of a global crisis. The successful adaptation to digital data collection methods highlights the potential benefits of such tools, particularly as we enter a new age of artificial intelligence (AI).

The Effect of Temporal Persistence of Loneliness on Dementia: A Longitudinal Analysis From the Hunter Community Study.

OBJECTIVES: Loneliness is common and becoming a public health concern. Although there is the clear evidence of the variable effect of temporal differences in loneliness (transient/situational and persistent/chronic) on health, their effect on dementia risk is unclear. This study aims to assess the effect of transient/situational and persistent/chronic loneliness on dementia risk. METHOD: Participants aged 55 years and older from the Hunter Community Study were recruited. Loneliness was measured using a single item measure. Dementia was defined as per International Classification of Disease-10 (ICD 10) codes. The Fine-Gray subdistribution hazard model was performed to calculate dementia risk. RESULTS: Of 1968 total participants with mean age of 66 years, (3%) 57 developed dementia and (7%) 135 died over the mean follow up of 10 years. Both persistent/chronic and transient/situational loneliness significantly increased the risk of all cause dementia in adjusted models (HR 2.74, 95% CI 1.11-6.88, p 0.03 and HR 2.35, 95% CI 1.21-4.55, p 0.01 respectively) with mean time to event of 9.7 years. Feeling lonely below the age of 70 years elevated the risk of dementia in later life (HR 4.01, 95% CI 1.40-11.50, p 0.01). CONCLUSIONS: Loneliness (both persistent/chronic and transient/situational) was associated with increased risk of all cause dementia, especially if loneliness was experienced before the age of 70 years. These results suggest that promoting coping strategies for loneliness especially in persons 70 years and younger may play a role in preventing dementia.

Reimagining faculty development: A paradigm shift from content to transformative learning processes.

BACKGROUND: Faculty development programs in health professional education traditionally emphasise theories, principles, and effective teaching practices. However, the efficacy of these strategies in instigating meaningful changes in instructional practices has come under scrutiny. METHODS: This qualitative research aims to enhance our understanding and support of educators' ongoing learning and growth. Employing a transformative learning lens, the study explored the experiences, professional development practices, and responsibilities of clinical educators who participated in a faculty development course. Utilising Mezirow's transformative learning theory as a framework, this research investigated the transformative journey of educators, analysing reflective pieces from 144 participants. RESULTS: The study findings revealed shifts in pedagogical approaches, ranging from the recognition of a haphazard teaching style to the intentional integration of evidence-based methods and pedagogical philosophies. The thematic analysis identified key stages in the transformative process, illuminating educators' commitment to structured teaching, self-directed learning, and continuous improvement. CONCLUSION: This research has contributed valuable insights into how faculty development programs can stimulate reflective practices and transformative learning in health professional education. The article argues for the centrality of transformative learning processes in faculty development, presenting an intriguing perspective on sustainable and impactful professional growth. Trends across learning experiences are presented, accompanied by practical recommendations. The implications of the research for clinical educators, administrators, and developers of formal faculty professional development programs are also discussed.

Prevalence and type of unmet needs experienced by carers of people living with dementia.

OBJECTIVES: Carers of people with dementia experience significant physical, emotional, and social burdens. Needs assessment can provide important information to assist services in providing support to carers to reduce these burdens. However, few studies have examined the prevalence of unmet needs experienced by carers of people with dementia using a quantitative instrument. This study aimed to examine the prevalence and type of unmet needs experienced by carers of people with dementia in Australia. METHODS: This was a cross-sectional survey of carers providing support to community-dwelling individuals living with dementia. Carers were recruited through geriatric clinics, aged care providers, support services and community organisations. Consenting carers completed a survey including an 80-item study-specific unmet needs instrument for carers (UNI-C) and sociodemographic characteristics. Descriptive statistics were used to identify the most prevalent unmet needs reported by carers. RESULTS: A total of 169 carers (response rate 47%) completed the survey. Most (87%) carers reported at least one unmet need. Carers reported a median of 16.0 (IQR = 24.0; max = 58) out of a possible 80 unmet needs. The most frequently endorsed unmet needs spanned a range of areas including emotional wellbeing, accessing health and aged care services, managing apathy, and finding information. CONCLUSION: This study highlighted that a large proportion of carers experience unmet needs associated with caring for someone with dementia. Developing and rigorously testing interventions to meet carers' commonly reported unmet needs are warranted.Supplemental data for this article is available online at https://doi.org/10.1080/13607863.2022.2053833 .

Optimising diagnosis and post-diagnostic support for people living with dementia: geriatricians' views.

BACKGROUND: Providing a timely and accurate diagnosis of dementia and delivering appropriate support following a diagnosis are essential to allow individuals and their families to plan for the future. Recent studies suggest that provision of diagnosis and post-diagnosis support is suboptimal. This study explored geriatricians' views about strategies to improve quality of care across these domains. METHODS: An anonymous online survey of geriatricians and advanced trainees in one Australian state was conducted. An Expert Advisory Group of geriatricians, behavioural scientists and consumers proposed strategies to improve quality of care in relation to diagnosis and post-diagnosis support for people with dementia, which formed the survey items. Potential strategies were guided by, but not limited to, dementia and chronic care guidelines. Participants were asked the extent to which they agreed that implementing each of the proposed strategies would improve the quality of dementia care. RESULTS: Of 59 participants (response rate 42%), all agreed that improving accessibility of geriatricians would improve the accuracy and timeliness of diagnosis. Over 90% were supportive of strategies to improve capacity of general practitioners to accurately diagnose dementia. Between 97-100% agreed that information provided following diagnosis should encompass symptom progression, treatments, psychological supports, and advance care planning. Just over two-thirds thought that life expectancy should be discussed at this time. There were high levels of support for strategies already included in existing dementia care guidelines, however geriatricians also agreed with a range of possible strategies not currently included in guidelines. CONCLUSIONS: Geriatricians perceive that timeliness and accuracy of dementia diagnosis may be improved by increasing access to geriatricians and training general practitioners in diagnosing dementia. They also believe it is appropriate to provide information at the time of diagnosis across a comprehensive range of areas, including potentially sensitive topics such as advance care planning. Future studies should explore the views of other groups of health care providers and consumers about these approaches. The strategies proposed should be considered for inclusion in future dementia care guidelines.

Contextualising tobacco use in the social, economic and political transformation of Punjab.

This review article provides a historical context of tobacco use in Punjab, determined by the sociopolitical transitioning of this pre-colonial province to an autonomous Indian State. Although these events were marked by a complex historical process, the state's retention of its culture offers an interesting aspect of this development. For instance, these events have been marked from the conception of Sikhism to the changing borders of the territory of Punjab while positioning the use of tobacco within these boundaries. This social, economic and developmental history of Punjab has therefore been a subject of interest to the academic scholars and makers of tobacco-related policies.

Utility estimations of health states of older Australian women with atrial fibrillation using SF-6D.

PURPOSE: To estimate SF-6D utility scores for older women with atrial fibrillation (AF); calculate and compare mean utility scores for women with AF with various demographic, health behaviours, and clinical characteristics; and develop a multivariable regression model to determine factors associated with SF-6D utility scores. METHODS: This study evaluated N = 1432 women diagnosed with AF from 2000 to 2015 of the old cohort (born 1921-26) of the Australian Longitudinal Study on Women's Health (ALSWH) who remained alive for at least 12 months post first recorded AF diagnosis. Self-reported data on demographics, health behaviours, health conditions, and SF-36 were obtained from the ALSWH surveys, corresponding to within three years of the date of the first record of AF diagnosis. Linked Pharmaceutical Benefits Scheme (PBS) data determined the use of oral anticoagulants and comorbid conditions, included in CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75 years, Diabetes, Stroke or TIA, Vascular disease and Age 65-74 years) score calculation, were assessed using state-based hospital admissions data. Utility scores were calculated for every woman from their SF-36 responses using the SF-6D algorithm with Australian population norms. Mean utility scores were then calculated for women with various demographic, health behaviours, and clinical characteristics. Ordinary Least Square (OLS) regression modelling was performed to determine factors associated with these utility scores. Two different scenarios were used for the analysis: (1) complete-case, for women with complete data on all the SF-36 items required to estimate SF-6D (N = 584 women), and (2) Multiple Imputation (MI) for missing data, applied to missing values on SF-36 items (N = 1432 women). MI scenario was included to gauge the potential bias when using complete data only. RESULTS: The mean health utility was estimated to be 0.638 ± 0.119 for the complete dataset and 0.642 ± 0.120 for the dataset where missing values were handled using MI. Using the MI technique, living in regional and remote areas ([Formula: see text]) and the use of oral anticoagulants ([Formula: see text] were positively associated with health utility compared to living in major cities and no use of anticoagulants, respectively. Difficulty to manage on available income [Formula: see text], no/low physical activity [Formula: see text], disability [Formula: see text], history of stroke ([Formula: see text] and history of arthritis [Formula: see text] were negatively associated with health utility. CONCLUSION: This study presents health utility estimates for older women with AF. These estimates can be used in future clinical and economic research. The study also highlights better health utilities for women living in regional and remote areas, which requires further exploration.

Are older and seriously ill inpatients planning ahead for future medical care?

BACKGROUND: Despite the perceived ethical, personal and health service benefits of advance care planning (ACP), the extent to which older and seriously ill Australian inpatients have considered future health decisions remains uncertain. This study aimed to determine in a sample of older and seriously ill inpatients, the proportion who had: 1) engaged in four advance care planning (ACP) activities; 2) not engaged in ACP activities but wanted to; and 3) reasons why they had not engaged. METHODS: Cross-sectional face-to-face standardised interview survey with inpatients in a tertiary referral centre who were either: aged 80+ years; aged 55+ years with progressive chronic disease(s); or judged by treating clinicians as having a life expectancy of less than 12 months. Patients indicated whether they had engaged in four ACP activities: (1) appointed medical substitute-decision-maker(s), (2) recorded end-of-life wishes in an advance directive or care plan; and talked about their end-of-life wishes with their: (3) support persons and/or (4) doctors. Patients who had not engaged in activities were asked whether they wished this to occur and reasons why. RESULTS: One hundred eighty-six inpatients consented to the study (80% of approached). Of these, 9% (n = 16) had engaged in four ACP activities; 27% (n = 50) had not engaged in any. Half (n = 94, 52%) had appointed a medical substitute-decision-maker, 27% (n = 50) had recorded wishes in an advance directive or care plan, 51% (n = 90) had talked about their end-of-life wishes with support persons and 27% (n = 48) had talked with their doctor. Patients who wanted to, but had not, engaged in the four ACP activities were unaware they could record wishes or appoint decision-makers, or indicated providers had not initiated conversations. CONCLUSION: Relatively few inpatients had engaged in all four ACP activities. More inpatients had discussed end of life issues with family and appointed substitute decision makers, than completed written documents or talked with doctors. Community education and a more active role for community and hospital-based providers in supporting patients and families to collaboratively resolve end-of-life decisions may increase the probability wishes are known and followed.

Composite reliability of workplace-based assessment of international medical graduates.

OBJECTIVE: The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. The performance rather than the competency of practising doctors should, however, be assessed, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing IMGs. DESIGN AND SETTING: Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each was assessed in the workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 mini-clinical examination exercises (mini-CEX), and 1020 multi-source feedback (MSF) assessments. PARTICIPANTS: 103 male and 39 female candidates from 28 countries (Africa, Asia, Europe, South America, South Pacific) in urban and rural hospitals of the Hunter New England Health region. MAIN OUTCOME MEASURES: The composite reliability across the three WBA tools, expressed as the standard error of measurement (SEM). RESULTS: In our WBA program, a combination of five CBD and 12 mini-CEX assessments achieved an SEM of 0.33, greater than the threshold 0.26 of a scale point. Adding six MSF results to the assessment package reduced the SEM to 0.24, which is adequately precise. CONCLUSIONS: Combining data from different WBA assessment instruments achieves acceptable reliability for assessing IMGs, provided that the panel of WBA assessment types are carefully selected and the assessors are calibrated.

Improving hospital-based end of life care processes and outcomes: a systematic review of research output, quality and effectiveness.

BACKGROUND: As in other areas of health delivery, there is a need to ensure that end-of-life care is guided by patient centred research. A systematic review was undertaken to examine the quantity and quality of data-based research aimed at improving the (a) processes and (b) outcomes associated with delivering end-of-life care in hospital settings. METHODS: Medline, EMBASE and Cochrane databases were searched between 1995 and 2015 for data-based papers. Eligible papers were classified as descriptive, measurement or intervention studies. Intervention studies were categorised according to whether the primary aim was to improve: (a) end of life processes (i.e. end-of-life documentation and discussions, referrals); or (b) end-of-life outcomes (i.e. perceived quality of life, health status, health care use, costs). Intervention studies were assessed against the Effective Practice and Organisation of Care methodological criteria for research design, and their effectiveness examined. RESULTS: A total of 416 papers met eligibility criteria. The number increased by 13% each year (p < 0.001). Most studies were descriptive (n = 351, 85%), with fewer measurement (n = 17) and intervention studies (n = 48; 10%). Only 18 intervention studies (4%) met EPOC design criteria. Most reported benefits for end-of-life processes including end-of-life discussions and documentation (9/11). Impact on end-of-life outcomes was mixed, with some benefit for psychosocial distress, satisfaction and concordance in care (3/7). CONCLUSION: More methodologically robust studies are needed to evaluate the impact of interventions on end-of-life processes, including whether changes in processes translate to improved end-of-life outcomes. Interventions which target both the patient and substitute decision maker in an effort to achieve these changes would be beneficial.

Uptake, prevalence and predictors of first-time use for the 75+ Health Assessment Scheme.

In 1999, the Australian Federal Government introduced Medicare items for Health Assessments for people aged 75 years and older (75+ health assessments). This research examined uptake of these assessments and identified predictors of use by women from the Australian Longitudinal Study on Women's Health (ALSWH). Assessments were identified for each year from 1999 to 2013 using linked Medicare data. Time to first assessment was examined, as well as social and health factors associated with having an assessment. From 1999 to 2013, 61.8% of women had at least one assessment. Almost one-third had an assessment within 2 years of their introduction, 25% of women died before having an assessment and 13% survived but did not have an assessment. Factors associated with assessment included being widowed, private health insurance, marital status, education, having arthritis and urinary incontinence, and less difficulty managing on income. Many women never received an assessment, and many only received one. Promotion of the 75+ health assessments is necessary among older women to increase uptake.

Composite reliability of workplace-based assessment for international medical graduates.

OBJECTIVE: The fitness to practise of international medical graduates (IMGs) is usually evaluated with standardised assessment tests. Practising doctors should, however, be assessed on their performance rather than their competency, for which reason workplace-based assessment (WBA) has gained increasing attention. Our aim was to assess the composite reliability of WBA instruments for assessing the performance of IMGs. DESIGN AND SETTING: Between June 2010 and April 2015, 142 IMGs were assessed by 99 calibrated assessors; each cohort was assessed at their workplace over 6 months. The IMGs completed 970 case-based discussions (CBDs), 1741 Mini-Clinical Examination Exercises (mini-CEX) and 1020 multisource feedback (MSF) sessions. PARTICIPANTS: 103 male and 39 female candidates based in urban and rural hospitals of the Hunter New England Health region, from 28 countries (Africa, Asia, Europe, South America, South Pacific). MAIN OUTCOME MEASURES: The reliability of the three WBA tools; the composite reliability of the tools as a group. RESULTS: The composite reliability of our WBA toolbox program was good: the composite reliability coefficient for five CBDs and 12 mini-CEX was 0.895 (standard error of measurement, 0.138). When the six MSF results were included, the composite reliability coefficient was 0.899 (standard error of measurement, 0.125). CONCLUSIONS: WBA is a reliable method for assessing IMGs when multiple tools and assessors are used over a period of time. This form of assessment meets the criteria for "good assessment" (reliability ≥ 0.8) and can be applied in other settings.

Workplace-based assessment for international medical graduates: at what cost?

OBJECTIVE: To estimate the cost of resources required to deliver a program to assess international medical graduates (IMGs) in Newcastle, Australia, known as the Workplace Based Assessment (WBA) Program. DESIGN AND SETTING: A costing study to identify and evaluate the resources required and the overheads of delivering the program for a cohort of 15 IMGs, based on costs in 2012. MAIN OUTCOME MEASURES: Labour-related costs. RESULTS: The total cost in 2012 for delivering the program to a typical cohort of 15 candidates was $243,384. This equated to an average of $16,226 per IMG. After allowing for the fees paid by IMGs, the WBA Program had a deficit of $153,384, or $10,226 per candidate, which represents the contribution made by the health system. CONCLUSION: The cost per candidate to the health system of this intensive WBA program for IMGs is small.

Refresh of a Clinical Skills Assessment for Physician Trainees.

Purpose: The Royal Australasian College of Physicians (RACP) oversees physician training across Australia and Aotearoa New Zealand. Success in a written examination and clinical skills assessment (known as the clinical examination) at the mid-point of training is a requirement to progress from basic to advanced training. The clinical examination had evolved over many years without a review process. This paper describes the approach taken, the changes made and the evaluation undertaken as part of a formal review. Methods: A working party that included education experts and examiners experienced in the assessment of clinical skills was established. The purpose of the clinical examination and competencies being assessed were clarified and were linked to learning objectives. Significant changes to the marking and scoring approaches resulted in a more holistic approach to the assessment of candidate performance with greater transparency of standards. Evaluation over a 2-year period was undertaken before the adoption of the new approach in 2019. Results: In 2017 testing of a new marking rubric occurred during the annual examination cycle which confirmed feasibility and acceptability. The following year an extensive trial utilising the new marking rubric and a new scoring approach took place involving 1142 examiners, 880 candidates and 5280 scoresheets which led to some minor modifications to the scoring system. The final marking and scoring approaches resulted in unchanged pass rates and improved inter-rater reliability. Feedback from examiners confirmed that the new marking and scoring approaches were easier to use and enabled better feedback on performance for candidates. Conclusion: The refresh of the RACP clinical examination has resulted in an assessment that has clarity of purpose, is linked to learning objectives, has greater transparency of expected standards, has improved inter-rater reliability, is well accepted by examiners and enables feedback on examination performance to candidates.

The Effect of Sleep Duration and Excessive Daytime Sleepiness on All-Cause Dementia: A Longitudinal Analysis From the Hunter Community Study.

OBJECTIVES: It has been proposed that abnormal sleep duration and excessive daytime sleepiness might be risk factors for dementia. This study assessed the interaction between sleep duration and excessive daytime sleepiness, and the effect of sleep duration in the presence or absence of excessive daytime sleepiness on dementia risk in community-dwelling older adults. DESIGN: A longitudinal study. SETTING AND PARTICIPANTS: Data from 2187 community-dwelling participants with mean age 70 years from the Hunter Community Study were included in this study. METHODS: Participants were classified as participants with long sleep duration (slept >8 hours per night), recommended sleep duration (7-8 hours) as per the National Sleep Foundation, or short sleep duration (slept <7 hours per night). The Berlin Questionnaire was used to identify excessive daytime sleepiness. Dementia was defined as per International Classification of Diseases, 10th Revision codes, from hospital admissions and death data. To calculate all-cause dementia risk, the Fine-Gray sub-distribution hazard model was computed with death as a competing risk. RESULTS: Over a mean follow-up of 6 years, 64 participants developed dementia and 154 deaths were identified. The average onset of dementia was 5.4 years. Long sleep duration was associated with increased dementia risk only in the presence of excessive daytime sleepiness (adjusted hazard ratio, 2.86; 95% confidence interval 1.03-7.91). A statistically significant interaction was found between excessive daytime sleepiness and sleep duration for all-cause dementia. CONCLUSIONS AND IMPLICATIONS: Long sleep duration with excessive daytime sleepiness was associated with increased risk of dementia. This suggests the importance of promoting awareness of healthy sleep and the possible role of nurturing good quantity and quality sleep in reducing the risk of dementia.

The effect of anxiety on all-cause dementia: A longitudinal analysis from the Hunter Community Study.

BACKGROUND: Anxiety is common, however, the effect of chronicity of anxiety on dementia has not been explored. This study aims to assess the longitudinal relationship between chronic versus resolved versus new onset anxiety, and all-cause dementia risk. METHODS: A total of 2132 participants with mean age 76 years from the Hunter Community Study were recruited. Anxiety was measured using Kessler Psychological Distress Scale (K10). Dementia was defined as per International Classification of Disease-10 codes. The Fine-Gray subdistribution hazard model was computed to assess dementia risk, while adjusting for the competing risk of death. RESULTS: Chronic anxiety and new onset anxiety at follow-up were associated with all-cause dementia risk (HR 2.80, 95% CI 1.35-5.72 and HR 3.20, 95% CI 1.40-7.45 respectively) with an average time to dementia diagnosis of 10 years (SD = 1.7) whereas resolved anxiety was not. In subgroup analyses, these results were driven particularly by chronic and new anxiety among participants below the age of 70 years (HR 4.58, 95% CI 01.12-18.81 and HR 7.21, 95%CI 1.86-28.02 respectively). Sensitivity analyses imputing missing data and addressing reverse causation gave very similar results. CONCLUSION: Chronic and new anxiety were associated with increased risk of all-cause dementia, and this association was significant in those 70 years and younger. However, the resolved anxiety at follow-up reduced the risk, similar to that of the non-exposed group. These results suggest that timely management of anxiety may be a viable strategy in reducing the risk of dementia.

Preferred type, timing and format of dementia information: A cross-sectional survey of carers of people living with dementia.

OBJECTIVES: To clarify the unmet information needs of carers of people living with dementia, including the stage of their care journey at which topics become relevant, and the preferred format and mode of delivery of information. METHODS: A cross-sectional survey of carers of people living with dementia was conducted between April 2022 and October 2022. Carers were recruited through public and private geriatric hospital and community clinics, aged care providers, an online research register and community dementia services. Consenting carers completed a survey assessing sociodemographic characteristics, preferred type and timing of information about dementia, accessing services, changes in behaviour/personality, changes in physical/emotional health, managing own health/well-being and preferred information format and mode of delivery. RESULTS: A total of 163 carers returned a survey (20% response rate). Most carers (75-98%) reported wanting information across a range of topics. Carers preferred general dementia information at diagnosis, information about accessing services at or within the first year of diagnosis, and information on managing symptoms as they emerged. Carers were most interested in receiving information in-person face-to-face (60% very interested), written information (51% very interested) or via face-to-face group information sessions (42% very interested). CONCLUSIONS: Carers of people living with dementia expressed a desire for information on a wide range of topics, which changed as the dementia of the person they cared for progressed. Information needs to be made available in a variety of formats to cater for differing ways in which it is consumed.