A first voice perspective of people experiencing homelessness on preferences for the end-of-life and end-of-life care during the COVID-19 pandemic

Objective

People experiencing homelessness often encounter progressive illness(es) earlier and are at increased risk of mortality compared to the housed population. There are limited resources available to serve this population at the end-of-life (EOL). The purpose of this study was to gain insight into preferences for the EOL and end-of-life care for people experiencing homelessness. Utilizing an interpretive phenomenology methodology and the theoretical lens of critical social theory, we present results from 3 participants interviewed from August to October 2020, with current or previous experience of homelessness and a diagnosis of advanced disease/progressive life-threatening illness.

Results

A key finding focused on the existential struggle experienced by the participants in that they did not care if they lived or died. The participants described dying alone as a bad or undignified way to die and instead valued an EOL experience that was without suffering, surrounded by those who love them, and in a familiar place, wherever that may be. This study serves to highlight the need for improvements to meet the health care and social justice needs of people experiencing homelessness by ensuring equitable, humanistic health and end-of-life care, particularly during the context of the COVID-19 pandemic.

Factors associated with residents’ responsive behaviours towards staff in long-term care homes: A systematic review

Background and Objectives

When staff experience responsive behaviors from residents, this can lead to decreased quality of work-life and lower quality of care in long-term care homes. We synthesised research on factors associated with resident responsive behaviours directed towards care staff and characteristics of interventions to reduce the behaviours.

Research Design and Methods

We conducted a mixed-methods systematic review with quantitative and qualitative research. We searched 12 bibliographic databases and “grey” literature, using two keywords (long-term care, responsive behaviours) and their synonyms. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. We developed a coding scheme using the ecological model as an organising structure and prepared narrative summaries for each factor.

Results

From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training background (individual level); staff approaches to care (interpersonal level); leadership and staffing resources (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of behaviours, and quantitative findings on the impact of staff approaches to care on behaviours. Effects of interventions (n=14) to reduce the behaviours were inconclusive.

Discussion and Implications

We identified the need for enhanced understanding of the interrelationships among factors associated with resident responsive behaviours towards staff and processes leading to the behaviours. To address these gaps and to inform theory-based effective interventions for preventing or mitigating responsive behaviours, we suggest intervention studies with systematic process evaluations.

Factors Influencing Resident Responsive Behaviors Toward Staff in Nursing Homes: A Systematic Review

When staff experience various types of resident responsive behaviors, this can lead to decreased quality of work-life and lower quality of care. We synthesized empirical quantitative and qualitative evidence on factors associated with resident responsive behaviors directed towards staff in nursing homes. We searched 12 bibliographic databases and "grey" literature with two key words: long-term care and responsive behaviors resulting in 7671 sources. Pairs of reviewers independently completed screening, data extraction, and risk of bias assessment. Based on extracted data, we developed a coding scheme of factors utilizing the ecological model as an organizational structure. We then applied the coding scheme to quantitative and qualitative articles and prepared narrative summaries for each factor. From 86 included studies (57 quantitative, 28 qualitative, 1 mixed methods), multiple factors emerged, such as staff training about responsive behaviors (individual level); staff approaches to care (interpersonal level); leadership, staffing resources, and physical environment (institutional level); and racism and patriarchy (societal level). Quantitative and qualitative results each provided key insights, such as qualitative results pertaining to leadership responses to reports of responsive behaviors, and quantitative findings on the impact of staff approaches to care on responsive behaviors. By synthesizing both quantitative and qualitative evidence, this review provides a comprehensive overview of factors associated with resident responsive behaviors towards staff. Our findings offer insights into promising factors for long-term care system and nursing home managers to address to strive to reduce responsive behaviors of residents toward staff in nursing homes.

Identification of the porcine cytomegalovirus major capsid protein gene

A major capsid protein (MCP) gene homologue of porcine cytomegalovirus (PCMV) was identified. Sequence analysis indicated that the PCMV MCP gene is 4,026 nucleotides in length encoding a protein of 1,341 amino acid residues. The predicted molecular weight of the PCMV MCP is 151,456 Da, equivalent to those of other herpesvirus MCP counterparts. Phylogenetic analysis using herpesviral MCP gene sequences confirmed that PCMV is a betaherpesvirus with higher homology with human herpesvirus-6 and -7 than human and mouse cytomegaloviruses. The serum of pig experimentally infected with PCMV did not react with bacterially expressed MCP, suggesting that the PCMV MCP may not be related to the humoral immune response in the course of PCMV infection. Also, we established polymerase chain reaction (PCR) protocols using primers corresponding to MCP gene sequences for detection of PCMV infection. The PCR protocol would be effective for the diagnosis of slow-growing PCMV infection, for which traditional methods involving virus-isolation are not useful.

Analysis of porcine cytomegalovirus DNA polymerase by consensus primer PCR

We used a consensus primer PCR method to amplify a region of herpesviral DNA-directed DNA polymerase gene using degenerate primers for initial characterization of the porcine cytomegalovirus (PCMV) genome. The sequence of the PCR product from PCMV DNA template and its alignment with other herpesvirus DNA polymerase counterparts showed that both conserved amino acid residues and conservative amino acid substitutions are in parallel. Phylogenetic analysis revealed that PCMV should be included in the clade comprising human herpesvirus 6 and 7, rather than human and mouse cytomegaloviruses, in Betaherpesvirus subfamily.