Experiences of People Living with Parkinson's Disease in Care Homes: A Qualitative Systematic Review

BACKGROUND

Incidence of disability secondary to Parkinson's disease is increasing faster globally than any other neurological condition. The diverse appearance of symptomatology associated with Parkinson's, and the degenerative nature and subsequent functional decline, often increase dependence on caregivers for assistance with daily living, most commonly within a care home setting. Yet, primary literature and evidence synthesis surrounding these unique and complex care needs, challenges and the lived experiences of this population living in long-term nursing or residential facilities remains sparce. The aim of this review is to synthesize qualitative literature about the lived experience of people with Parkinson's disease living in care home settings.

METHODS

A systematic search of the literature was conducted in October 2023 across six different databases (CINAHL, Medline, EMBASE, PsycINFO, Scopus and Cochrane Library). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) was used to guide this review.

RESULTS

Five articles met the inclusion criteria. Four themes were identified following evidence synthesis: (1) Unique pharmacological challenges. (2) Transitioning and adapting to care home life and routines. (3) Dignified care within care homes. (4) Multidisciplinary care vacuum in care homes.

CONCLUSION

This review revealed the significant and unique challenges for people with Parkinson's disease when transitioning into care homes. These are exacerbated by wider social care challenges such as staffing levels, skill mixes and attitudes as well as a lack of disease-specific knowledge surrounding symptomatology and pharmacology. The lack of multi-disciplinary working and risk-adverse practice inhibited person-centred care and autonomy and reduced the quality of life of people living with Parkinson's disease in care homes. Recommendations for practice highlight training gaps, the need for consistent and improved interdisciplinary working and better person-centred assessment and care delivery.

Analysis of adenovirus DNA detected in rodent species from the Democratic Republic of the Congo indicates potentially novel adenovirus types

Different species of adenoviruses (AdVs) infect humans and animals and are known for their role as pathogens, especially in humans, with animals, primarily rodents, often serving as model systems. However, although we know over 100 types of human AdVs, we know comparatively little about the diversity of animal AdVs. Due to the fact that rodents are the most diverse family of mammals and a standard model system for human disease, we set out to sample African rodents native to the Democratic Republic of the Congo and test them for AdV DNA using a semi-nested consensus PCR. A total of 775 animals were tested, and viral DNA was detected in four of them. The AdV DNA found belongs to three different AdVs, all being closely related to murine adenovirus 2 (MAdV-2). Considering the genetic differences of the amplicon were 9%, 11% and 19% from MAdV-2 and at least 10% from each other, they seem to belong to up to three different novel types within the Murine mastadenovirus B species. This evidence of genetic diversity highlights the opportunities to isolate and study additional AdVs that infect rodents as models for AdV biology and pathology.

23 Viability staining techniques for cryopreserved spermatozoa in 3 caudata species

Salamanders are the most threatened vertebrate taxa; thus, conservation-based research including spermatozoa cryopreservation and other assisted reproductive technologies is essential to their survival. To determine the effectiveness of sperm cryopreservation, methods for evaluating sperm quality are necessary but underdeveloped in caudate research. Evaluating motility has been the primary analysis for sperm viability but is difficult to perform due to the scythe-like morphology, slow rotating progression, and minute undulations of the tail membrane. Estimating apoptosis is a new approach to evaluating caudate spermatozoa survival through cryostress. Fluorescent dyes, such as SYBR-14, annexin-V, and propidium iodide (PI), are valuable tools for identifying degrees of cell viability, apoptosis, and necrosis. Annexin-V marks the externalization of phosphatidylserine on the cell membrane indicating early steps in the apoptosis signalling cascade. Compromised membranes allow PI, a nucleic acid stain, access to DNA, marking cellular necrosis. The SYBR-14 is a nucleic acid stain that permeatesssss intact membranes, labelling live cells. These fluorescent stains were assessed for marking viability and stages of cell death in post-thaw spermatozoa across 3 caudate species: the Eastern tiger salamander (Ambystoma tigrinum), Kweichow Emperor newt (Tylototriton kweichowensis), and black-spotted newt (Notophthalmus meridionalis). For each species, spermic urine samples were acquired by hormone treatment and frozen based on protocols developed in A. tigrinum, yielding an average of 18.2% relative motility recovered at thaw. Straws were thawed for 5min at 20°C. Viability was tested by staining 5μL 1:1 with a 1:50 dilution of SYBR-14 and 2μL of PI. Stages of cell death were evaluated by staining 10μL with 2μL of annexin-V and 2μL of PI. Cell viability was assessed immediately under a fluorescence microscope. For each of the 3 species, 2 samples were stained with both assays in triplicate. Sperm stained with SYBR-14 alone were considered viable, and sperm stained with any annexin-V or PI were considered not viable. Visible dynamic shifting from SYBR-14 to PI staining was observed in real time, indicating rapid necrosis. Morphological abnormalities, not observed in unstained samples, were prevalent across all species following staining, signifying a possible cytotoxic effect of the dyes. High mortality and abnormality rates suggest that fluorescent dyes have elevated toxicity and permeability in caudate sperm. Caudate spermic urine has a very low osmolality, implying high permeability, which could lead to rapid staining and toxicity effects. Shorter incubation times may be required for accurate staining. Results may also indicate that cryopreservation protocols need to be species specific and do not transfer well across taxa. This is one of the earliest studies to evaluate the use of fluorescent stain protocols on measuring cell viability in caudate sperm and indicates that further refinement is required.

Prepared for Practice? Interns' Experiences of Undergraduate Clinical Skills Training in Ireland

BACKGROUND

Many previous studies on internship have reported a lack of preparedness for the role. More recently in Ireland, medical schools have introduced formal clinical skills training programmes. This study sought to evaluate the impact, if any, of formal skills training in the medical training on intern's preparedness for practice.

METHODS

The study utilized a survey approach followed by focus group discussions. The aim was to identify the skills that were taught and assessed in medical training and the skills that were actually required in their intern year.

RESULTS

Most interns had received skills training in designated skills laboratories. No intern had received training in all skills advised in the European guidelines. Skills taught to all interns were intravenous cannulation, basic life support, and basic suture. Skills required from all interns were intravenous cannulation, phlebotomy, and arterial blood sampling. Removal of peripherally inserted central line (PICC) lines, central lines, and chest drains were commonly requested but not taught. Senior staff underestimated skill abilities and expected failure.

CONCLUSION

These findings identify discordance between the skills taught and the skills required in the job. There is a need for standardization in the clinical skills training to ensure that all interns enter practice with equal competencies. Consideration should be given to experiential learning opportunities such as subintern programmes to consolidate learning and improve preparedness. Improvement in communications with senior clinicians is indicated to ensure that expectations are realistic and reflective of actual training.

When should surgeons retire?

BACKGROUND

Retirement policies for surgeons differ worldwide. A range of normal human functional abilities decline as part of the ageing process. As life expectancy and their population increases, the performance ability of ageing surgeons is now a growing concern in relation to patient care. The aim was to explore the effects of ageing on surgeons' performance, and to identify current practical methods for transitioning surgeons out of practice at the appropriate time and age.

METHODS

A narrative review was performed in MEDLINE using the terms 'ageing' and 'surgeon'. Additional articles were hand-picked. Modified PRISMA guidelines informed the selection of articles for inclusion. Articles were included only if they explored age-related changes in brain biology and the effect of ageing on surgeons' performance.

RESULTS

The literature search yielded 1811 articles; of these, 36 articles were included in the final review. Wide variation in ability was observed across ageing individuals (both surgical and lay). Considerable variation in the effects of the surgeon's age on patient mortality and postoperative complications was noted. A lack of neuroimaging research exploring the ageing of surgeons' brains specifically, and lack of real markers available for measuring surgical performance, both hinder further investigation. Standard retirement policies in accordance with age-related surgical ability are lacking in most countries around the world.

CONCLUSION

Competence should be assessed at an individual level, focusing on functional ability over chronological age; this should inform retirement policies for surgeons.

The use of megavoltage cone-beam CT to complement CT for target definition in pelvic radiotherapy in the presence of hip replacement

In Europe and the USA combined, over half a million people had a hip joint replaced in 2005, contributing to the increasing number of radiotherapy patients with metallic hip prostheses. The treatment plan for external beam radiation therapy is based on the delineation of the anatomy in the planning CT scan. When implanted objects of high atomic number (Z) material are present, however, severe image artefacts are generated in conventional CT, strongly hindering the ability to delineate some organs. This is particularly the case for the planning of prostate patients with hip prostheses. This short communication presents the use of a new imaging modality, megavoltage cone-beam CT, to complement the regular CT for target definition of prostate cancer treatment of patients with hip replacements.

Safe trabeculectomy technique: long term outcome

AIM

To assess the long term outcome of a new trabeculectomy technique.

METHODS

Trabeculectomy was performed using a fornix based conjunctival flap, an anterior chamber maintainer, a standardised punch technique, and a combination of adjustable and releasable sutures in 56 eyes of 53 patients. The main outcome measures were the postoperative intraocular pressure (IOP) and the frequency of early postoperative complications. The mean follow up time was 15.7 (range 12-21) months.

RESULTS

The mean preoperative and postoperative IOP at 12 months were 21.2 (SD 6) and 12.8 (3.0) mm Hg, respectively. All patients had an IOP of <21 mm Hg, 90.9% had an IOP <18 mm Hg, and 61.4% had an IOP <14 mm Hg. Postoperative complications were infrequent: flat anterior chamber (1.8%), bleb leakage (0%), or hypotony (1.5%) beyond 3 weeks, or choroidal detachment at any time point (8.9%).

CONCLUSIONS

This novel trabeculectomy method offers the possibility to tailor the IOP postoperatively with a minimum of postoperative complications and excellent IOP control at the long term follow up.

ERK activity facilitates activation of the S-phase DNA damage checkpoint by modulating ATR function

Although Erk kinase has been recently reported to function in the DNA damage response, the mechanism governing this process is unknown. We report here that hydroxyurea (HU) activates Erk via MEK1, a process that is sensitized by a constitutively active MEK1 (MEK1Q56P) and attenuated by a dominant-negative MEK1 (MEK1K97M). While ectopic MEK1Q56P sensitized HU-induced S-phase arrest, inhibition of Erk activation via U0126, PD98059, and MEK1K97M attenuated the arrest, and thereby enhanced cells to HU-induced toxicity. Taken together, we demonstrate an important contribution of Erk to the activation of the S-phase DNA damage checkpoint. This can be attributed to Erk's regulatory role in modulating ATR function. Inhibition of Erk activation with U0126/PD98059 and MEK1K97M substantially reduced HU-induced ATR nuclear foci, leading to a dramatic reduction of gammaH2AX and its nuclear foci. Reduction of MEK1 function by a small interference RNA (siRNA) MEK1 and ectopic MEK1K97M significantly decreased HU-induced gammaH2AX. Conversely, ectopic MEK1Q56P enhanced gammaH2AX foci. Furthermore, immunofluorescent and cell fractioning experiments revealed cytosolic and nuclear localization of ATR. HU treatment caused the redistribution of ATR from the cytosol to the nucleus, a process that is inhibited by U0126. Collectively, we show that Erk kinase modulates HU-initiated DNA damage response by regulating ATR function.

Needling-revision of failed filtering blebs

PURPOSE

To investigate the efficacy and safety of needling-revision of failed blebs after trabeculectomy.

METHODS

A retrospective chart review of 28 eyes of 28 patients who underwent a trabeculectomy with subsequent needling-revision between January 2002 and December 2003. The mean follow-up was 15 months after the first needling-revision. All interventions were conducted by the same surgeon. Absolute success was defined as an IOP <18 mmHg without medication or as an IOP reduction > 20% without medication if the preoperative IOP was < or = 21 mmHg. Relative success was defined as meeting these criteria with or without medication.

RESULTS

The mean interval between trabeculectomy and the first needling-revision was 5 months. Repeated needling-revision (up to 3 times) was performed as clinically necessary. In 90% of the needling-revisions 5-FU was used to prevent postoperative fibrosis. The mean +/- SD IOP before needling-revision and at the last follow-up was respectively 24.7 +/- 6 and 15.7 +/- 3 mmHg (p<0.001) Needling-revision was an absolute success in 39% (11/28) and a relative success in 68% (19/28). Minor complications attributed to needling-revision occurred in 32% including self reabsorbing subconjunctival bleeding (1), filamental (1) and punctate keratitis (1), transient choroidal effusion (3), wound leak (4) and hyphaema (2). Progression of cataract occurred in 1 patient. A serious complication occurred in 1 case (hypotony with persistent macular oedema).

CONCLUSIONS

Bleb needling-revision can prevent more invasive intervention in a significant number of patients with failed trabeculectomy blebs. Complications are similar to those seen after trabeculectomy.

Comparison of optical coherence reflectometry and ultrasound central corneal pachymetry

In 50 eyes of 25 patients we prospectively measured the central corneal thickness (CCT) comparing the OLCR (Optical Low Coherence Reflectometry) pachymeter with the contact ultrasound pachymeter. The OLCR system was mounted on to a Haag-Streit slit lamp. Every single measurement was the result of 5 scans. With the contact ultrasound Sonomed pachymeter we performed 5 separate measurements and calculated the mean. The correlation between the two measurements was excellent (r = 0.99). The mean standard deviation (SD) of the measurements taken with the non-contact OLCR pachymeter was significantly lower than with the contact ultrasound pachymeter, 0.49 microm and 4.71 microm respectively (p < 0.01). The variability of the CCT measurements taken with the non-contact OLCR pachymeter is significantly lower than the variability of the CCT measurements taken with the contact ultrasound pachymetry.

Magnetic resonance imaging of relative glycosaminoglycan distribution in patients with autologous chondrocyte transplants

RATIONALE AND OBJECTIVES

Autologous chondrocyte transplantation (ACT) is a potential treatment for full-thickness chondral lesions in the knee. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) has recently been developed as a sensitive and specific measure of cartilage glycosaminoglycans (GAGs). Under the conditions of dGEMRIC, T1 is directly related to the GAG concentration. Our aim for this study was to demonstrate the potential of dGEMRIC to evaluate ACT implants.

METHODS

Eleven ACT implants were studied 2 to 24 months postoperatively by dGEMRIC. T1 values from three regions of interest were obtained to examine GAG content (1) in the implant, (2) in native cartilage adjacent to the implant, and (3) in native cartilage further removed from the implant (as "control").

RESULTS

One implant failed and therefore was not included. Four of the implants were studied between 2 and 6 months postoperatively and showed low T1 (GAG), less than 80% of the control native cartilage. Five of the six implants studied between 12 and 24 months postoperativley showed T1 (GAG) comparable to (>80%) of control. One 18-month graft showed low T1 comparable to the surrounding native cartilage, with normal GAG seen in cartilage far from the graft site. The GAG index (T1 values of the graft normalized to control) from the group of implants 6 months or less was 59% +/- 5% of control, whereas those at 12 to 24 months were 91% +/- 18% of control. The two groups were statistically different with a P value of 0.005.

CONCLUSIONS

The GAG level in grafts that were implanted for less than 12 months appeared to be lower than that in the remote cartilage. At 12 months or greater, the grafts in this study had GAG levels that were comparable to both the adjacent and remote cartilage. This preliminary study of ACT implants has shown that it is feasible to apply the dGEMRIC technique in patients with ACT as a way to obtain information related to the composition of grafts. These results provide motivation and the pilot data with which to design further clinical studies.

Some potential errors in the measurement of mercury gas exchange at the soil surface using a dynamic flux chamber

A series of controlled environment experiments were conducted to examine the use of a dynamic flux chamber to measure soil emission and absorption of total gaseous mercury (TGM). Uncertainty about the appropriate airflow rates through the chamber and chamber exposure to ambient wind are shown to be major sources of potential error. Soil surface mercury flux measurements over a range of chamber airflow rates showed a positive linear relationship between flux rates and airflow rate through the chamber. Mercury flux measurements using the chamber in an environmental wind tunnel showed that exposure of the system to ambient winds decreased the measured flux rates by 40% at a wind speed of 1.0 m s(-1) and 90% at a wind speed of 2 m s(-1). Wind tunnel measurements also showed that the chamber footprint was limited to the area of soil inside the chamber and there is little uncertainty of the footprint size in dry soil.

Competencies of Liberal Education in Post-RN Baccalaureate Students: A Longitudinal Study

The purpose of this longitudinal study was to examine the relationship among liberal education competencies as demonstrated in the professional and personal lives of post-RN students and time spent in a BScN program. The six competencies identified by Dressel (1979) and used by Bottoms (1988) to define the liberally educated person provided the framework for this study. The Dressel competencies have been validated in the literature as being representative of the universe of competencies that are anticipated outcomes of baccalaureate nursing education. Results indicated that after 5 years of part-time study at the baccalaureate level, significant differences were found in the competencies of liberal education as demonstrated in the professional and personal lives of post-RN learners. The competencies as demonstrated in the professional lives of post-RN learners developed consistently over time, while the development of competencies as demonstrated in the personal lives of learners lagged behind. The study contributes to the small but growing body of literature which explores the impact of a liberal education on post-RN learners.

Disadvantaged women and smoking

High rates of smoking are found among disadvantaged women, and there is a demand for cessation interventions specifically targeted to meet their needs. This project used a number of information sources to examine the factors associated with these women's smoking behaviours and the potential barriers and supports to cessation. Few of the women-centred cessation programs whose representatives were contacted were appropriate for, or available to, disadvantaged women in Canada. Interviews with 386 disadvantaged women revealed that their smoking was intimately linked with their life situation of poverty, isolation and caregiving; smoking was a mechanism for coping with the stress of their lives. Agencies outside traditional tobacco control organizations, such as women's centres, were well positioned to initiate or expand services that support smoking cessation for these women and were trusted by the women who used their services. The findings have implications for programs, research and policy.

Teens for healthy living

Improving the health and quality of life of adolescents is a fundamental aspiration of community health nurses. But developing health promotion programs that are attractive to young people can be a major challenge. In a rural Nova Scotia school district, this challenge has been met by bringing the teens themselves into the design and implementation of the program.

Exploring nursing outcomes for health promotion

The author examines nursing outcomes in relation to the aspect of nursing that deals with health promotion. The focus is on identifying factors that influence nursing outcomes and outcome selection, health promotion in the context of today's nursing practice, and the importance of nurses articulating their unique contribution to health promotion. The author also discusses measurement challenges inherent in outcome evaluation, and suggests future directions for enhancing outcome evaluation in health promotion.

Detection and differentiation of microbial siderophores by isoelectric focusing and chrome azurol S overlay

Siderophores are microbial, low molecular weight iron-chelating compounds. Fluorescent Pseudomonads produce different, strain-specific fluorescent siderophores (pyoverdines) as well as non-fluorescent siderophores in response to low iron conditions. We present an isoelectric focusing method applicable to unpurified as well as to purified pyoverdine samples where the fluorescent siderophores are visualized under UV illumination. Siderophores from different Pseudomonas sp., amongst which are P. aeruginosa, P. fluorescens and P. putida, including egg yolk, rhizospheric and clinical isolates as well as some derived Tn5 mutants were separated by this technique. Different patterns could be observed for strains known to produce different siderophores. The application of the chrome azurol S assay as a gel overlay further allows immediate detection of non-fluorescent siderophores or possibly degradation products with residual siderophore activity. The method was also applied to other microbial siderophores such as deferrioxamine B.

Oncogene rearrangements in chronic B-cell leukemia

Forty-four B-chronic lymphocytic leukemias (CLL) were studied by Southern blot analysis using probes for the Ig genes and bcl-1, bcl-2 (major, minor and 5' breakpoint region), bcl-3, c-myc, and retinoblastoma (Rb) loci. Eight cases had three or more rearranged JH bands, indicating oligoclonality, clonal evolution, or chromosomal translocation. One case had a rearrangement of the bcl-1 locus and three of the bcl-2 locus. In the first case, comigration of the rearranged bcl-1 and JH sequences indicated a t(11;14)(q13;q32) translocation, which, in contrast to previously described cases, seems to be completely reciprocal. One case with a bcl-2 rearrangement showed comigration of the bcl-2 major breakpoint region and a rearranged JH band. This indicates a t(14;18) (q32;q21). The two other cases showed rearrangements of the bcl-2 5' breakpoint region without apparent comigration. No rearrangements were detected of c-myc and bcl-3, located at chromosome 19, nor was a deletion of Rb found. All but three cases had CD5 expression. The exceptions included the t(11;14) and the t(14;18) cases. Our results confirm recent data on rearrangements at the 5' site of bcl-2 in CLL. Additionally, they corroborate the presumption that CD5-negative chronic B-cell leukemias should be considered apart from classical CLL.

The relationships between physical activity and health-promoting behaviours in mid-life women

The purpose of this study is to examine the inter-relationships among participation between physical activity, perceived well-being, self-esteem, health status, health locus of control and health-promoting lifestyle activities of middle-aged women in a rural context. Since women comprise the largest (living) segment of the older population, it is extremely important to study the predictors of health promoting activities in this age group prior to old age. Recent research has noted that participation in physical activity acts as an entry point to reflect on health behaviour practices, creating a ripple effect to other areas of lifestyle behaviours. The research questions were framed within the Health Promotion Model. The study utilized a longitudinal experimental design. The findings of this study contribute to the small, but growing, research base on physical activity as a health-promoting lifestyle behaviour and physical activity as a lifestyle practice of women in the mid-life years. Findings also provide a base for the development of community physical-activity programmes and other intervention strategies to enhance the health and well-being of women, particularly those residing in a rural setting.

Beyond the rhetoric: benefits of a baccalaureate education for nursing

This article examines the benefits and value of expanding the educational base for nursing. It argues that if nursing is to accept a broader mandate for the promotion of health, the educational preparation of the nurse must focus as much on the development of the nurse as a person, as on the knowledge, skills and attitudes that are specific to the profession. It suggests that to effect the changes required in the health care system nurses require increased levels of autonomy. A professional liberal education will contribute to a strong sense of professional autonomy and self-actualization; both are essential qualities for today's contemporary nurse.

Promoting health among teenagers

The need for health promotion programmes geared to adolescents has never been more acute. Today's youth lives in a "throw away society" characterized by an impermanence of both objects and human relations--which works counter to traditional health values and practices. The result has been a rise in teenage drug-addiction, suicide, abortion, delinquency and alcoholism. How can we make nurses and health services more accessible to adolescents? Below, Angela Gillis describes a model for adolescent health promotion and provides some practical suggestions for dealing more effectively with this age group.